Aggressive multiple sclerosis: proposed definition and treatment algorithm

@article{Rush2015AggressiveMS,
  title={Aggressive multiple sclerosis: proposed definition and treatment algorithm},
  author={Carol Rush and Heather J. MacLean and Mark Steven Freedman},
  journal={Nature Reviews Neurology},
  year={2015},
  volume={11},
  pages={379-389}
}
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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99 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
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99 Citations

Aggressive multiple sclerosis (2): Treatment
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The available evidence, gaps in knowledge and future research needed to fill those gaps are identified and the difficulties in developing a consensus about what defines aggressive MS are detailed.
Highly active multiple sclerosis: An update.
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Deciding which DMT to use in a specific patient requires a careful analysis of a patient’s disease course for high-risk factors for early progression, consideration of the efficacy and safety profile for potential therapy, as well as understanding of a patients’ lifestyle and expectations.
Severe, Highly Active, or Aggressive Multiple Sclerosis
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It is imperative to recognize aggressive MS to effectively treat it before patients progress, and a definition and new treatment algorithm are proposed to achieve this goal.
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It may be advisable to offer an HE-DMT to MS patients early after diagnosis, taking into account drug safety profile, disease severity, clinical and/or radiological activity, and patient-related factors, including possible comorbidities, family planning, and patients’ preference in agreement with the EAN/ECTRIMS and AAN guidelines.
Sequencing of disease-modifying therapies for relapsing–remitting multiple sclerosis: a theoretical approach to optimizing treatment
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A sequencing approach for treating RRMS is discussed, with importance given to the long-term risks and individual preference when devising a treatment plan, and evidence-based strategies to counter breakthrough disease are also addressed.
Disease modifying therapies for relapsing multiple sclerosis
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Methods such as stratifying patients on the basis of estimated risk for future disability, weighing patient specific factors and preferences, and using objective outcomes to adjudicate treatment success are discussed, and emerging drug therapies and strategies are reviewed.
Acute multiple sclerosis lesion pathology does not predict subsequent clinical course—a biopsy study
TLDR
Uniform white matter subacute demyelination is associated with a diverse clinical course ranging from a monophasic illness to progressive MS, suggesting that extraneous factors distinct from the basic pathology significantly influence the clinical course in MS.
Early clinical markers of aggressive multiple sclerosis.
TLDR
It is suggested that older age at symptom onset, greater disability during the first year, and pyramidal signs in the firstyear are early indicators of aggressive multiple sclerosis.
Use of monoclonal antibodies in patients with multiple sclerosis in the practice of a neurologist
  • N. Y. Lashch
  • Medicine, Biology
    Meditsinskiy sovet = Medical Council
  • 2020
TLDR
In patients with frequent exacerbations and signs of radiological activity of the disease, according to magnetic resonance imaging of the brain and spinal cord, monoclonal antibody preparations are effectively used and the method of immune system reconstruction leads to a decrease in autoagression in MS.
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