The study by Confavreux et al. investigates the influence of the patterns of onset and relapses on the progression of irreversible disability in multiple sclerosis (MS). The research involved 1844 patients with an average disease duration of 11 years. The patients were categorized into those with a relapsing-remitting onset (1562 patients) and those with a progressive onset (282 patients). The study used the Kurtzke Disability Status Scale to assess disability severity and progression, focusing on scores 4, 6, and 7, which indicate limited walking ability, the ability to walk with unilateral support, and the ability to walk with minimal support, respectively. Key findings include: - Patients with a progressive onset of MS had significantly shorter median times to reaching scores 4, 6, and 7 compared to those with a relapsing-remitting onset (P<0.001 for all comparisons). - The time from score 4 to score 6 was similar in both groups (5.7 and 5.4 years, respectively, P=0.74). - The progression of progressive, irreversible disability in patients with primary progressive MS was not significantly influenced by the presence or absence of superimposed relapses. - In patients with secondary progressive MS, the presence of superimposed relapses did not affect the time course of progressive, irreversible disability. The study concludes that relapses do not significantly influence the progression of irreversible disability in MS. This finding suggests a dissociation between recurrent acute focal inflammation and progressive degeneration of the central nervous system.The study by Confavreux et al. investigates the influence of the patterns of onset and relapses on the progression of irreversible disability in multiple sclerosis (MS). The research involved 1844 patients with an average disease duration of 11 years. The patients were categorized into those with a relapsing-remitting onset (1562 patients) and those with a progressive onset (282 patients). The study used the Kurtzke Disability Status Scale to assess disability severity and progression, focusing on scores 4, 6, and 7, which indicate limited walking ability, the ability to walk with unilateral support, and the ability to walk with minimal support, respectively. Key findings include: - Patients with a progressive onset of MS had significantly shorter median times to reaching scores 4, 6, and 7 compared to those with a relapsing-remitting onset (P<0.001 for all comparisons). - The time from score 4 to score 6 was similar in both groups (5.7 and 5.4 years, respectively, P=0.74). - The progression of progressive, irreversible disability in patients with primary progressive MS was not significantly influenced by the presence or absence of superimposed relapses. - In patients with secondary progressive MS, the presence of superimposed relapses did not affect the time course of progressive, irreversible disability. The study concludes that relapses do not significantly influence the progression of irreversible disability in MS. This finding suggests a dissociation between recurrent acute focal inflammation and progressive degeneration of the central nervous system.