Progressive Multiple Sclerosis

Daniel Ontaneda, MD Multiple Sclerosis and Other CNS Inflammatory Diseases p. 736-752 June 2019, Vol.25, No.3 doi: 10.1212/CON.0000000000000727
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PURPOSE OF REVIEW: This article provides an update on progressive forms of multiple sclerosis (MS), with a focus on pathogenic mechanisms, clinical features, imaging features, and recent therapeutic advances.

RECENT FINDINGS: Progressive forms of MS are identified by a history of progressive accrual of disability independent of relapse, but they share many biological, clinical, and MRI features with relapsing MS. Both relapses and new lesions can occur in the context of progressive MS, and establishing when the transition from relapsing to progressive MS occurs is often difficult. Several pathogenic mechanisms coexist in progressive MS. Targeting inflammation in both primary and secondary progressive MS appears to reduce the accumulation of disability.

SUMMARY: Progressive MS remains a diagnostic challenge, and the pathogenesis underlying progression is complex. Significant overlap in the biology and clinical and imaging features of progressive MS exists with relapsing forms of the disease. The use of disease-modifying and symptomatic treatments may improve the quality of life for patients with progressive MS.

Address correspondence to Dr Daniel Ontaneda, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Ave, U-10, Cleveland, OH, ontaned@ccf.org.

RELATIONSHIP DISCLOSURE: Dr Ontaneda serves as a consultant for Biogen; Genentech, Inc; and Sanofi Genzyme and receives research/grant support from Genentech, Inc; the National Institutes of Health; the National Multiple Sclerosis Society; Novartis AG; the Patient-Centered Outcomes Research Institute; Race to Erase; and Sanofi Genzyme.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Ontaneda discusses clinical trial results for biotin, fingolimod, ibudilast, mycophenolate mofetil, natalizumab, and rituximab for the treatment of progressive multiple sclerosis.

© 2019 American Academy of Neurology.