Patients with relapsing-remitting illness have attacks of one or more symptoms with varying frequency and with variable degrees of recovery but do not progress between attacks. Relapsing-remitting MS patients have attacks without interval progression, which is the essential feature of this type of MS. If there is progression between attacks, this is secondary progressive MS. In contrast, primary progressive MS is a type of MS in which patients have no attacks and worsening disease is not followed by subsequent improvement. If primary progressive patients have a subsequent attack with any recovery, they are reclassified as relapsing progressive MS.
It is clear that MS patients can suffer disability but not have secondary progressive, relapsing progressive, or primary progressive MS. No satisfactory terms or descriptors for stepwise progressing MS are in common use.
Rapidly progressive MS or malignant MS are terms that are used to describe a small minority of patients who become disabled in a short period of time. These patients typically will have three or more attacks in their first year, often severe, and possess gene combinations (HLA-B-7 and DR-2) that occur in a small minority of MS patients. It is particularly important that such patients be provided with expert care in MS clinics because aggressive therapy is the only way to avoid severe permanent disability. Aggressive immunosuppressive therapy (chemotherapy) with Cytoxan or Novantrone will usually stabilize them. Despite the presence of severe disability when first seen, more than a quarter or more of these patients can experience remarkable improvement. HIV screening is important, as rare patients with AIDS can occasionally mimic this type of illness. They do not benefit from the types of treatment that MS patients do.
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