Multiple Sclerosis: Current Status and Strategies for the Future

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Table of Contents
Front Matter R1-R18
Executive Summary 1-16
1 Introduction 17-28
2 Clinical and Biological Features 29-114
3 Characteristics and Management of Major Symptoms 115-176
4 Disease Management and Measurement 177-240
5 Strategies for Future Research on Disease Mechanisms 241-276
6 Future Strategies for Therapies 277-324
7 Building and Supporting the Research Enterprise 325-346
8 Recommendations 347-368
Appendix A: Committee and Staff Biographies 369-376
Appendix B: List of Expert Consultants 377-378
Appendix C: Workshop Agendas 379-384
Appendix D: Kurtze's Expanded Disability Status Scale 385-386
Appendix E: Drugs Used in the Treatment of MS 387-400
Appendix F: U.S. Social Security Administration's Criteria for Qualifying as Disabled from MS 401-404
Appendix G: Treatments That Have Been Claimed to Be of Benefit in MS 405-412
Index 413-438

Page 31

FIGURE 2.1 Spectrum of disease course (refer to Table 2.1 for definitions). SOURCE: Adapted from Lublin and Reingold, 1996.¹²⁵

lapsing MS, worsening occurs in most patients during acute attacks with incomplete recovery. In progressive MS, the dominant pattern is a gradual accumulation of neurologic deficits, with slow clinical worsening.

Disease activity and progression have both clinical and subclinical components. Clinical disease activity and progression are judged by observation and neurologic examination. Subclinical components refer to pathological changes that are not observable in a clinical examination but are observed using a variety of laboratory tests, predominantly neuroimaging parameters.

Clinical Activity

Relapses. Relapses are variously referred to as acute attacks, exacerbations, or disease flare-ups. They involve the acute, or sudden onset, of focal neurologi-

Table of Contents

Front Matter R1-R18

Executive Summary 1-16

1 Introduction 17-28

2 Clinical and Biological Features 29-114

3 Characteristics and Management of Major Symptoms 115-176

4 Disease Management and Measurement 177-240

5 Strategies for Future Research on Disease Mechanisms 241-276

6 Future Strategies for Therapies 277-324

7 Building and Supporting the Research Enterprise 325-346

8 Recommendations 347-368

Appendix A: Committee and Staff Biographies 369-376

Appendix B: List of Expert Consultants 377-378

Appendix C: Workshop Agendas 379-384

Appendix D: Kurtze's Expanded Disability Status Scale 385-386

Appendix E: Drugs Used in the Treatment of MS 387-400

Appendix F: U.S. Social Security Administration's Criteria for Qualifying as Disabled from MS 401-404

Appendix G: Treatments That Have Been Claimed to Be of Benefit in MS 405-412

Index 413-438

Clinical Activity