What Are the Different Types of Progressive Multiple Sclerosis?

Multiple sclerosis (MS) is the most common form of central demyelinating disease. In the acute active phase of the disease, there are multiple inflammatory demyelinating plaques in the central nervous white matter, and old lesions form calcified plaques due to glial fibrous hyperplasia. They are characterized by multiple lesions, remissions, and recurrent courses, and they occur in the optic nerve, spinal cord and brain Dry, more common in young and middle-aged, women are more common than men.

Basic Information

English name

multiple sclerosis, MS

Visiting department

Neurology

Multiple groups

Young women, middle-aged women

Common locations

Common causes

May be related to genetic, environmental and other factors

Common symptoms

The first symptom is mostly one or more weakness

Contagious

no

Causes of multiple sclerosis

The etiology is unknown, and it is related to genetic factors, and environmental factors such as viral infections and geographic autoimmune responses have a certain relationship.

Multiple Sclerosis Typing

Currently recognized clinical classification of MS:

1. Relapsing-remitting MS (RRMS)

The most common type of disease in MS is 80% of MS patients. This type is early in the onset of the disease. It shows obvious recurrence and remission processes, and basically recovers with each attack, leaving no or only minor sequelae. With the progress of the disease, most of them eventually change to SPMS within 5-15 years.

2. Secondary Progressive MS (SPMS)

A type of course after RRMS is manifested in the process of relapse after the relapse, the disease can not be completely relieved with recurrence and leaves some sequelae, the disease gradually worsens gradually. About 50% of patients with RRMS transition to this type within 10 years / 80% within 20 years.

3. Primary Progressive MS (PPMS)

MS is a rare type of disease. 10% to 15% of MS patients initially present with this type. The clinical course does not relieve the recurrence process. The disease is slowly and progressively exacerbated, and the disease duration is greater than one year.

4. Progressive relapsed MS (PRMS)

MS is a rare type of disease. About 5% to 10% of MS patients present with this type of disease. The disease is always exacerbated slowly, and a few of them alleviate the recurrence process.

Clinical manifestations of multiple sclerosis

Multiple sclerosis is relatively diffuse, so the symptoms and signs are also more complicated. Neuritis, retrobulbar optic neuritis, ophthalmoplegia, paralysis of the limbs, pyramidal tract signs, and mental symptoms can occur. Ataxia, limb tremor, and nystagmus occurred when the lesion was located in the cerebellum. Lesions invade the medial longitudinal bundle and there are persistent, irregular, multiple involuntary forms of involuntary ophthalmomyoclonus. If dizziness and vertical nystagmus occur that are difficult to explain, especially in young patients, acute vertigo and vertical nystagmus persist after the dizziness stops.

Early in the disease, fluctuating sensorineural hearing loss and dizziness may occur. Due to multiple lesions, the symptoms are complicated and vary depending on the lesion. If there is a demyelination zone or sclerotic plaque in the brainstem and cerebellum, which damages the vestibular nucleus or the structure associated with the vestibule, the clinical manifestations are persistent vertigo, which is exacerbated when turning the head and accompanied by nausea and vomiting. Tinnitus and deafness are rare. Some patients have nystagmus and the form is variable. Vertical nystagmus and swinging horizontal nystagmus are also common. The nystagmus fast phase points in the gaze direction.

Multiple sclerosis test

Skull CT examination, magnetic resonance imaging (MRI), and MR is the most effective auxiliary diagnostic method for detecting multiple sclerosis, with a positive rate of 62% to 94%. Cerebrospinal fluid examination, brainstem auditory evoked potentials, etc.

Ophthalmic examination: Visual evoked potential (VEP) examination is abnormal; visual field examination may appear central dark spots, blindness and other defects.

Multiple sclerosis diagnosis

Depending on the clinical manifestations, the further evidence necessary to diagnose MS is also different and can be divided into the following situations:

First case

Clinical manifestations: 2 clinical episodes a; objective clinical evidence of 2 lesions or objective clinical evidence of 1 lesion with reasonable evidence of 1 previous episode b;

2. The second type of situation

Clinical manifestations: 2 clinical episodes a; objective clinical evidence of 1 lesion;

Further evidence necessary for the diagnosis of MS: The multiplicity of space requires any of the following 2 items:

(1) There are 1 T2 lesions in at least 2 of the 4 typical CNS lesion areas (paraventricular, near cortex, subventricular, and spinal cord) in MS;

(2) Waiting for another clinical attack involving different parts of the CNS a.

3. The third type of situation

Clinical manifestations: 1 clinical episode a; objective clinical evidence of 2 lesions;

Further evidence necessary to diagnose MS:

The multiplicity of time requires any of the following 3 items:

(1) Asymptomatic radon-enhanced and non-enhanced lesions are present at the same time at MRI;

(2) Follow-up MRI examinations have new T2 lesions and / or thoracic enhancement lesions, regardless of the time interval from the baseline MRI scan;

(3) Waiting for another clinical attack a.

4. The fourth type of situation

Clinical manifestations: 1 clinical episode a; objective clinical evidence of 1 lesion (clinical isolated syndrome);

Further evidence necessary to diagnose MS:

The multiplicity of spaces requires any of the following two items:

(1) There are 1 T2 lesions in at least 2 of the 4 typical CNS lesion areas (paraventricular, near cortex, subventricular, and spinal cord) in MS;

(2) Waiting for another clinical attack involving different parts of the CNS a.

The multiplicity of time must meet any of the following three:

(1) Asymptomatic radon-enhanced and non-enhanced lesions are present at the same time at MRI;

(2) Follow-up MRI examinations have new T2 lesions and / or thoracic enhancement lesions, regardless of the time interval from the baseline MRI scan;

(3) waiting for another clinical attack a;

5. Fifth type of situation

Clinical manifestations: suggestive of insidious progressive neurological dysfunction (PPMS) of MS;

Further evidence necessary to diagnose MS:

Retrospective or prospective investigations indicate that the disease progresses for 1 year and has 2 of the following 3d:

(1) There are 1 T2 lesions in the MS characteristic lesion area (next to the ventricle, near the cortex or under the curtain) to prove the spatial multipleness of the lesions in the brain;

(2) There are 2 T2 lesions in the spinal cord to prove the spatial multipleness of the spinal cord lesions;

(3) CSF positive results (isoelectric focus electrophoresis evidence indicates that there are oligoclonal bands and / or increased IgG index).

When the clinical manifestations meet the above diagnostic criteria and there is no other more reasonable explanation, it can be clearly diagnosed as MS; when MS is suspected but does not fully meet the above diagnostic criteria, it is diagnosed as "possible MS"; other diagnoses can explain the clinical manifestation more reasonably , The diagnosis is "non-MS".

Note: An "a" episode (relapse, worsening) is defined as: a current or past event characterized by CNS acute inflammatory demyelinating lesions; found by subjective narrative or objective examination of the patient; lasting at least 24 hours; and No signs of fever or infection. Clinical seizures need to be confirmed by contemporaneous objective examinations; even in the absence of objective evidence of CNS, certain past events with typical symptoms and progression of MS can provide reasonable support for previous demyelinating lesions. The subjective narrative symptoms (previous or present) of the patient should be multiple episodes that last at least 24 hours. Before confirming the diagnosis of MS, it is necessary to determine: at least one attack must be confirmed by objective examination; patients with previous visual impairment have positive visual evoked potentials; or MRI examination has found demyelination changes in the CNS area consistent with previous neurological symptoms.

"B" is the most reliable clinical diagnosis based on objective evidence of 2 episodes. In the absence of objective evidence of neurological involvement, reasonable evidence for a previous episode includes: a past event with typical symptoms and progression of inflammatory demyelinating disease; at least one clinical episode supported by objective evidence.

"C" requires no further evidence. However, it is still necessary to make MS-related diagnosis with the help of imaging data and according to the above diagnostic criteria. When imaging or other tests (such as CSF) are negative, careful diagnosis of MS or other possible diagnoses should be considered. Before diagnosing MS, it must be satisfied that: there is no other more reasonable explanation for all clinical manifestations; and there is objective evidence supporting MS.

"D" does not require to enhance the lesion. For patients with brainstem or spinal cord syndrome, the responsible lesions are not included in the statistics of MS lesions.