Is MS a progressive disease?

Here is My Question:
Is MS a progressive disease?

Answer:
This is an excellent question. I think many people tend to use imprecise terminology when describing clinical features of MS. Let me give you a framework for many of these common terms.

1. Relapse: This refers to new or worsening symptoms caused by new inflammatory activity. The reason we often argue about whether new or worsening symptoms are caused by new inflammatory activity (i.e. not a relapse) is because we often cannot prove, through history, exam or even MRI that there is evidence of new inflammatory activity and there could be other explanations for the new or worsening symptoms.
2. Remitting: This only means that new or worsening symptoms stabilize and improve to some extent compared to their peak severity. It does not imply a return to normal and the improvement can take up to 6 months or longer.
3. Stable: We use this term to imply no evidence of relapse or disease progression over a given interval of time, usually yearly intervals.
4. Progressive: This refers to continuous worsening in neurological function over an interval of time usually too long to be considered a relapse. Most neurologists use an interval of 6 or 12 months to define this continuous worsening. This means that progressive disease can only be defined in retrospect. Furthermore, people with progressive disease will often stabilize without improvement for periods exceeding a year prior to demonstrating further progression. This feature was documented years ago by Dr Donald Goodkin. Often when we see continuous, rapid, and dramatic worsening over shorter intervals (usually 3 to 6 months), we also see dramatic evidence of inflammatory disease activity on MRI, a feature that is atypical for progressive disease. These people are often younger than typical progressive patients as well. Most progressive patients are above the age of 45 at diagnosis.

The main problem with the casual use of these terms by both lay people and professionals is that they often are used for other purposes. For instance, the fact that MS is a chronic disease (i.e. it never disappears completely) is often confused with the concept of disease progression. While many people do develop progressive disease as defined in # 4 above, at least 25 % or more never develop evidence of progressive disease despite the chronicity of their condition. 
I hope this helps

Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
#MS #multiplesclerosis