Active and progressive

In this issue of Neurology® , Lublin and over 30 multiple sclerosis (MS) specialists from around the world propose a new consensus framework for MS classification.1 The increasing importance of MRI in clinical management and treatment trials, together with expanding treatment options and improved understanding of the pathophysiology of MS, motivated the present re-examination of MS phenotypic classifications and clinical course descriptions. The new schema supplants the one proposed by Lublin and Reingold2 in 1996 depicting 4 courses of MS that has been widely embraced in research and in clinical practice. The original 4 clinical subtypes were based on an international survey of MS clinicians, and utilized clinical information alone to describe relapsing-remitting, primary progressive, secondary progressive, and progressive-relapsing phenotypes. However, distinctions among the original 4 subtypes are imprecise and do not reflect current capabilities to target MS treatments based on integrated assessment of clinical and MRI data.