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Multiple Sclerosis (MS) Learning Zone
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Understanding MS

Declaration of sponsorship Novartis Pharma AG
Read time: 45 mins
Last updated:20th Dec 2021
Published:12th Aug 2021

What is your understanding of multiple sclerosis (MS)? Recognise the unmet needs of people with MS and understand the core principles of optimal MS management.

  • Discover clear strategies to enable shared decision-making between people with MS and their doctor
  • Learn why holistic care can be more effective than treating physical symptoms alone
  • How early should we be using high-efficacy therapies (HET)? And what is the impact for people not treated with HET? Continue on to learn more

Unmet needs in multiple sclerosis

Learn about the complex, unmet needs of people living with multiple sclerosis (MS), and how busy clinicians can meet them following best-practice strategies.

  • Many clinicians are aware that people with MS have unmet needs, but some of these may persist undetected. Learn more about the complex unmet needs in people with MS.
  • How do people with MS benefit from shared decision-making? Novartis-sponsored content in this section covers the many benefits of enabling people to make informed care decisions.
  • Below, discover the clinical actions that can help meet unmet needs in both patients and clinicians; they are diverse and sometimes surprising

Multiple sclerosis

MS is an autoimmune disease characterised by inflammation and damage to the central nervous system (CNS). Common MS symptoms include impairments to cognition, walking, and balance; bladder or bowel dysfunction; abnormal tiredness; or visual disturbances1. The symptoms of MS are caused by peripherally driven inflammation and neurodegeneration of the CNS2–5.

MS is characterised by four disease courses or phenotypes6,7:

  • clinically isolated syndrome (CIS)
  • relapsing-remitting MS (RRMS)
  • secondary progressive MS (SPMS)
  • primary-progressive MS (PPMS)

PPMS differs in important ways from RRMS and SPMS, discussed below, and can be considered apart from relapsing forms of the disease7.

The onset of MS is typically marked by CIS, which is the first episode of neurological symptoms caused by inflammation or demyelination in the CNS. CIS, which must persist for at least 24 hours, does not yet satisfy diagnostic criteria for MS as people who experience CIS may or may not develop MS8. RRMS, however can develop from CIS2,3,7.

Approximately 85% of people with MS are initially diagnosed with RRMS8. RRMS is characterised by clearly defined episodes of new or increasing neurologic symptoms (‘relapses’, ‘exacerbations’), followed by periods of partial or complete recovery (‘remissions’)7. RRMS can be characterised as ‘active’ (with relapses and/or evidence of new magnetic resonance imaging [MRI] activity over a period of time) or ‘not active’, and ‘worsening’ (a confirmed increase in disability following a relapse), or ‘not worsening’7.

SPMS follows an initial relapsing-remitting course. Some people with RRMS transition to a secondary progressive course, which shows progressive worsening of neurologic function (accumulation of disability) over time. SPMS can be characterised as ‘active’ (with relapses and/or evidence of new MRI activity during a period of time) or ‘not active’, and ‘with progression’ (evidence of disability accumulation over time, with or without relapses or new MRI activity), or ‘without progression’7.

Following 6–10 years from MS onset, approximately 25%–40% of people with RRMS have progressed to SPMS, with a median time to transition ranging from 10 to 23 years9–12

PPMS is characterised by worsening neurologic function from symptom onset, without early relapses or remissions. PPMS can be described as ‘active’ (with an occasional relapse and/or evidence of new MRI activity over time), or ‘not active’, and ‘with progression’ or ‘without progression’7.

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Management of multiple sclerosis

Consider these Novartis-resources on best-practice management of multiple sclerosis (MS).

  • What are the main diagnostic criteria of MS? Learn how diagnosis of MS is supported by magnetic resonance imaging (MRI), and lumbar puncture
  • We provide an answer to a core question in MS care: why are medications to treat MS most effective during the early, inflammatory phase of MS, becoming less efficacious as MS advances?
  • Explore the benefits of continuous symptom management with improvements to patient comfort, safety, quality of life, and more – see below


Multiple sclerosis (MS) is an immune-mediated disease, caused by peripherally driven inflammation and neurodegeneration of the central nervous system (CNS)2–5.

As MS progresses, lesions in the CNS and the brain indicate advancement from neuroinflammation to neurodegeneration, leading to irreversible neuroaxonal degeneration, demyelination, and cumulative disability, diminishing mobility, cognitive decline, and loss of independence2–5.

MS disease phenotypes comprise clinically isolated syndrome (CIS), relapsing remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS)6,7. Approximately 85% of people with MS are diagnosed with RRMS8. As described in the previous section, PPMS differs from relapsing MS phenotypes (RRMS, SPMS) in important ways. Almost 15% of people with MS are diagnosed with PPMS7.

Follow the link to learn some of the important differences between PPMS and relapsing forms of MS

The development of relapsing forms of MS, excluding PPMS, is shown in Figure 223.



Figure 2. Evolution of relapsing forms of multiple sclerosis (RRMS, SPMS) (Adapted24–28). CIS, clinically isolated syndrome; CNS, central nervous system; GM, grey matter; MRI, magnetic resonance imaging; MS, multiple sclerosis; RRMS, relapsing-remitting multiple sclerosis; SPMS, secondary progressive multiple sclerosis; WM, white matter.

Referral timing and pathways

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