Review article
SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS
VANJA BAŠIĆ KES
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, University of Zagreb, School of Dental Medicine, Zagreb and Josip Juraj Strossmayer University of Osi
NEVENA GRBIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
MILJENKA JELENA JURAŠIĆ
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
IRIS ZAVOREO
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
LUCIJA ZADRO MATOVINA
; Sestre milosrdnice University Hospital Centre, Department of Neurology, Reference Center for Neuroimmunology and Neurogenetics of the Ministry of Health, Zagreb, Croatia
Abstract
Introduction: Multiple sclerosis (MS) is a chronic infl ammatory autoimmune disease of the central nervous system. There are various types of the disease but this article is based on describing secondary progressive multiple sclerosis (SPMS). SPMS is defi ned by relapses at the disease onset, then progressing with continuous worsening during the course of the disease. Diagnosis is made retrospectively. It is still a challenge for clinicians when to decide that the disease course has taken the secondary progressive phase. Aim: Our aim was to unite scientifi c papers on SPMS and see if there is any pattern that can predict progression of the disease. Also, we investigated whether there were any criteria on how and when to make the diagnosis of MS. Methods: We searched MEDLINE for chronic progressive MS and included literature dating back from the year 2005. Results: We found 92 review articles by exploring MEDLINE but only chose the systematize ones and those describing SPMS. By studying the literature, it is noticed that SPMS occurs in 80%-90% of patients receiving no treatment. Usually, the disease reaches chronic phase after 15-20 years. There are some patterns that can predict the disease course in secondary phase. It appears that the age at disease onset could predict disease progression to secondary phase. If the disease occurs later in life, the time to progressive phase is shorter. The frequency of relapses can also be a predictor of disease progression. According to some data, the frequency of relapses in the fi rst 2-5 years is associated with a higher risk of disease progression. Even though these data are available, there are no clear predictors of disease progression. Locheider et al. published an article in 2016, proposing criteria for SPMS defi nition. These criteria include increasing EDSS by 1 point if initial EDSS was <5, or increasing EDSS by 0.5 points if initial EDSS was ≥6 in the absence of relapse, minimal EDSS 4 at the time of progression, minimal pyramid FS score >2 at the time of progression, confi rmation of disease progression at two or more consecutive visits at ≥3 months apart, and required confi rmation within the FS leading to the progression event. It is necessary to see whether the criteria proposed will be defi nitely accepted. SPMS is still a therapeutic challenge for clinicians. According to the ECTRIMS/EAN guidelines from 2018, it is recommended to start treatment of SPMS with mitoxantrone or interferon but in agreement with patients because of the potential side effects. Conclusion: SPMS is still a clinical and therapeutic challenge. The recently proposed defi nition criteria can make it easier for clinicians to establish the diagnosis of SPMS. It will take time to see if these criteria will be defi nitely accepted or modified.
Keywords
secondary progressive multiple sclerosis; treatment; criteria
Hrčak ID:
208629
URI
Publication date:
16.11.2018.
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