b'Medicine and ResearchRReetthhiinnkkiinnggPPrrooggrreessssiioonnMMSSmmaayybbeeaattwwoopprroocceessss,,rraatthheerrtthhaannaattwwoossttaaggee,,ddiisseeaasseeFor many years, relapsing multiple sclerosisTThheettwwoopprroocceessssvviieewwhas been considered a two-stage disease. AIn the two-process view of MS, progression person was first diagnosed with relapsing- has the potential to occur from the beginning remitting MS, and it was expected that laterin RRMSperhaps even before the obvious theywouldprobablystophavingrelapsessymptoms that lead to seeking an MS diagnosis and transition to a stage called secondary and slowly accumulate over time. The effects progressive MS. The following denitionsof this progression may be hidden for years, reect the traditional understanding of thebut damage may be occurring nonetheless. two-stage thinking:When it becomes apparent, this is referred to asRReellaappssiinnggrreemmiittttiinnggMMSS clearly identiableprogression independent of relapse activity. attacks lasting days or weeks, with periodsWhile currently available treatments are between relapses being stable and absenthighly effective in preventing relapses and the of disease progression. After an attack, manyworsening that can cause relapses, their efficacy people experience a full recovery, but someagainst the separate process of progression will experience residual loss in mental orremains unclear. Research is ongoing into what physical function upon recovery. causes progression, as opposed to relapse,SSeeccoonnddary-progressivebegins with anand what treatments have a directeffect on RRMS classication that becomes consistentlythat process. progressive and includes more frequentWith this new thinking and its associated relapseswithminorremission.Lossofterminology, as well as biomarkers that may physical and mental function accumulateshelp to specically identify when progression without recovery between attacks.is happening, our ability to observe and track progression is growing by leaps and bounds. In this paradigm, disease progression wasThis is leading to new approaches in research generally thought not to occur in people withand an increased interest in studying and MS unless it was linked to relapse, or to occurtreating progression.slowly and sporadically. Then, as relapsesThis shift in thinking gets us closer to a decreased over time, the progression increased. true understanding of MS progressiona New research indicates this thinking maynecessary step in learning to stop it in its be incorrect. The medical community is shiftingtracks. What we learn about progression will its view of MS from a two-stage disease to ahelp not just those with RRMS or SPMS but two-process disease, where relapse andalso those with primary progressive MS. The progression are two processes that occurrapid growth in this area of research ushers simultaneously.in a new era of hope for all people with MS. msfocusmagazine.org 6'