Multiple sclerosis : emerging epidemiological trends and redefining the clinical course
Portaccio, Emilio (Università degli Studi di Firenze)
Magyari, Melinda (Copenhagen University Hospital Rigshospitalet)
Kubala Havrdova, Eva (Charles University (Praga, República Txeca))
Ruet, Aurelie (Université de Bordeaux)
Brochet, Bruno (Université de Bordeaux)
Scalfari, Antonio (Imperial College London)
Di Filippo, Massimiliano (University of Perugia)
Tur, Carmen (Hospital Universitari Vall d'Hebron)
Montalban, Xavier (Hospital Universitari Vall d'Hebron)
Amato, Maria Pia (IRCCS Fondazione Don Carlo Gnocchi)
Universitat Autònoma de Barcelona

Date:	2024
Abstract:	Multiple sclerosis is a chronic, inflammatory, and neurodegenerative disease of the central nervous system and a major cause of neurological disability in young adults. Its prevalence and incidence are increasing, and it has been estimated at over 2. 8 million cases worldwide, in addition to recent trends towards a shift in MS prevalence to older ages, with peak prevalence estimates in the sixth decade of life. Although historically the relapsing and progressive phases of the disease have been considered separate clinical entities, recent evidence of progression independent of relapse activity (PIRA) has led to a reconsideration of multiple sclerosis as a continuum, in which relapsing and progressive features variably coexist from the earliest stages of the disease, challenging the traditional view of the disease course. In this Series article, we provide an overview of how the traditional description of the clinical course of MS and epidemiological trends in Europe have evolved. For this purpose, we focus on the concept of PIRA, discussing its potential as the main mechanism by which patients acquire disability, how its definition varies between studies, and ongoing research in this field. We emphasise the importance of incorporating the assessment of hidden clinical manifestations into patient management to help uncover and quantify the PIRA phenomenon and the possible implications for future changes in the clinical classification of the disease. At the same time, we provide insights into overcoming the challenges of identifying and defining PIRA and adopting a new understanding of the clinical course of MS.
Grants:	"la Caixa" Foundation LCF/BQ/PI20/11760008 "la Caixa" Foundation 100010434
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Multiple sclerosis ; Epidemiology ; Progression idependent of relapse activity ; Clinical classification
Published in:	The Lancet Regional Health - Europe, Vol. 44 (august 2024) , ISSN 2666-7762

DOI: 10.1016/j.lanepe.2024.100977
PMID: 39444703

14 p, 773.6 KB

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