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. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Am J Med. 2020 Jul 17;133(12):1380–1390.e2. doi: 10.1016/j.amjmed.2020.05.049

Figure 1. The New Natural History of MS.

Figure 1.

The top half of the figure illustrates the natural history of relapse-onset MS in the pretreatment era. During the relapsing phase, disability accumulation was thought to result from incomplete recovery from relapses, until relapse-independent disability, designated SPMS, supervened. The “new” natural history of MS in the current treatment era is shown in the bottom half. With use of highly effective therapies, attacks are abolished in most patients, but insidious progression independent of relapse activity, termed “silent progression”, is now evident during the relapsing phase.

Abbreviations: EDSS, extended disability status score; CIS, clinically isolated syndrome; MS, multiple sclerosis; SPMS, secondary progressive multiple sclerosis.