Delaying the development of secondary progressive MS

The fact that some people with MS are able to recover from relapses faster and better than others is an important but poorly understood observation.

The disease course of progressive MS is characterised by the build-up of neurologic disability (the loss of some bodily or mental functions) with or without relapses. People with relapsing forms of MS often go on to develop a progressive form, known as secondary progressive MS.

The onset of the progressive disease course is age-dependent rather than disease duration–dependent and is the strongest determinant of poor long-term prognosis. Other factors associated with poor long-term prognosis are the location of initial lesions, the frequency of early relapse and incomplete recovery from individual relapses, causing additional cumulative disability.

Researchers at the Mayo clinic, USA, suggested that complete to almost complete recovery from early relapses could potentially delay or prevent progressive MS onset.

Their investigation on a large population of people with secondary progressive MS strongly suggested that poor recovery from early relapses led to considerably earlier onset of progressive MS than good recovery from early relapses.

The delay in developing progressive MS in people with good recovery from relapses has the following treatment implications:

1. An early and aggressive treatment plan could be adopted in patients with a severe and sudden relapse or a history of poor recovery from relapses.
2. For people experiencing one or more relapses per year, with poor recovery, rapid escalation to stronger second-line disease modifying drugs can be considered without waiting to establish a high frequency of relapses.
3. Future methods for remyelination and axonal repair are likely to work best if applied in early relapses to delay or ultimately prevent later progressive disease course development.

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