Albelo-Martínez Marelisa, Rizvi Syed
Department of Neurology, Brown University Health and Rhode Island Hospital, Alpert Medical School of Brown University, USA.
Neurotherapeutics. 2025 Jul;22(4):e00601. doi: 10.1016/j.neurot.2025.e00601. Epub 2025 May 9.
Progressive forms of multiple sclerosis (MS) include primary progressive MS (PPMS) and secondary progressive MS (SPMS). Unlike relapsing-remitting MS (RRMS), progressive MS is recognized by relentless progression with accumulating disability, rare to no relapses nor new activity on MRIs. Clinically, neurologic worsening in MS can occur in the relapsing-remitting (RRMS) phase of disease due to incomplete recovery from neuroinflammatory relapses. However, a progressive disease course is the dominant factor related to accumulating disability. There is persistent central nervous system (CNS) compartmentalized inflammation, mitochondrial dysfunction and altered immune responses. Unlike in RRMS, the efficacy of disease modifying agents (DMA) in progressive MS has been limited, highlighting the need for novel therapeutic approaches that address both inflammation and neurodegeneration. This article explores current management of progressive MS, and future directions in targeting the unique pathophysiology of this complex disease.
多发性硬化症（MS）的进展型包括原发性进展型MS（PPMS）和继发性进展型MS（SPMS）。与复发缓解型MS（RRMS）不同，进展型MS的特点是病情持续进展，残疾不断累积，MRI上很少或没有复发及新的活动病灶。临床上，MS的神经功能恶化可发生在疾病的复发缓解（RRMS）阶段，原因是神经炎症性复发后恢复不完全。然而，疾病进展过程是导致残疾累积的主要因素。存在持续的中枢神经系统（CNS）局灶性炎症、线粒体功能障碍和免疫反应改变。与RRMS不同，疾病修正治疗药物（DMA）在进展型MS中的疗效有限，这凸显了需要针对炎症和神经退行性变的新型治疗方法。本文探讨了进展型MS的当前治疗方法，以及针对这种复杂疾病独特病理生理学的未来方向。
