During the past 18 years, much has been learned regarding the pathology of MS including early manifestations of the disease which precede confirmed diagnosis. This increased understanding of MS and limitations in the current terminology used to describe MS prompted a re-examination of the disease subtypes by the International Advisory Committee on Clinical Trials of MS which convened in October 2012. Consensus and recommendations offered by the advisory committee were published online in the journal Neurology on World MS Day, May 28, 2014.
The committee recommends that the core descriptions of relapsing and progressive disease should be maintained, with certain modifications and clarifications. Suggested modifications include assessment of disease activity, as defined by clinical relapses and/or MRI activity (contrast-enhancing lesions; new or unequivocally enlarging T2 lesions assessed at least annually), and clinical evidence of disease progression independent of relapses over a given period of time in patients who have a progressive disease course (PPMS or SPMS).
The following are examples of newly proposed descriptions that consider measures of disease activity. A patient with RRMS who has a new gadolinium-enhancing lesion would be considered to be “RR–active.” Conversely, a patient with a relapsing course but no relapses, gadolinium-enhancing activity, or new or enlarging T2 lesions would be “RR-not active.” A patient with PPMS with no acute attacks and no MRI activity would be “PP–not active.” However, a patient with PPMS who has an acute attack would be “PP–active,” replacing the current progressive-relapsing MS definition.
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