Part 1

Secondary-progressive multiple sclerosis (SPMS) is generally defined as the onset of irreversible neurological disability in the absence of relapses in patients with a prior relapsing-remitting (RRMS) course. The invention of the SPMS phenotype has proved problematic. The pathology of RRMS and SPMS differs in degree, not kind, leading some to argue that there is no biological rationale for distinguishing phenotypes at all (Scalfari A. Mult Scler 2021;27:1002-1007). So it is not surprising that no biomarker signalling the onset of SPMS has been identified (Cree et al. Neurology 2021;97:378-388). The transition from RRMS to SPMS is of variable length, which likely reflects the limitations of detection and the diagnostic criteria used rather than the evolution of a distinct biology. The transition period is typically 2-3 years, which is the average duration of diagnostic uncertainty (Katz Sand et al. Mult Scler 2014;20:1654-1657). Read More

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This year marks the centenary of two important events in medicine. In January of 1922, Frederick Banting became the first to successfully treat diabetes with intravenous insulin. (Nicolae Paulescu was less celebrated for opting for the rectal route and is now better known as the founder of a Romanian fascist party.) Read More

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The year 2021 saw several important shifts in how secondary-progressive multiple sclerosis (SPMS) is viewed and which may lead to improvements in diagnosis and management. Read More