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Multiple Sclerosis and it's effects to the Body

Since life is not typically shortened by MS, this is going to be anywhere between thirty and fifty years.

So the disease starts out with a relapsing-remitting phase that includes series of attacks, and then typically considerable or complete recovery from attacks, and then after fifteen or twenty years or even more, typically the disease will change to secondary progressive MS, where between attacks people will not be stable. They'll become slowly and steadily worse. They may continue to have attacks, but the really defining feature of this phase of disease is this slow steady worsening.

Going on now to the fifth slide, what's generally understood at this point is that relapsing-remitting MS and secondary progressive MS are not different diseases or different types of disease, but in fact, are time points on an evolution of disease. So it's going from say a child to a grownup, or something of that sort. It's different names for the same thing at different times.

In most patients, as we see on this clinical course in MS patient slide - maybe 85% - what happens first is a clinically isolated syndrome, meaning the first attack, the first symptom. This is clearly defined as clinical MS after another attack, and is at that point defined as relapsing-remitting MS. Then, as I said before, after ten, fifteen, twenty years, this will convert to secondary progressive MS.

"Somewhere between two and five percent of all people with multiple sclerosis, even with the best of imaging, show no abnormalities in the brain or spinal cord."

In a much smaller fraction of patients, the disease starts with progression and this is called primary-progressive MS. People with progressive MS may at some point develop relapses after the disease is established, and that's called progressive-relapsing MS, which is probably even more rare than primary-progressive MS.

On the next slide, I've drawn some arrows simply to indicate that clinically isolated...

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