Diagnosis and Types of MS

primary progressive MS

Dr. Yeung

Director MS Clinical Trials Research Unit Foothills MS Clinic, Calgary View BIO

Q :

In the interview with Dr. Owens in MS Canada, he stated, that primary progressive MS "seems to be a disease with a different primary cause" and although the cause is unknown "it looks and feels like a different disease". Could someone expand on the latter statement? It is so difficult to obtain information on primary-progressive that any information is most welcome.
A :

There are four clinical patterns of multiple sclerosis: relapsing remitting (RRMS), secondary progressive (SPMS), primary progressive (PPMS), and progressive relapsing (PRMS). Definitions of these can be found on the MS Society website by clicking here.
About 85% of patients with MS have relapsing remitting multiple sclerosis (RRMS). This is characterized by exacerbations (episodes of neurological dysfunction such as paralysis, optic neuritis, numbness, etc.) with or without complete recovery. They are clinically stable between attacks. This form is most common in young women, and the disease can be treated with the immunomodulatory therapies (interferon-betas, glatiramer acetate, mitoxantrone, and natalizumab).

In primary progressive multiple sclerosis (PPMS), there is gradual progression of disability (neurological symptoms progress without recovery) from onset without superimposed relapses; this occurs in ~10% of MS patients. There is a preponderance in middle-aged men, and the immunomodulatory treatments seem to have no effect; the mainstay of treatment is management of symptoms. There have also been some studies suggesting the underlying pathology may be different between the different forms of MS; the reason for this is currently unknown and further research is underway.
Because of these differences, it is possible that "multiple sclerosis" is an umbrella term, and that the different clinical forms align along a spectrum under that umbrella. Further clarification from future studies is necessary to delineate this further.
9/2/2008 3:03:11 AM
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DISCLAIMER: Please be aware that this information does not necessarily represent the opinion of the MS Society of Canada, and is not intended as medical advice. For specific advice and opinion, always consult a physician.
© 2008 Multiple Sclerosis Society of Canada | www.mssociety.ca

http://www.msanswers.ca/QuestionView.aspx?L=2&QID=1291

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Do drugs prevent the progression into secondary progressive MS?

Dr. Schapiro

Clinical Professor of Neurology View BIO

Q :

It seems that 90% of people with relapsing remitting MS develop secondary progressive MS in time. What is the currently available data on the effects of beta-interferon or glatiramer acetate? Do these drugs delay the time of onset of the transformation? Do they prevent the progression into secondary progressive MS?

A :

The data that 90% of people with relapsing MS develop secondary progressive MS is to be questioned. The reality is that when the population is sampled at any one time 55% have relapsing MS and 33% have secondary progressive.

If 90% developed secondary progressive it would change the number of those with that diagnosis greatly over time and it simply doesn't. That number comes from a misinterpretation of old natural history data and the desire to scare people onto therapy instead of being reasonable and understanding.

The other issue is that studies on immune modulating medication are relatively short. That is out of practical necessity. However each medication has attempted to get long term data and in every case there is a clear difference made by treatment. Thus it seems reasonable to assume that these medications have made a major difference in delaying the time to transformation (even if the transformation had been previously exaggerated).

They certainly delay the progression if not prevent it in many but clearly not all. I usually answer this by pointing out I used to have a floor in the hospital devoted to MS with 18 patients hospitalized daily. Now I have 1-2 in the hospital at any one time. That is quite a difference and the reason appears to be treatment oriented.
9/2/2008 3:20:11 AM
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DISCLAIMER: Please be aware that this information does not necessarily represent the opinion of the MS Society of Canada, and is not intended as medical advice. For specific advice and opinion, always consult a physician.
© 2008 Multiple Sclerosis Society of Canada | www.mssociety.ca

http://www.msanswers.ca/QuestionView.aspx?L=2&QID=1605

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