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