Progressive multiple sclerosis
The new classification of phenotypes of progressive multiple sclerosis distinguishes four subtypes of secondary progressive multiple sclerosis (SPMS) and primary progressive multiple sclerosis PPMS based on the expressed or not expressed disease activity (relapse or MR activity) and the presence or absence of progression of the patient’s disability. The diagnosis of progressive MS is usually retrospective; one can still not determine with certainty in which patients and when the disease will change from RRMS to SPMS, since there are no clearly defined clinical, radiological, immunological or pathological criteria for determining the point of transition. Conventional MR techniques have a limited ability to visualize a heterogeneous pathological substrate in progressive MS involving diffuse changes of gray and white matter, cortical demyelination, and neurodegeneration. Therefore, in progressive MS, the correlation between clinical presentation and lesion burden visualized by conventional MR techniques is often very weak, and yet there are no validated quantitative radiological measures of diffuse damage that would have predictive value for the onset of disability. Future therapeutic options in progressive MS place emphasis on neuroprotective strategies that may promote remyelination, microglial activation, and mitochondrial protection.
Key words:
heterogeneous pathological substrate; neuroprotective strategies; progressive multiple sclerosis; retrospective diagnosis
OGLASI
