A new app that offers a new, visual way of understanding multiple sclerosis (MS) was recently launched at the American Academy of Neurology Annual Meeting in Boston. The app is a disease simulation that creates visualization of MS as a swimming pool. According to creator and MS specialist Stephen C. Krieger, MD, the app depicts an MS disease topography, mapped in the central nervous stem, as a tool to better understand the variable way MS can develop and change over time. “We have categories of MS clinical course—relapsing-remitting disease, primary progressive, secondary progressive, that clinical trials are based on, but in practice we often see a mixture of relapsing and progressive disease, and so I’ve tried to conceptualize that as a continuum,” said Dr. Krieger in an interview. Thus, the app can serve as a tool for helping patients and physicians better understand the disease and its progression. “People learn through metaphor. They learn from tying something they don’t understand through something that they do.”
Regarding the visualization, Dr. Krieger noted that progression is the loss of reserve and the ability to compensate for damage. “More of underlying becomes clinically revealed and people have progression of multifocal signs and symptoms of MS. I call that the recapitulation hypothesis,” he noted. Dr. Krieger presented poster data at the AAN meeting evaluating the recapitulation hypothesis using a longitudinal clinical cohort (P4.392). The pilot empirical test examined a subgroup of 10 patients who transitioned from relapsing MS to secondary progressive MS. Results indicated that roughly 83 percent of prior acute relapse symptoms were noted at the transition to secondary primary MS and roughly 91 percent of symptoms were present at most recent visit. According to Dr. Krieger, these data support the recapitulation hypothesis and the model’s depiction of disease topography as the loci of subsequent clinical progression.
In terms of next steps, Dr. Krieger believes that the poster lays out a methodology that could be studied with big cohorts to refine the model and ultimately use it in a more personalized way. “The potential of this model to encapsulate certain key features of the disease that we haven’t necessarily put all together before, and if hypothesis it proves to be true, would have real implications for how we as clinicians look at patients with this disease.”Next Story