Secondary progressive multiple sclerosis: current knowledge and future challenges.
The secondary progressive phase of multiple sclerosis (MS), which is characterised by a steady accrual of fixed disability after an initial relapsing remitting course, is not clearly understood. Although there is no consensus on the mechanisms underlying such a transition to the progressive phase, epidemiological and neuroimaging studies indicate that it is probably driven by the high prevalence of neurodegenerative compared with inflammatory pathological changes. This notion is lent support by the limited efficacy of available immunomodulating and immunosuppressive treatment strategies, which seems to be further decreased in the late stages of secondary progressive MS. No established clinical or paraclinical predictors of the transition from relapsing remitting to secondary progressive MS have been described. However, the use of quantitative MRI-derived measures is warranted to monitor natural history studies and therapeutic trials of secondary progressive MS with increased reliability. In view of the small effects of immunomodulating and immunosuppressive treatments in preventing the transition to secondary progression, the development of treatments promoting neuroaxonal repair remains an important goal in this disease.
Rovaris
Marco
M
Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy.
Confavreux
Christian
C
Furlan
Roberto
R
Kappos
Ludwig
L
Comi
Giancarlo
G
Filippi
Massimo
M
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D003952:Diagnostic Imaging / Q000379:methods; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology
D000276:Adjuvants, Immunologic; D007166:Immunosuppressive Agents