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Defining the clinical course of multiple sclerosis: The 2013 revisions
Open accessAbstract
Accurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Standardized descriptions published in 1996 based on a survey of international MS experts provided purely clinical phenotypes based on data and consensus at that time, but imaging and biological correlates were lacking. Increased understanding of MS and its pathology, coupled with general concern that the original descriptors may not adequately reflect more recently identified clinical aspects of the disease, prompted a re-examination of MS disease phenotypes by the International Advisory Committee on Clinical Trials of MS. While imaging and biological markers that might provide objective criteria for separating clinical phenotypes are lacking, we propose refined descriptors that include consideration of disease activity (based on clinical relapse rate and imaging findings) and disease progression. Strategies for future research to better define phenotypes are also outlined.
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“PPMS (10-15% of patients) is characterised by an insidious, slowly progressive increase in neurological disability over time, usually without relapses.2”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [2]
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“At this time it is considered essential that a diagnosis of MS only be made in a patient who has symptoms suggestive of demyelination. 2”
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“Misdiagnosis of MS remains an issue in clinical practice. 8-11”
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Metadata
- Authors
- Lublin, F. D., Reingold, S. C., Cohen, J. A., Cutter, G. R., Sørensen, P. S., Thompson, A. J., Wolinsky, J. S., Balcer, L. J., Banwell, B., Barkhof, F., Bebo, B., Calabresi, P. A., Clanet, M., Comi, G., Fox, R. J., Freedman, M. S., Goodman, A. D., Inglese, M., Kappos, L., Kieseier, B. C., Lincoln, J. A., Lubetzki, C., Miller, A. E., Montalban, X., O'Connor, P. W., Petkau, J., Pozzilli, C., Rudick, R. A., Sormani, M. P., Stüve, O., Waubant, E., & Polman, C. H.
- Affiliations
- Cleveland Clinic (US)
- From the Corinne Goldsmith Dickenson Center for Multiple Sclerosis (F.D.L., A.E.M.), Icahn School of Medicine at Mount Sinai, New York, NY; Scientific and Clinical Review Associates, LLC (S.C.R.), Salisbury, CT; The Mellen Center for MS Treatment and Research (J.A.C., R.J.F., R.A.R.), Cleveland Clinic, OH; the Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; the Danish Multiple Sclerosis Center (P.S.S.), Department of Neurology, Copenhagen University Hospital Rigshospitalet...
- Corresponding author
- Lublin, Fred D.
- ORCID
- Lublin, Fred D.
- Reingold, Stephen C.
- Cohen, Jeffrey A.
- Cutter, Gary R.
- Sørensen, Per Soelberg
- Thompson, Alan J.
- Wolinsky, Jerry S.
- Balcer, Laura J.
- Banwell, Brenda
- Barkhof, Frederik
- Bebo, Bruce
- Calabresi, Peter A.
- Comi, Giancarlo
- Fox, Robert J.
- Goodman, Andrew D.
- Inglese, Matilde
- Kappos, Ludwig
- Lincoln, John A.
- Lubetzki, Catherine
- Miller, Aaron E.
- O'Connor, Paul W.
- Pozzilli, Carlo
- Rudick, Richard A.
- Sormani, Maria Pia
- Stüve, Olaf
- Waubant, Emmanuelle
- Polman, Chris H.
- Venue
- Neurology
- Published
- 2014-07-15
- Volume
- 83
- Issue
- 3
- Pages
- 278-286
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4117366
- OpenAlex
- W2105206040
- Cited by
- 3,177
- References
- 32
- Citations by year
- 2026: 229 · 2025: 266 · 2024: 335 · 2023: 308 · 2022: 333 · 2021: 333 · 2020: 298 · 2019: 274 · 2018: 232 · 2017: 236 · 2016: 193 · 2015: 105 · 2014: 27
- FWCI
- 139.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Neurology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Multiple Sclerosis Society
- Eli Lilly and Company
- Pfizer
- Amylin Pharmaceuticals
- GlaxoSmithKline
- Sanofi
- Gilead Sciences
- Biogen
- Teva Pharmaceutical Industries
- Alexion Pharmaceuticals
- Celgene
- F. Hoffmann-La Roche
- Cleveland Clinic
- Novartis Pharmaceuticals Corporation
- University of Alabama at Birmingham
- European Committee for Treatment and Research in Multiple Sclerosis
- Wellcome Trust
- Ironwood Pharmaceuticals, Incorporated
- University of Alabama
- Myelin Repair Foundation
- University of Texas Health Science Center at Houston
- GW Pharmaceuticals
- Acorda Therapeutics
- Prothena
- Glenmark Pharmaceuticals
- National Institute for Health and Care Research
- Multiple Sclerosis Society
- University of Cambridge
- European Commission
- Bayer HealthCare
- Wolfson Foundation
- National Research Foundation
- Eisai
- Multiple Sclerosis International Federation
- Schweizerische Multiple Sklerose Gesellschaft
- Sun Pharma
- Serono Symposia International Foundation
- Grifols
- National Institutes of Health
- Genentech
- EMD Serono
- Bayer Canada
- Sanofi Genzyme
- Canadian Institutes of Health Research
- Natural Sciences and Engineering Research Council of Canada
- Medical Research Council
- National Heart, Lung, and Blood Institute
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Keywords
- multiple sclerosis, clinical course, disease phenotypes, clinical trial design, relapse rate, disease activity, disease progression, MRI findings, biomarkers
- MeSH terms
- Clinical Trials as Topic, Humans, Multiple Sclerosis, Societies, Medical, Consensus
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