Scott Thomas F, Hackett Christopher T, Quigley Matthew R, Schramke Carol J
Allegheny General Hospital, Department of Neurology, Pittsburgh, USA; Drexel University College of Medicine, Department of Neurology, Pittsburgh, USA.
Drexel University College of Medicine, Department of Neurology, Pittsburgh, USA.
Clin Neurol Neurosurg. 2014 Dec;127:86-92. doi: 10.1016/j.clineuro.2014.09.008. Epub 2014 Oct 2.
To describe a "new natural history" of multiple sclerosis (MS), characterizing three patterns of progression in Relapsing MS (RMS) patients during the "treatment era," using newly developed definitions. By utilizing our simple model we intend to predict which patients are most likely to reach an EDSS of 6.0.
We stratified MS progression into three distinct patterns: aggressive MS (AMS), intermediate MS (IMS) and mild MS (MMS), based on Expanded Disability Status Scale (EDSS) score rate of change. These groups were compared for progression of EDSS before and after reaching these definitions.
The three groups remained significantly different in terms of disability throughout their disease courses p ≤ 0.001; 98% of the patients used disease modifying treatments (DMTs). AMS patients represent a significantly more disabling and aggressive form of MS than the IMS group.
Transition from relatively mild MS to aggressive course may begin at any time in the first 15 years, despite DMTs. Our definition for AMS is unique and identifies a group of patients who become permanently disabled within two years after a variable amount of time in a benign phase, despite treatment with modern DMTs.
描述多发性硬化症（MS）的“新自然史”，使用新制定的定义来刻画复发型多发性硬化症（RMS）患者在“治疗时代”的三种进展模式。通过运用我们的简单模型，我们旨在预测哪些患者最有可能达到扩展残疾状态量表（EDSS）评分6.0。
我们根据扩展残疾状态量表（EDSS）评分变化率将MS进展分为三种不同模式：侵袭性MS（AMS）、中度MS（IMS）和轻度MS（MMS）。对这些组在达到这些定义之前和之后的EDSS进展情况进行比较。
在整个病程中，这三组在残疾程度方面仍存在显著差异（p≤0.001）；98%的患者使用了疾病修正治疗（DMTs）。与IMS组相比，AMS患者代表了一种致残性更强、更具侵袭性的MS形式。
尽管使用了DMTs，但从相对轻度的MS转变为侵袭性病程可能在最初15年的任何时候开始。我们对AMS的定义是独特的，它识别出了一组患者，尽管接受了现代DMTs治疗，但在经历了一段可变时间的良性期后，在两年内会永久性残疾。
