Clinical Management of Progressive Multiple Sclerosis

Progressive multiple sclerosis encompasses both primary and secondary forms characterised by a sustained increase in neurological disability independent of acute relapses. Pathologically, it reflects a shift from focal inflammatory demyelination towards diffuse neurodegeneration, microglial activation and failure of endogenous repair. Clinical management aims to slow disability accumulation, alleviate symptoms and maximise quality of life. Current practice stratifies patients by age, disease duration and evidence of ongoing inflammatory activity, guiding the use of anti-inflammatory disease-modifying therapies where benefit is established. Symptomatic management spans spasticity control, pain relief, bladder and bowel support, fatigue management and psychological care. Rehabilitation interventions targeting mobility, balance and cognition are integral to preserving function. Biomarkers including neuroimaging measures of brain and spinal atrophy, serum neurofilament light chain levels and novel imaging of myelin content increasingly inform prognosis and treatment response. Despite advances in relapsing forms, therapy options for non-active progressive disease remain limited, prompting growing emphasis on neuroprotective and remyelinating strategies alongside innovative trial designs to accelerate evaluation of pipeline agents.

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Clinical Management of Progressive Multiple Sclerosis publication trend

The graph below shows the total number of articles in clinical management of progressive multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Progressive multiple sclerosis (PMS): A form of MS defined by continuous neurological worsening, subdivided into primary and secondary types based on disease course.

Disease-modifying therapies (DMTs): Agents designed to alter the underlying disease process rather than solely addressing symptoms.

Remyelination: The restoration of myelin sheaths around axons, crucial for functional recovery and neuroprotection.

Neuroprotection: Strategies aimed at preserving neuronal integrity and function in degenerative conditions.

Expanded Disability Status Scale (EDSS): A composite scale measuring neurological impairment and ambulation in MS.

Sphingosine-1-phosphate receptor modulators (S1P modulators): Oral agents that prevent lymphocyte egress from lymphoid tissue, reducing central nervous system inflammation.

References

1. Disease-modifying therapies for relapsing/active secondary progressive multiple sclerosis – a review of population-specific evidence from randomized clinical trials. Therapeutic Advances in Neurological Disorders (2023).
2. Updates and advances in multiple sclerosis neurotherapeutics. Neurodegenerative Disease Management (2022).
3. Central nervous system macrophages in progressive multiple sclerosis: relationship to neurodegeneration and therapeutics. Journal of Neuroinflammation (2022).
4. Diagnosis and Management of Progressive Multiple Sclerosis. Biomedicines (2019).
5. Designing Multi-arm Multistage Adaptive Trials for Neuroprotection in Progressive Multiple Sclerosis. Neurology (2022).
6. Novel Drugs in a Pipeline for Progressive Multiple Sclerosis. Journal of Clinical Medicine (2022).