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Tytuł pozycji:

The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history.

Tytuł:
The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history.
Autorzy:
Sorensen PS; Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark.
Sellebjerg F; Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark.
Hartung HP; Department of Neurology, University Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Montalban X; Department of Neurology, Hospital General Universitari Vall D'Hebron, Cemcat, Barcelona, Spain.; Division of Neurology, University of Toronto, St. Michael's Hospital, Toronto, Canada.
Comi G; Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Tintoré M; Department of Neurology, Hospital General Universitari Vall D'Hebron, Cemcat, Barcelona, Spain.
Źródło:
Brain : a journal of neurology [Brain] 2020 Sep 01; Vol. 143 (9), pp. 2637-2652.
Typ publikacji:
Journal Article; Review
Język:
English
Imprint Name(s):
Publication: Oxford : Oxford University Press
Original Publication: London.
MeSH Terms:
Demyelinating Diseases/*diagnostic imaging
Demyelinating Diseases/*therapy
Magnetic Resonance Imaging/*trends
Multiple Sclerosis/*diagnostic imaging
Multiple Sclerosis/*therapy
Humans ; Immunosuppressive Agents/therapeutic use ; Multiple Sclerosis, Chronic Progressive/diagnostic imaging ; Multiple Sclerosis, Chronic Progressive/therapy ; Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging ; Multiple Sclerosis, Relapsing-Remitting/therapy
Contributed Indexing:
Keywords: biomarkers; clinically isolated syndrome; epidemiology; imaging; multiple sclerosis
Substance Nomenclature:
0 (Immunosuppressive Agents)
Entry Date(s):
Date Created: 20200726 Date Completed: 20210216 Latest Revision: 20210216
Update Code:
20240104
DOI:
10.1093/brain/awaa145
PMID:
32710096
Czasopismo naukowe
In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.
(© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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