April 22, 2015 /
Researcher creates new, visually appealing model of multiple sclerosis
WASHINGTON — Multiple sclerosis may be more of a continuum than three distinct types of disease, and a new model attempts to capture that nuance, researchers reported here.
The “topographical” model could provide a new way of looking at disease course, Stephen Krieger, MD, of Mount Sinai in New York City, told MedPage Today.
“There’s thought that MS is more of a continuum,” Krieger said during an interview. “We should not think in terms of those categories, but we should think of it as a mixture of relapses and progression and how specifically they mix together.”
Currently, MS is classified as being in one of three groups: relapsing-remitting, secondary progressive, and primary progressive. But Krieger — a protege of Fred Lublin, MD, of Mount Sinai, who created the 3-category model of MS — said that system doesn’t accurately capture the range of disease.
“There’s real diagnostic uncertainty,” Krieger told MedPage Today. “It takes us years to figure out which category someone is in. A lot of progressive patients stay like they are for years. You’re not always sure which category someone fits into, nor do those categories tell us how someone’s disease is going to progress.”
For his new model — which Krieger calls a “true admixture of inflammation and progression” that describes the clinical course of MS in a more biologically informed way — he incorporated five factors: topographical distribution of lesions and the relapses they cause, relapse frequency, relapse severity, relapse recovery, and progression rate.
It essentially suggests that the clinical manifestations of MS are a consequence of the interplay between inflammatory lesions — the relapsing part of the disease — and generalized loss of functional capacity, as seen in the progressive part of the disease.
To illustrate the concept, Krieger came up with a peak-and-pool model: there’s a shallow end that drops off into a deep end, where the shallow end represents the spinal cord and optic nerve, the mid-section represents the posterior fossa, and the cerebral hemispheres constitute the deep end.
At the same time, brain lesions appear as topographic peaks that rise from the floor of the pool. The water’s surface is the clinical threshold, and when the central nervous system lesions’ peaks cross it, a relapse or flare occurs.
Disease progression is represented by a falling water level, which essentially represents a loss of neurons and declining brain volume — something that can be measured on MRI, Krieger said. Also, the model implies that progression could take the form of relapses as these peaks start to rise above the water, Krieger said.
~~~~~~~~~~~~~~~~~~~~
.
.
.
Visit our MS Learning Channel on YouTube: http://www.youtube.com/msviewsandnews
Stay informed with MS news and information - Sign-up here
For MS patients, caregivers or clinicians, Care to chat about MS? Join Our online COMMUNITY CHAT
