Severe, Highly Active, or Aggressive Multiple Sclerosis

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Purpose of Review:

Despite the efficacy of current therapies for relapsing forms of multiple sclerosis (MS), there remains a group of patients whose disease fails to respond and warrants a different approach to treatment. This article reviews this form of aggressive MS and proposes a definition and new treatment algorithm. Failing to recognize aggressive MS and initiate more effective therapy will result in a lost opportunity to effectively treat the disease.

Recent Findings:

Natural history studies, together with the results of contemporary clinical trials, help to identify and profile a subset of patients with relapsing MS who have a much poorer prognosis and for whom conventional treatment tends to fail. Therapies that have shown success in the treatment of this patient group with aggressive MS are reviewed and discussed.


It is imperative to recognize aggressive MS to effectively treat it before patients progress. Recognizing aggressive MS as early as possible is the key to successful implementation of a proposed algorithm.

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