Aggressive multiple sclerosis: proposed definition and treatment algorithm

  title={Aggressive multiple sclerosis: proposed definition and treatment algorithm},
  author={Carol Rush and Heather J. MacLean and Mark Steven Freedman},
  journal={Nature Reviews Neurology},
Multiple sclerosis (MS) is a CNS disorder characterized by inflammation, demyelination and neurodegeneration, and is the most common cause of acquired nontraumatic neurological disability in young adults. The course of the disease varies between individuals: some patients accumulate minimal disability over their lives, whereas others experience a rapidly disabling disease course. This latter subset of patients, whose MS is marked by the rampant progression of disability over a short time period… 
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Defining the clinical course of multiple sclerosis
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Prognostic factors for multiple sclerosis: the importance of natural history studies
  • G. Ebers
  • Medicine, Psychology
    Journal of Neurology
  • 2005
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