HealthCare Journey for Multiple Sclerosis
  • Home
  • About Us
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • Health & Wellness
  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
    • Physical Therapy Blog
    • Patient Blog
    • Caregiver Blog
    • Research Blogs >
      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
    • What is MS?
    • Diagnosis
    • Treatment
    • MS Tips
  • Symptoms
    • Balance and Walking Issues
    • Breathing/Respiratory
    • Bowel Dysfunction
    • Cognitive Dysfunction
    • Crying/Laughing Uncontrollably (PBA)
    • Depression and Anxiety
    • Dizziness/Vertigo
    • Dysphagia
    • Fatigue
    • Foot Drop
    • Hearing or Smell or Taste Changes
    • Heat Sensitivity
    • Leg Weakness
    • Loss of Hand Dexterity and Coordination
    • Memory and Mutliple Sclerosis
    • Migraines
    • Numbness/Tingling/Altered Sensation
    • Nystagmus and Oscillopsia
    • Pain
    • Sexual Dysfunction
    • Sleep Issues
    • Spasticity/Spasms/Cramps
    • Speech/Swallowing
    • Urination/Bowel Problems
    • Vision
  • MS Clinics
  • MS Topics
    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
    • Pediatric Multiple Sclerosis
  • Register With Us
  • Terms of Use/Privacy/HIPAA
  • MS HealthCare Journey

Progression and Inflammation in Multiple Sclerosis Explained

10/15/2017

1 Comment

 
The concepts of progression and inflammation are somewhat independent of one another.

When considering inflammation in MS, we are referring to confirmed new relapses of neurological disability that is due to a new discrete inflammatory event in the central nervous system.  Another sign of inflammation is new or enlarging, or contrast enhancing lesions on MRI.  Evidence of inflammation such as these examples suggest that the disease course would be benefitted by a disease modifying therapy.

It is possible to show signs of inflammation but also to show signs of disability progression.  This is typically defined as the accumulation of permanent disability that can be detected on your neurological examination.  This can be reflected in many ways.  More typically, ambulatory dysfunction is readily seen as a sign of progression.  However, progression can also occur in coordination problems, bladder or bowel changes, cognitive dysfunction, visual disturbance, etc.  The point is that the worsening in the exam doesn’t get better but remains 3 or even 6 months later on the exam (when we see this we call it “confirmed” progression).

The progressive phase of MS, which is experienced by the majority of MS patients later on in the disease course, is felt to be a different phase of the disease and not entirely explained by inflammation (indeed, the progressive phase often occurs while there is no signs of ongoing inflammation).

In other cases, you can see both in the same patient.  When this happens, some of our MS disease modifying therapies may be able to slow down the disease course.  The b-cell depleting therapies (such as Ocrevus or off-label dosing of Rituxan) have data showing they can slow down the progressive phase in these types of patients.  

The important take away from this is that we are less interested in using those old names for MS (ie, relapsing-remitting, secondary progressive, primary progressive, etc), but we are more interested in knowing if there is ongoing signs of inflammation which would argue for use of an appropriate Disease Modifying Therapy that may help slow down the disease course which should translate into more time with a better quality of life (compared to doing nothing to treat the disease).

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
1 Comment
Dorothy Whittington link
3/1/2020 05:32:32 pm

Thank you for the information. Dr. Nielsen I have been taking medicine for ADD since 1998. I saw the paragraph on how Rituxan can slow down the progression of MS. I am not taking rituxan but taking another medication for ADD.
When my mom passed I started taking meds for feeling sad. Is that why I wasn’t depressed when Dr. Yu told me I had MS.
Thank you again for recommending this site.
Dorothy Whittington

Reply



Leave a Reply.

    DISCLAIMER: 
    The medical information and opinions on this site are provided as an information resource only, and are not to be used or relied on for any diagnostic or treatment purposes. The information and opinions expressed do not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

    Archives

    January 2020
    July 2019
    October 2017
    January 2017
    March 2016
    February 2016
    July 2015
    April 2015
    March 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014

    READ ABOUT OUR AUTHORS

    Categories

    All
    Abnormal Sensations
    Caregivers
    Diagnosis
    Dr. Kinkel
    Dr. Nielsen's Blogs
    Fatigue
    Insurance
    Medical Costs
    Mobility
    New Treatments
    Pain
    Physicians
    PML
    Prescription Drugs
    Sleep
    Symptoms
    Tom Mellor

    RSS Feed


© 2020 HealthCare Journey, LLC. All Rights Reserved.
HealthCare Journey™ is a trademark of HealthCare Journey, LLC
Picture
  • Home
  • About Us
  • Virtual MS Center
    • Q & A for Virtual MS Center
    • Read About Our Virtual MS Center Staff
  • News & Resources
  • Health & Wellness
  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
    • Physical Therapy Blog
    • Patient Blog
    • Caregiver Blog
    • Research Blogs >
      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
    • What is MS?
    • Diagnosis
    • Treatment
    • MS Tips
  • Symptoms
    • Balance and Walking Issues
    • Breathing/Respiratory
    • Bowel Dysfunction
    • Cognitive Dysfunction
    • Crying/Laughing Uncontrollably (PBA)
    • Depression and Anxiety
    • Dizziness/Vertigo
    • Dysphagia
    • Fatigue
    • Foot Drop
    • Hearing or Smell or Taste Changes
    • Heat Sensitivity
    • Leg Weakness
    • Loss of Hand Dexterity and Coordination
    • Memory and Mutliple Sclerosis
    • Migraines
    • Numbness/Tingling/Altered Sensation
    • Nystagmus and Oscillopsia
    • Pain
    • Sexual Dysfunction
    • Sleep Issues
    • Spasticity/Spasms/Cramps
    • Speech/Swallowing
    • Urination/Bowel Problems
    • Vision
  • MS Clinics
  • MS Topics
    • Pregnancy and Infertility
    • Caregivers and Family Members
    • Employment and MS
    • Medical Costs and Insurance
    • Pediatric Multiple Sclerosis
  • Register With Us
  • Terms of Use/Privacy/HIPAA
  • MS HealthCare Journey