New Multiple Sclerosis Model Visualizes Disease Course

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WASHINGTON — A new visual model of multiple sclerosis attempts to more clearly convey the continuum of the disease and bridge gaps in the current three-category MS classification system to change the way the medical community thinks about disease course.

“The Lublin clinical course phenotypes have been extremely important for our understanding of relapsing MS, primary-progressive MS, and secondary-progressive MS for the past 20 years,” Stephen Krieger, MD, of Mount Sinai in New York City, told Neurology Advisor. “They've been really useful for clinical trial design, but it's not always clear what category a patient fits in or how the disease is going to progress.”

With the new “topographical” model, Krieger — a protege of Fred Lublin, MD, also of Mount Sinai, and creator of the three-category MS model — attempted to more accurately describe the range of the disease.

“What this model tries to do is to build on those existing categories to present a unified model of MS clinical course that starts at the earliest stages of relapsing disease and evolves all the way through the late stages of progressive disease in a unified way,” Kreiger explained.

His model integrates the concept of inflammation, the relapsing part of MS, with generalized loss of functional capacity, which signifies disease progression. It suggests that clinical manifestations of the disease are a function of the interplay between these two disease facets.

The new model incorporates several varying key parameters in MS disease progression: the topographical distribution of lesions, the relapses the distribution causes, relapse frequency, relapse severity, relapse recovery, and progression rate.

A 3D-rendered animation of the model, shown at the American Academy of Neurology 2015 meeting, depicted several phenotypes of MS disease course and provided a clear visual representation of the new model.

In the animation, brain lesions appear as topographic peaks that rise up from the floor of a pool of water that ranges from shallow to deep. The shallow end of the pool represents the spinal cord and optic nerve, the mid-section represents the posterior fossa, and the deep end represents the cerebral hemispheres, Kreiger explained.

The water's surface represents clinical thresholds. When peaks cross the threshold and breach the surface, this signifies a relapse or flare. Peaks that occur below the surface are clinically silent. Falling water level indicates disease progression and declining functional capacity.

“I think the model is a useful window through which to look at MS disease course and understand it from a clinical outcomes perspective and an individual patient perspective,” Kreiger said.

He collaborated with Harrison and Star, a healthcare communications company, to create the animation. An interactive app of the topographical model of MS is currently in the works.

Reference

  1. Krieger SC. #P4.013. “The Topographical Model of Multiple Sclerosis: A New Visualization of Disease Course.” Presented at: AAN 2015. April 18-25, 2015; Washington, DC. 

Video Editor: Brianne Aiken; Videographer/Producer: Nicole Blazek

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