The consensus statement is based partly on an improved correlation between MRI and MS clinical disease activity.
The Consortium of Multiple Sclerosis Centers (CMSC) recommends that the Lublin–Reingold clinical classification of multiple sclerosis (MS) be modified to include evidence of new MRI gadolinium-enhancing (Gd+) T1-weighted lesions “and probably unequivocally new or enlarging T2 lesions,” according to a consensus statement published in the Fall 2012 International Journal of MS Care. The group also proposed that Gd+ lesions and possibly unequivocally new or enlarging T2 lesions be recognized as contemporary or prior subclinical relapses, respectively.
No available biomarker is superior to the combination of MRI and clinical criteria for the purpose of disease classification or distinguishing between relapsing and progressive MS, according to the report, which was written by Stuart D. Cook, MD, Professor of Neurosciences at the University of Medicine and Dentistry of New Jersey in Newark, and colleagues. Furthermore, the clinical classification of MS is likely to be revised periodically as experimental quantitative measures are validated and become widely available, the CMSC added.
Questions About the Lublin–Reingold Classification
The Lublin–Reingold clinical classification identifies four types of MS—relapsing-remitting MS, secondary progressive MS, primary progressive MS, and progressive relapsing MS. Over time, neurologists have raised questions about the classification, such as whether progressive relapsing MS is truly a distinct category and whether each of the classification’s categories is heterogeneous.
In addition, neurologists have observed that it is difficult to determine a patient’s transition from relapsing to progressive MS on clinical grounds alone. Others have noted that inter- and intraexaminer variability and limitations in the Expanded Disability Status Scale (EDSS) could hamper the assessment of disease progression. In a 2009 article, Lincoln et al. proposed that MRI be added to the Lublin–Reingold clinical classification of MS.