Primary Progressive Multiple Sclerosis

  • Massimo Filippi
  • Giancarlo Comi

Part of the Topics in Neuroscience book series (TOPNEURO)

Table of contents

  1. Front Matter
    Pages I-X
  2. M. Filippi, M. Rovaris, G. Comi
    Pages 1-3
  3. G. Rice, M. Kremenchutzky, D. Cottrell, J. Baskerville, G. Ebers
    Pages 5-10
  4. W. Brück
    Pages 11-16
  5. X. Montalban
    Pages 17-24
  6. L. Leocani, G. Comi
    Pages 25-33
  7. M. P. Amato
    Pages 35-45
  8. G. T. Ingle, A. J. Thompson, D. H. Miller
    Pages 63-76
  9. Z. Caramanos, A. C. Santos, S. J. Francis, S. Narayanan, D. Pelletier, D. L. Arnold
    Pages 89-112
  10. M. Filippi, M. A. Rocca
    Pages 113-124
  11. Back Matter
    Pages 125-128

About this book


"Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. " Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin­ ical trials have excluded PPMS patients on two counts. Clinical worsening devel­ ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi­ ence suggests that the results may not be dramatic.


MR imaging Primary progressive multiple sclerosis functional magnetic resonance imaging (fMRI) magnetic resonance magnetic resonance imaging magnetic resonance imaging (MRI) magnetic resonance spectroscopy multiple sclerosis neurophysiology

Editors and affiliations

  • Massimo Filippi
    • 1
  • Giancarlo Comi
    • 2
  1. 1.Neuroimaging Research Unit Department of NeuroscienceScientific Institute and University Ospedale San RaffaeleMilanItaly
  2. 2.Clinical Trials Unit Department of NeuroscienceScientific Institute and University Ospedale San RaffaeleMilanItaly

Bibliographic information