In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.

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多发性硬化症的病程明显较轻：诊断标准，治疗方法和自然病史发生变化。

在过去的十年中，多发性硬化病的病程发生了变化。从脱髓鞘疾病的最初迹象到进展的过程，多发性硬化症的自然病史似乎较轻，这可能是多种因素之间相互作用的结果，这些因素包括诊断标准的变化，多发性硬化症的流行病学变化，早期和适当的影响。改善疾病的治疗方法和改善人群的总体健康状况。已经建议将没有任何与神经功能障碍一致的临床症状病史的所谓MRI脱髓鞘病变的偶然发现，即所谓的放射孤立综合征，视为多发性硬化症的初始病程。新的诊断标准已使许多患者在首次临床脱髓鞘事件（临床分离综合征）中进行了多发性硬化症诊断。其余患有临床孤立综合征的患者预后较好，并且对于复发缓解型多发性硬化症，预后变得更加有利。复发缓解型多发性硬化症患者的疾病活动性降低可部分归因于更有效的新疾病缓解疗法，但在临床试验中也发现安慰剂治疗的患者疾病活动性下降。这可能由几个因素来解释：诊断标准的改变，更明确的纳入标准，高风险患者（例如合并症患者）的排除以及复发和疾病恶化的更严格定义。然而，这些因素也使采用改变疾病疗法的患者的病程看起来更有利。另外，将治疗目标改变为稳定的疾病（无疾病活动的证据=无复发，无疾病恶化和无MRI活动）可自行改变复发缓解型多发性硬化的病程。疾病缓解药物的有效性已减少了从复发缓解到继发进行性多发性硬化的过渡。进行性多发性硬化的概念也已从两个非常不同的类别（原发性进行性和继发性进行性多发性硬化）演变为统一的进行性多发性硬化症类别，然后可以将其分为活动或不活动类别。也，用疾病修饰疗法治疗进行性多发性硬化症的趋势不断增加，可能有助于改变进行性多发性硬化症的病程。总之，在过去的十年中，由于多种因素之间的复杂相互作用，从脱髓鞘疾病的第一个征兆到进行性病程的多发性硬化症的整个病程似乎较温和。