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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
After an initial episode of CNS inflammation the patient may make a full recovery, and this is a clinically isolated syndrome. If there is then recurrence, with recovery to baseline, the patient is said to have relapsing–remitting MS. If there then develops progression of neurological impairment between relapses, this is secondary progressive disease. Finally, a small proportion of patients present with the insidious onset of a relentlessly progressive disease, without relapses, and this is primary progressive MS.
Neurology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
A first attack is categorised as a ‘clinically isolated syndrome’ After many years most of these patients will enter a phase of progression with or without attacks, called secondary ‘progressive multiple sclerosis’
Demyelinating syndrome
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Jeffrey Hernandez, Leticia Tornes, Janice Y. Maldonado
Two other disease courses have been described that were both present in our clinical case. These are disease courses seen prior to the diagnosis of CDMS. Clinically Isolated Syndrome (CIS): CIS is the first clinical presentation of RRMS and usually presents as a syndrome: unilateral optic neuritis, transverse myelitis, or a brainstem attack (Miller et al., 2005). Patients with CIS and an abnormal brain MRI are likely to develop clinically definite MS (CDMS) (Fisniku et al., 2008).Radiologically Isolated Syndrome (RIS): May be considered a presymptomatic phase of MS, usually an incidental image finding highly suggestive of an inflammatory demyelinating disease, in the absence of clinical signs and symptoms of MS. Patients should be closely monitored (Lublin et al., 2014).
An update on the use of sphingosine 1-phosphate receptor modulators for the treatment of relapsing multiple sclerosis
Published in Expert Opinion on Pharmacotherapy, 2023
Laura Dumitrescu, Athanasios Papathanasiou, Catalina Coclitu, Afagh Garjani, Nikos Evangelou, Cris S. Constantinescu, Bogdan Ovidiu Popescu, Radu Tanasescu
The main phenotypes of MS are relapsing-remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS) [1,6]. The relapsing-remitting phenotype is present at onset in about 90% of the cases and is usually followed by a secondary progressive phase (i.e. SPMS) consisting of gradual disability accrual, with (i.e. active SPMS) or without overlapping relapses [1]. Clinically isolated syndrome (CIS), defined as the first clinical attack most likely related to MS but not yet fulfilling MS diagnostic criteria is another potential presentation [1,7]. Around 1 in 8 people with MS are diagnosed with PPMS. In PPMS, the symptoms gradually worsen and accumulate over time, in the absence of overt clinical relapses, but overt clinical relapses may sometimes occur (in 3% of cases i.e. progressive-relapsing MS).
Ofatumumab subcutaneous injection for the treatment of relapsing forms of multiple sclerosis
Published in Expert Review of Clinical Immunology, 2022
G. Dalla Costa, L. Leocani, G. Comi
According to the European Medicines Agency (EMA), the term relapsing MS includes 1), patients with RRMS, 2), patients with SPMS and superimposed relapses, and 3), patients with a clinically isolated demyelination event and evidence of dissemination of lesions in time and space according to the revised McDonald criteria [11]. Recent studies suggest that approximately 67% of patients with a first demyelinating event (clinically isolated syndrome – CIS) satisfy the diagnostic criteria for MS at the time of the occurrence of an attack [12]. In the last 25 years, we have seen a massive acceleration on the development of disease-modifying treatments (DMTs) for relapsing MS (RMS) and more recently two DMTs have been approved for both PPMS and SPMS. The analysis of DMTs for progressive MS is out of the scope of this review which will concentrate on relapsing MS.
DORADA adherence study: full view into RebiSmart subdomains parameters in multiple sclerosis treatment
Published in Current Medical Research and Opinion, 2021
Zbyšek Pavelek, Michal Novotný, Blanka Klímová, Marek Peterka, Pavel Potužník, Martina Kövári, Martin Vališ
About 80% of patients experience the disease as a "clinically isolated syndrome" (CIS). These are the first signs of the demyelination process and involve infiltration by inflammatory cells, affecting the brain, spinal cord and optic nerve. Thus, the initial symptoms are related to vision, balance, muscle control, and other basic bodily functions. Approximately 85–90% of patients suffer from relapsing-remitting MS (RRMS), which is manifested by alternating attacks and remissions2,3. The disease is currently incurable, but progression and disability can be successfully delayed. There are several molecules (for oral and patent administration) with different mechanisms of action for the treatment of the RRMS form of the disease. These are: interferon beta-1a, interferon beta-1b, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, natalizumab and alemtuzumab.