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A much-needed focus on progression in multiple sclerosis
Alan J Thompson
The Lancet Neurology, Volume 14, Issue 2, February 2015, Pages 133–135
Few neurological disorders have seen so great a transformation in public perception as multiple sclerosis. Over the past 20 years, the disease has moved from being an untreatable disorder with few management options to one with active management underpinned by a wide range of oral and injectable treatments, at least for patients with the relapsing-remitting form of the disease (RRMS). The effect that this development has had on people affected by RRMS is difficult to overstate, but these improvements overshadow a less palatable fact: for a sizeable proportion of patients—those with progressive multiple sclerosis—almost no treatment options are available. This group includes patients who develop progression with a gradual deterioration in disability after a period with RRMS (secondary progressive multiple sclerosis) and a smaller number who are aware of a gradual worsening in disability from onset (primary progressive multiple sclerosis). Taken together, these groups constitute more than 50% of the 2·3 million people with multiple sclerosis worldwide.1 Every time a new treatment for RRMS comes on the market, it serves to remind people with progressive multiple sclerosis that they are still waiting and, unsurprisingly, contributes to a sense of frustration and neglect.