A 30-year-old woman with relapsing-remitting MS (RRMS) has had 2 relapses in the past year, one involving optic neuritis and one brainstem relapse. MRI shows 5 new T2 lesions and 2 gadolinium-enhancing lesions compared to 12 months ago. This disease activity pattern defines:
- A Clinically isolated syndrome (CIS)
- B Highly active / rapidly evolving RRMS ✓
- C Secondary progressive MS (SPMS)
- D Primary progressive MS (PPMS)
Correct answer: B. Highly active / rapidly evolving RRMS
Explanation
Highly active RRMS is defined by ≥2 relapses in the previous year (with or without treatment) AND ≥1 gadolinium-enhancing lesion or significant new T2 lesion load. This phenotype warrants high-efficacy disease-modifying therapy (alemtuzumab, natalizumab, ocrelizumab, cladribine) as first-line per EAN/ECTRIMS 2024 guidelines, rather than platform therapies. CIS is a first demyelinating episode. SPMS/PPMS require progressive disability accumulation over months without relapse.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.