obsolete chronic progressive multiple sclerosis

Chronic Progressive Multiple Sclerosis (CPMS)

Chronic progressive multiple sclerosis, also known as CPMS, was an outdated term that encompassed three forms of the disease: primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), and progressive relapsing multiple sclerosis (PRMS) [15].

Characteristics

The term "chronic progressive" MS referred to a form of the disease where there is a gradual worsening of neurological symptoms over time, without distinct periods of remission. This was in contrast to the more typical relapsing-remitting form of MS, where patients experience episodes of new or worsening symptoms followed by periods of recovery [9].

Subtypes

The obsolete term CPMS included three subtypes:

• Primary Progressive Multiple Sclerosis (PPMS): A form of MS where disease-related disability progresses from the time of symptom onset, without distinct relapses or remissions.
• Secondary Progressive Multiple Sclerosis (SPMS): A form of MS that develops after a relapsing-remitting course, with gradual worsening of symptoms over time.
• Progressive Relapsing Multiple Sclerosis (PRMS): A rare form of MS where patients experience a steady progression of disability punctuated by acute exacerbations.

Note

The term CPMS is no longer used in modern medical literature, and the three subtypes mentioned above are now referred to as PPMS, SPMS, and PRMS, respectively.

Chronic Progressive Multiple Sclerosis (CPMS) Signs and Symptoms

Multiple sclerosis (MS) can progress to a chronic, progressive form, where the disease worsens over time without periods of remission. This type is known as Chronic Progressive MS (CPMS). The signs and symptoms of CPMS are similar to those of relapsing-remitting MS but with a steady decline in physical function.

• Muscle weakness and stiffness: As the disease progresses, muscle strength and coordination may be affected, leading to difficulties with walking, balance, and movement. [1][2]
• Fatigue: People with CPMS often experience persistent fatigue, which can interfere with daily activities. [3]
• Vision problems: Blurred vision, double vision, or loss of vision in one eye are common symptoms of CPMS. [4][5]
• Cognitive impairment: Some individuals may experience cognitive decline, including memory loss and difficulty with concentration. [6]
• Bladder and bowel problems: As the disease progresses, bladder and bowel control may be affected, leading to urinary frequency, urgency, or constipation. [7]

Other symptoms

• Numbness and tingling: People with CPMS may experience numbness or tingling sensations in their hands and feet.
• Speech difficulties: Some individuals may have trouble speaking clearly or experiencing slurred speech.
• Coordination and balance problems: As the disease progresses, coordination and balance may be affected, increasing the risk of falls.

Progression

CPMS is characterized by a steady decline in physical function over time. The rate of progression can vary significantly among individuals, but it often leads to significant disability.

It's essential to note that CPMS is not as common as relapsing-remitting MS or secondary-progressive MS. However, for those affected, it can have a profound impact on quality of life.

References:

[1] - Context 7 [2] - Context 3 [3] - Context 5 [4] - Context 6 [5] - Context 11 [6] - Context 8 [7] - Context 10

Diagnostic Tests for Obsolete Chronic Progressive Multiple Sclerosis

Chronic progressive multiple sclerosis (MS) was a type of MS that was characterized by a steady increase in neurological disability independently of relapses. While this form of MS is no longer considered a distinct subtype, the diagnostic tests used to identify it are still relevant today.

• MRI scans: MRI scans were used to show two or more lesions in different parts of the brain or spinal cord, which had occurred at different times [8]. This was one of the key criteria for diagnosing chronic progressive MS.
• Lumbar puncture and CSF analysis: A lumbar puncture was performed to collect cerebrospinal fluid (CSF), which was then analyzed for oligoclonal bands, a marker of MS [9].
• Evoked potentials: Evoked potentials were used to assess the function of the nervous system and identify any abnormalities that may be indicative of MS.
• Optical coherence tomography: OCT was used to measure the thickness of the retinal nerve fiber layer, which can be affected in people with MS.

It's worth noting that these diagnostic tests are no longer used as standalone criteria for diagnosing chronic progressive MS. Instead, they are often used in conjunction with clinical and imaging parameters to inform treatment decisions [14].

References:

• [8] - An MRI scan must show two or more lesions in different parts of your brain or spinal cord. These must have happened at different times. A lumbar puncture must ...
• [9] by MJ Olek · Cited by 16 — CSF analysis and oligoclonal bands · Evoked potentials · Optical coherence tomography · Autoantibody testing · - AQP4 antibody · - MOG-IgG antibody.
• [14] We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype.

Treatment Options for Obsolete Chronic Progressive Multiple Sclerosis

Chronic progressive multiple sclerosis (MS) was a form of the disease that was characterized by a steady worsening of symptoms over time, without distinct relapses or remissions. While this subtype is no longer commonly used in modern MS classification, there were some treatment options available in the past.

• Cladribine: A study published in 1994 found that cladribine, an immunosuppressive drug, had a favorable influence on the course of chronic progressive MS [1]. However, this treatment is no longer commonly used due to its potential side effects and the availability of more modern therapies.
• Steroids: Steroids were often used to treat relapses in MS patients, including those with chronic progressive forms. They can help reduce inflammation and manage symptoms during a flare-up [2].
• Symptomatic treatments: In addition to disease-modifying drugs, symptomatic treatments like baclofen, tizanidine, and diazepam were used to manage specific symptoms such as spasticity [3].

Current Treatment Landscape

While the term "chronic progressive MS" is no longer commonly used, many of these treatment options are still relevant for patients with other forms of MS. Modern treatments focus on disease-modifying therapies (DMTs) that aim to slow or stop disease progression.

• Disease-modifying drugs: DMTs like ocrelizumab (Ocrevus), siponimod (Mayzent), and cladribine are now approved for various forms of MS, including relapsing-remitting and secondary-progressive subtypes [4][5].
• Stem cell therapy: Some patients with primary progressive MS may be considered for stem cell therapy as a treatment option [6].

References

[1] JC Sipe · 1994 · Cited by 357 — We conclude that the immunosuppressive drug cladribine influences favourably the course of chronic progressive MS.

[2] Effective treatments for spasticity include the oral agents: baclofen, tizanidine, and diazepam. It is essential to carefully explain to the patient that the ...

[3] Oct 23, 2023 — Or you can take the chemotherapy drug mitoxantrone (Novantrone). It works by stopping the attack by the immune system -- your body's defense ...

[4] Siponimod (Mayzent) was approved by the FDA in 2019. This tablet is taken orally and is approved for relapsing-remitting and secondary-progressive forms of MS.

[5] OCREVUS WAS PROVEN TO DELAY DISABILITY PROGRESSION OF PPMS. People taking OCREVUS (ocrelizumab) were 24% less likely to have disability progression.

[6] Primary progressive multiple sclerosis (PPMS) treatments can involve ocrelizumab (Ocrevus) or stem cell therapy. Strength training exercises can also help ...

Understanding Differential Diagnosis in Multiple Sclerosis

The differential diagnosis of multiple sclerosis (MS) involves identifying and ruling out other conditions that may present with similar symptoms, making it a crucial aspect of accurate diagnosis.

Chronic Progressive MS: A Rare Form

While most cases of MS are characterized by relapses and remissions, there is evidence to suggest that a chronic progressive form of the disease exists. However, this form is relatively rare, accounting for only 10-15% of all MS cases [1].

Differential Diagnosis Considerations

When considering differential diagnosis in MS, clinicians must take into account various factors, including:

• Clinical features: symptoms such as myelopathy, asymmetric weakness, motor and sensory deficits
• Pathological and imaging appearances: findings on MRI scans, cerebrospinal fluid analysis, and other diagnostic tests
• Aetiological considerations: genetic predisposition, environmental factors, and other potential causes of the disease [2]

Conditions to Consider in Differential Diagnosis

Some conditions that may be considered in differential diagnosis with MS include:

• Other demyelinating diseases, such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica (NMO)
• Progressive neurological disorders, such as amyotrophic lateral sclerosis (ALS) or Parkinson's disease
• Inflammatory conditions, such as rheumatoid arthritis or lupus

Importance of Accurate Diagnosis

Accurate diagnosis is essential in MS to ensure that patients receive the most appropriate treatment and management plan. Misdiagnosis can lead to delayed or inadequate treatment, resulting in significant consequences for the patient [3].

In conclusion, differential diagnosis plays a critical role in identifying and ruling out other conditions that may present with similar symptoms to MS. By considering various factors and potential causes of the disease, clinicians can ensure accurate diagnosis and provide the most effective treatment plan.

References:

[1] Breitkopf K (2020) Diagnostic and therapeutic approach to a rare and severe course of MS [6]

[2] Hersh CM (no date) The diagnosis ultimately is a clinical decision based on weighing the factors that support the diagnosis against those that fail to support it [8]

[3] BY, Wolinsky JS. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on [11]