1 The definitions provided consensus on terminology to describe various clinical courses of MS and highlighted areas where there was lack of consensus, or confusion. In 1996, the US National Multiple Sclerosis Society (NMSS) Advisory Committee on Clinical Trials in Multiple Sclerosis defined the clinical subtypes of multiple sclerosis (MS). Strategies for future research to better define phenotypes are also outlined. While imaging and biological markers that might provide objective criteria for separating clinical phenotypes are lacking, we propose refined descriptors that include consideration of disease activity (based on clinical relapse rate and imaging findings) and disease progression.
Increased understanding of MS and its pathology, coupled with general concern that the original descriptors may not adequately reflect more recently identified clinical aspects of the disease, prompted a re-examination of MS disease phenotypes by the International Advisory Committee on Clinical Trials of MS. Standardized descriptions published in 1996 based on a survey of international MS experts provided purely clinical phenotypes based on data and consensus at that time, but imaging and biological correlates were lacking. Bebo), National Multiple Sclerosis Society, New York, NY the Department of Neurology (P.A.C.), The Johns Hopkins Hospital, Baltimore, MD Fédération de Neurologie (M.C.), CHU Hôpital Purpan, Toulouse, France the Department of Neurology (G.C.), Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Canada the Department of Neurology (A.D.G.), University of Rochester Medical Center, NY the Departments of Neurology, Radiology and Neuroscience (M.I.), Mount Sinai School of Medicine, New York, NY the Department of Neurology (L.K.), University Hospital, Basel, Switzerland the Department of Neurology (B.C.K.), Heinrich-Heine-University, Düsseldorf, Germany the Department of Neurology (C.L.), Salpêtrière Hospital, UPMC, Paris, France the Department of Neurology-Neuroimmunology (X.M.), Cemcat, Hospital Universitari Vall d'Hebron, Barcelona, Spain the Division of Neurology (P.W.O.), St Michael's Hospital, Toronto the Department of Statistics (J.P.), University of British Columbia, Vancouver, Canada the Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome the Unit of Biostatistics (M.P.S.), Health Sciences Department, Genoa, Italy the Department of Neurology (O.S.), University of Texas Health Sciences Center, Dallas and the Multiple Sclerosis Center (E.W.), University of California, San Francisco.Īccurate clinical course descriptions (phenotypes) of multiple sclerosis (MS) are important for communication, prognostication, design and recruitment of clinical trials, and treatment decision-making. Banwell), The Children's Hospital of Philadelphia, PA the Departments of Radiology and Nuclear Medicine (F.B.) and Neurology (C.H.P.), VU Medical Center, Amsterdam, the Netherlands Research Programs Department (B. From the Corinne Goldsmith Dickenson Center for Multiple Sclerosis (F.D.L., A.E.M.), Icahn School of Medicine at Mount Sinai, New York, NY Scientific and Clinical Review Associates, LLC (S.C.R.), Salisbury, CT The Mellen Center for MS Treatment and Research (J.A.C., R.J.F., R.A.R.), Cleveland Clinic, OH the Department of Biostatistics (G.R.C.), University of Alabama at Birmingham the Danish Multiple Sclerosis Center (P.S.S.), Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark University College London Institute of Neurology (A.J.T.), UK the Department of Neurology (J.S.W., J.A.L.), University of Texas Health Sciences Center, Houston the Department of Neurology (L.J.B.), New York University Langone Medical Center, New York the Division of Neurology (B.