title: A study of patients with aggressive multiple sclerosis at disease onset.
abstract: OBJECTIVE
  Identify aggressive onset multiple sclerosis (AOMS) and describe its clinical course.
  
  
  METHODS
  AOMS patients were identified from a multiple sclerosis (MS) database based on a set of criteria. The subsequent clinical course of AOMS patients was then reviewed with the goal of potentially identifying the best approaches to manage these patients.
  
  
  RESULTS
  Fifty-eight of 783 (7.4%) patients in the MS database met the criteria for AOMS, and 43 patients who had complete data for the duration of their follow-up were included in the subsequent analysis. The mean duration of the follow-up was 54 months. Thirty-five patients (81%) were started on a conventional first-line agent (injectable therapies for MS). Only two of these 35 patients (5.7%) had no evidence of disease activity. Twenty-two of 35 patients suffering from refractory disease were switched to a more aggressive treatment (natalizumab, rituximab, alemtuzumab, cyclophosphamide). Eight patients were started on aggressive treatment as their initial therapy, and seven of these eight (87.5%) patients showed no evidence of disease activity.
  
  
  CONCLUSIONS
  With recognition of the crucial significance of early optimal treatment during the potential window of opportunity for best long-term outcomes, we describe AOMS within 1 year of disease onset and discuss possible treatment considerations for these patients.
authors.affiliation: Judit Jaffe Multiple Sclerosis Center, Weill-Cornell Medical College, New York City, NY.
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Kaunzner
authors.affiliation: Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, NJ.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Institute for Biostatistics and Epidemiology, Weill-Cornell Medical College, New York City, NY, USA.
authors.forename: Gulce
authors.initials: G
authors.lastname: Askin
authors.affiliation: Judit Jaffe Multiple Sclerosis Center, Weill-Cornell Medical College, New York City, NY.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Gauthier
authors.affiliation: Judit Jaffe Multiple Sclerosis Center, Weill-Cornell Medical College, New York City, NY.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Nealon
authors.affiliation: Judit Jaffe Multiple Sclerosis Center, Weill-Cornell Medical College, New York City, NY.
authors.forename: Timothy
authors.initials: T
authors.lastname: Vartanian
authors.affiliation: Judit Jaffe Multiple Sclerosis Center, Weill-Cornell Medical College, New York City, NY.
authors.forename: Jai S
authors.initials: JS
authors.lastname: Perumal
keywords: aggressive multiple sclerosis; algorithm; database; retrospective analysis; treatment course