These descriptions of the course of the disease have recently been modified to classify MS into either relapsing forms, with disability occurring both in relation to and independently of relapses, or progressive forms that are active or inactive, classified according to clinical or magnetic resonance imaging (MRI) findings 6 (Box 1).
10%–15% of patients follow a primary progressive course, characterized by the continuous worsening of neurological disability from the first manifestation of disease. In two-thirds of cases, the transition from this relapsing course to secondary progressive MS usually occurs after 10–15 years and, for some time, superimposed relapses may occur, reflecting ongoing inflammatory activity 5. In addition, progression may occur independently of relapse activity. In the majority of patients, the disease takes a relapsing course with intermittent periods of neurological dysfunction that may initially completely resolve however, as the disease advances, recovery is incomplete and disability accumulates.
Globally, some 2.8 million people are affected and its incidence and prevalence have been on the rise worldwide over the past few decades 3, 4. The aetiology of the disease remains elusive but a large body of evidence suggests that it is immune-mediated in nature 2. Multiple sclerosis (MS) is the most frequently occurring neuroinflammatory disease and the commonest cause of permanent disability in younger adults 1.
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