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Multiple Sclerosis Living with Multiple Sclerosis

Insidious Progression of MS: More Than Just Relapses and Remissions


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Summary & Participants

MS is considered a relapsing/remitting disease, which means its symptoms come and go in waves. But it's important to realize that even when your symptoms aren't acting up, the disease may still be progressing, and that stopping your medication is usually not a good idea. Join our panelists as they discuss the "insidious progression" of MS and various studies that have been done on it.

Medically Reviewed On: July 21, 2012

Webcast Transcript


DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. MS is considered a relapsing-remitting disease, which means its symptoms come and go in waves. But it's important to realize that even when your symptoms aren't acting up, the disease may still be progressing and that stopping your medication is usually not a good idea.

Here to discuss what's called "the insidious progression of MS" are two experts. First is Dr. Jeffrey Greenstein. He's a neurologist from Temple University. Welcome. And to his left is another neurologist Dr. Rick Munschauer. He's from the University of New York at Buffalo. Thanks for being here.

FREDERICK MUNSCHAUER, MD: Thank you David.

DAVID R. MARKS, MD: Now, relapsing-remitting does not necessarily mean that the disease doesn't keep going. Why is that?

FREDERICK MUNSCHAUER, MD: That's very true, David. Certainly, the majority of people with multiple sclerosis experience the disease as a series of attacks where they'll have some difficulty with sensation or coordination or vision or balance, and then they heal. There may be weeks or months before another attack comes.

One of the major changes in our thinking about multiple sclerosis is that the disease is really quite more active than what we see clinically. I think our best insight to that has been a series of new studies where people have MRI scans of their head done at very frequent intervals, and we find new areas of inflammation coming and going in people without clinical attacks, sometimes as many as 10 new spots on the MRI for every one major clinical attack. So the disease is more active than just exacerbations.

DAVID R. MARKS, MD: Jeff, why the disparity between the MRI findings and the symptomatology?

JEFFREY GREENSTEIN, MD: We think that part of the explanation for this is that eloquent areas in the brain are not always affected by what's going on. For example, an area that might cause a clinical problem might cause weakness and be very apparent, but an area that may be involved with cognitive function may not be as readily apparent. Also, there may be some effect of summations, so that you have to have a repeat episode or repetitive episodes occur before the symptom actually becomes manifest. These things might explain why there can be disease activity going on in the brain without it being apparent to the person who actually has the disease.

DAVID R. MARKS, MD: But it's still going on.

JEFFREY GREENSTEIN, MD: It's still going on.

DAVID R. MARKS, MD: What role does atrophy in the brain play in this disease?

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