Medical Hypothesis
Why Secondary Progressive Multiple Sclerosis Is a Relentlessly Progressive Illness
Robert M. Herndon, MD
Arch Neurol. 2002;59:301-304.
Secondary progressive multiple sclerosis is a relentlessly progressive,
usually ascending, disease process. Once secondary progression begins, regardless
of how long the disease was present before secondary progression began, patients
appear to progress at a uniform rate. Recent studies show that it responds
poorly to medications effective in relapsing remitting disease, although these
drugs decrease relapses and have a substantial effect on lesions seen on magnetic
resonance imaging. Disruption of axonal transport is known to occur in demyelinated
fibers. Synapses, vacated when axons are destroyed, cause sprouting in surviving
terminal axons, resulting in metabolic overload in the terminal axons. This
noninflammatory process would not be expected to be altered by current disease-altering
therapies.
From the Department of Neurology, Sonny V. Montgomery Department of
Veterans Affairs Medical Center and University of Mississippi Medical Center,
Jackson.
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