How do you distinguish between primary progressive MS versus relapsing remitting MS with superimposed relapses in a newly diagnosed patient that is naive to treatment?

Relapsing versus progressive MS are clinical phenotypes lacking clear objective radiologic or paraclinical distinctions. Recent literature emphasizes commonalities between these phenotypes, largely framing them as a spectrum of one disease rather than discrete disorders. Originally, these clinical p...

First, I scrutinize the history to look for evidence of progression over a year or more as we often determine PPMS retrospectively as it has a much more subtle presentation than RRMS. Patient specific factors such as presenting with a progressive myelopathy, male gender, age in 40s, primarily spinal...