Effect of MD1003 in Progressive Multiple Sclerosis (SPI2) (SPI2)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02936037
Recruitment Status : Recruiting
First Posted : October 18, 2016
Last Update Posted : May 16, 2018
Information provided by (Responsible Party):
MedDay Pharmaceuticals SA

Brief Summary:
The purpose of this study is to demonstrate the superiority of MD1003 over placebo in the disability of patients suffering from progressive multiple sclerosis and especially those with gait impairment.

Condition or disease Intervention/treatment Phase
Multiple Sclerosis Drug: MD1003 100mg capsule Drug: PLACEBO Phase 3

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 600 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

Randomized double blind placebo-controlled for at least 15 months, followed by an open label extension phase of up to 12 months.

The placebo-controlled phase, will end when the last patient randomized will perform his 15 months evaluation (visit 7). Then all patients will be treated with the active drug during an open-label extension phase for a total study duration of 27 months.

Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effect of MD1003 in Progressive Multiple Sclerosis: a Randomized Double Blind Placebo Controlled Study
Actual Study Start Date : December 2016
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : September 2019

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Placebo Comparator: GROUP 1
Placebo capsule, 1 capsule tid (morning,noon and evening) for 15 months at least, then switch to MD1003 100mg capsule, 1 capsule tid for up to 12 months
Drug: MD1003 100mg capsule
Other Name: high dose biotin

an inactive substance

Experimental: GROUP 2
MD1003 capsule, 1 capsule tid (morning,noon and evening) for 15 months at least (double blind period) and then for all patients in open label extension for up to 12 months
Drug: MD1003 100mg capsule
Other Name: high dose biotin

Primary Outcome Measures :
  1. Proportion of patients improved on either Expanded Disability Status Scale (EDSS) or time to walk 25 feet (TW25) [ Time Frame: 15 months ]

    Proportion of patients improved on either Expanded Disability Status Scale (EDSS) or time to walk 25 feet (TW25) :

    - with decreased EDSS at M12 confirmed at M15 (where decreased EDSS is defined as a decrease of at least 1 point if initial EDSS from 3.5 to 5.5 and of at least 0.5 point if initial EDSS from 6 to 6.5)


    - with improved TW25 of at least 20% at Month 12 and Month15

    compared to the lowest of the two EDSS and TW25* scores among inclusion and randomization visits.

    *The lowest TW25 value recorded among the four values obtained during the inclusion and randomization visits will be considered as the baseline TW25 value.

Secondary Outcome Measures :
  1. Time to EDSS progression confirmed at 12 weeks [ Time Frame: 15 months ]
  2. CGI-I score (clinical global impression of change - improvement), evaluated both by the patient (SGI) and by the evaluating physician (CGI) [ Time Frame: 15 months ]
  3. Mean change in TW25 between M0 and M15 [ Time Frame: 15 months ]

Other Outcome Measures:
  1. Brain MRI changes between M0 and M15 [ Time Frame: 15 months ]
  2. Remote monitoring of ambulation [ Time Frame: 15 months ]
  3. (MSQOL54) & (CAREQOL-MS) subscores and composite scores [ Time Frame: 15 months ]
  4. Subscores of the Kurtzke functional score [ Time Frame: 15 months ]
  5. Symbol digit modalities test (SDMT) [ Time Frame: 15 months ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient aged 18-65 years old
  • Signed and dated written informed consent form in accordance with local regulations: having freely given their written informed consent to participate in the study
  • Diagnosis of primary or secondary progressive MS fulfilling revised McDonald criteria (2010) and Lublin criteria (2014)
  • Documented evidence of clinical disability progression within the 2 years prior to inclusion, i.e. a) progression of EDSS during the past two years of at least 1 point sustained for at least 6 months if inclusion EDSS is from 3.5 to 5.5 or at least 0.5 point increase sustained for at least 6 months if inclusion EDSS is from 6 to 6.5 or b) increase of TW25 by at least 20% in the last two years sustained for at least 6 months or c) other well-documented objective worsening validated by the Adjudication Committee
  • EDSS at inclusion from 3.5 to 6.5
  • TW25 < 40 seconds
  • Kurtzke pyramidal functional subscore ≥2 defined as "minimal disability: patient complains of motor-fatigability or reduced performance in strenuous motor tasks (motor performance grade 1) and/or BMRC grade 4 in one or two muscle groups"

Exclusion Criteria:

  • Clinical evidence of a relapse in 24 months prior to inclusion
  • Treatment with any product containing biotin as single ingredient within six months prior to inclusion (multivitamin supplementation authorized if biotin < 1mg per day)
  • Concomitant treatment with fampridine at inclusion or in the 30 days prior to inclusion
  • New immunosuppressive/immunomodulatory drug initiated less than 90 days prior to inclusion
  • Treatment with botulinium toxin (except for cosmetic purpose) initiated within 6 months prior to inclusion
  • In-patient rehabilitation program within the 3 months prior to inclusion
  • Pregnancy, breastfeeding or women with childbearing potential without acceptable form of contraception
  • Men unwilling to use an acceptable form of contraception
  • Any general chronic handicapping/incapacitating disease other than MS
  • Any serious disease necessitating biological follow-up with biological tests using biotinylated antibodies or substrates
  • Past history of rhabdomyolysis/metabolic myopathy
  • Known fatty acids beta oxidation defect
  • Known hypersensitivity or intolerance to biotin, analogues or excipients, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
  • Patients with hypersensitivity or any contra-indication to Gadolinium
  • Patients with uncontrolled hepatic disorder, renal or cardiovascular disease, or cancer
  • Laboratory tests out of normal ranges considered by the investigator as clinically significant with regards to the study continuation
  • Patients with history or presence of alcohol abuse or drug addiction
  • Untreated or uncontrolled psychiatric disorders, especially suicidal risk assessed by Columbia-Suicide Severity Rating Scale (C-SSRS)
  • Participation in another research study involving an investigational product (IP) in the 90 days prior to inclusion, or planned use during the study duration
  • Patients likely to be non-compliant to the study procedures or for whom a long-term follow-up seems to be difficult to achieve
  • Relapse that occurs between inclusion and randomization visit

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02936037

Contact: abdelkarim Bendarraz

  Hide Study Locations
United States, Arizona
Barrow Neurology Clinics Recruiting
Phoenix, Arizona, United States, 85013
Principal Investigator: Aimee Borazanci, MD         
Mayo Clinic Arizona Recruiting
Scottsdale, Arizona, United States, 85259
Principal Investigator: Jonathan Carter, MD         
United States, California
Sutter East Bay Medical Foundation Recruiting
Berkeley, California, United States, 94705
Principal Investigator: Joanna Cooper, MD         
Neuro-Pain Medical Center Recruiting
Fresno, California, United States, 93710
Principal Investigator: Perminder Bhatia, MD         
University of Southern California Keck School of Medicine Recruiting
Los Angeles, California, United States, 90033
Principal Investigator: Lilyana Amezcua, MD         
MS Center of California Recruiting
Newport Beach, California, United States, 92663
Principal Investigator: Daniel S Bandari, MD         
UC Davis Health System Recruiting
Sacramento, California, United States, 95817-2307
Principal Investigator: Michelle Apperson, MD         
UCSF Multiple Sclerosis Center Recruiting
San Francisco, California, United States, 94117
Principal Investigator: Bruce Cree, MD         
United States, Colorado
University of Colorado Denver Recruiting
Aurora, Colorado, United States, 80045
Principal Investigator: John Corboy, MD         
United States, Connecticut
Yale New Haven Hospital Recruiting
North Haven, Connecticut, United States, 06473
Principal Investigator: Sharon Stoll, MD         
United States, Florida
Nova Clinical Research, LLC Recruiting
Bradenton, Florida, United States, 34209
Principal Investigator: Sanjay Yathiraj, MD         
University of Miami Miller School of Medicine Recruiting
Miami, Florida, United States, 33136
Principal Investigator: Kottil Rammohan, MD         
University South Florida Medical Clinic Recruiting
Tampa, Florida, United States, 33612
Principal Investigator: Derrick Robertson, MD         
United States, Illinois
Northwestern University - Feinberg School of Medicine Recruiting
Chicago, Illinois, United States, 60611
Principal Investigator: Bruce Cohen, MD         
University of Chicago Medical Center-Duchossois Center for Advanced Medicine (DCAM) Recruiting
Chicago, Illinois, United States, 60637
Principal Investigator: Anthony Reder, MD         
United States, Kansas
University of Kansas Medical Center Recruiting
Kansas City, Kansas, United States, 66160
Principal Investigator: Sharon Lynch, MD         
Rowe Neurology Institute Recruiting
Lenexa, Kansas, United States, 66214
Principal Investigator: Vernon Rowe, MD         
United States, Louisiana
Ochsner Health System Recruiting
New Orleans, Louisiana, United States, 70121
Principal Investigator: Bridget Bagert, MD         
United States, Maryland
Johns Hopkins Medicine Neurology & Neurosurgery Recruiting
Baltimore, Maryland, United States, 21287
Principal Investigator: Shiv Saidha, MD         
United States, Massachusetts
Harvard Medical School - Brigham and Women's Hospital Recruiting
Boston, Massachusetts, United States, 02115-5727
Principal Investigator: Christopher Severson, MD         
United States, Michigan
Wayne State University Recruiting
Detroit, Michigan, United States, 48201
Principal Investigator: Evanthia Bernitsas, MD         
United States, Minnesota
Minneapolis Clinic of Neurology Recruiting
Minneapolis, Minnesota, United States, 55422
Principal Investigator: Jonathan Calkwood, MD         
United States, Missouri
Washington University School of Medicine Recruiting
Saint Louis, Missouri, United States, 63110
Principal Investigator: Robert Naismith, MD         
United States, New Jersey
Holy Name Hospital Recruiting
Teaneck, New Jersey, United States, 07666
Principal Investigator: Mary Ann Picone, MD         
United States, New Mexico
The University of New Mexico - Multiple Sclerosis Specialty Clinic Recruiting
Albuquerque, New Mexico, United States, 87131
Principal Investigator: Corey Ford, MD         
United States, New York
SUNY Buffalo - University Neurology, Inc Recruiting
Buffalo, New York, United States, 14203
Principal Investigator: Bianca Weinstock-Guttman, MD         
Columbia University Medical Center Recruiting
New York, New York, United States, 10021-0005
Principal Investigator: Claire Riley, MD         
Mount Sinai School of Medicine - Corinne Goldsmith Dickinson Center for MS Recruiting
New York, New York, United States, 10029-6574
Principal Investigator: Aaron E Miller, MD         
Sub-Investigator: Fred D Lublin, MD         
University of Rochester Medical Center Recruiting
Rochester, New York, United States, 14642
Sub-Investigator: Andrew Goodman, MD         
Principal Investigator: Lawrence Samkoff, MD         
State University of New York (SUNY) Recruiting
Stony Brook, New York, United States, 11794
Principal Investigator: Patricia Coyle, MD         
United States, North Carolina
Raleigh Neurology Associates, P.A. Recruiting
Raleigh, North Carolina, United States, 27607
Principal Investigator: Mitchell Freedman, MD         
United States, Ohio
Cleveland Clinic Mellen Center for MS Recruiting
Cleveland, Ohio, United States, 44195
Principal Investigator: Devon Conway, MD         
United States, Oregon
Providence Multiple Sclerosis Center Recruiting
Portland, Oregon, United States, 97225
Principal Investigator: Kyle Smoot, MD         
United States, Pennsylvania
Thomas Jefferson University Recruiting
Philadelphia, Pennsylvania, United States, 19107
Principal Investigator: Thomas Leist, MD         
United States, Tennessee
Cole Neuroscience Center Recruiting
Knoxville, Tennessee, United States, 37920
Principal Investigator: Randy Trudell, MD         
Vanderbilt Comprehensive Multiple Sclerosis Center Recruiting
Nashville, Tennessee, United States, 37215
Principal Investigator: Harold Moses, MD         
United States, Texas
University of Texas Southwestern Medical Center Recruiting
Dallas, Texas, United States, 75390-8829
Principal Investigator: Benjamin Greenberg, MD         
Central Texas Neurology Consultants Recruiting
Round Rock, Texas, United States, 78681
Principal Investigator: Fox Edward, MD         
United States, Virginia
University of Virginia Health System Recruiting
Charlottesville, Virginia, United States, 22903
Principal Investigator: Myla Goldman, MD         
United States, Washington
Virginia Mason Medical Center Recruiting
Seattle, Washington, United States, 98101
Principal Investigator: Kita Mariko, MD         
Australia, New South Wales
John Hunter Hospital Recruiting
New Lambton, New South Wales, Australia, 2310
Principal Investigator: Jeannette Lechner-Scott, MD         
Australia, Victoria
Austin Hospital Recruiting
Heidelberg, Victoria, Australia, 3084
Principal Investigator: Richard Macdonell, MD         
The Royal Melbourne Hospital Recruiting
Parkville, Victoria, Australia, 3050
Principal Investigator: Mark Marriott, MD         
St Vincent's Hospital Recruiting
Fitzroy, Australia
Principal Investigator: Neil Shuey, MD         
Brain and Mind Centre/University of Sydney Recruiting
Sydney, Australia, 2050
Principal Investigator: Joshua Barton, MD         
Jessa Ziekenhuis - Campus Virga Jesse Recruiting
Hasselt, Limburg, Belgium, 3500
Principal Investigator: Nina De Klippel, MD         
UZ Gent Recruiting
Halle, Oost-Vlaanderen, Belgium
Principal Investigator: Guy Laureys, MD         
Universite Libre de Bruxelles - Hopital Erasme Recruiting
Anderlecht, Belgium, 1070
Principal Investigator: Gaetano Perrotta, MD         
UZ Antwerpen Recruiting
Edegem, Belgium, 2650
Principal Investigator: Barbara Willekens, MD         
Revalidatie & Ms Centrum Recruiting
Overpelt, Belgium, 3900
Principal Investigator: Bart Van Wijmeersch, MD         
Canada, British Columbia
Burnaby Hospital Recruiting
Burnaby, British Columbia, Canada, V5G 1T4
Principal Investigator: Galina Vorobeychik, MD         
Vancouver Hospital and Health Sciences Centre Recruiting
Vancouver, British Columbia, Canada, V6T 2B5
Principal Investigator: Virginia Devonshire, MD         
Canada, New Brunswick
Hôpital universitaire Dr George L-Dumont university Hospital Recruiting
Moncton, New Brunswick, Canada, E1C 8X3
Principal Investigator: Ludivine Witkowski, MD         
Canada, Nova Scotia
Nova Scotia Rehabilitation Center Recruiting
Halifax, Nova Scotia, Canada, B3H 3A7
Principal Investigator: Roger McKelvey, MD         
Canada, Ontario
Ottawa Hospital General Campus Recruiting
Ottawa, Ontario, Canada, ON K1H 8L6
Principal Investigator: Mark Freedman, MD         
Trillium Health Centre Recruiting
Toronto, Ontario, Canada, L5B 1B8
Principal Investigator: Daniel Selchen, MD         
Canada, Quebec
Montreal Neurologic Institute Recruiting
Montreal, Quebec, Canada, H3A 2B4
Principal Investigator: Paul Giacomini, MD         
Hopital de Notre Dame Recruiting
Montréal, Canada, H2L 4M1
Principal Investigator: J.Marc Girard, MD         
Doc. Radomir Talab - neurologist Recruiting
Hradec Králové, Czechia, 500 03
Principal Investigator: Radomir Talab, MD         
Nemocnice Jihlava Recruiting
Jihlava, Czechia, 586 33
Principal Investigator: Radek Ampapa, MD         
Vseobecna fakultni nemocnice v Praze Recruiting
Praha, Czechia, 128 21
Principal Investigator: Jana Lizrova Preiningerova, MD         
Fakultni nemocnice v Motole Recruiting
Praha, Czechia, 150 06
Principal Investigator: Eva Meluzinova, MD         
Nemocnice Teplice Recruiting
Teplice, Czechia, 415 29
Principal Investigator: Marta Vachova, MD         
Universitätsklinikum Essen Recruiting
Essen, Nordrhein-Westfalen, Germany, 45147
Principal Investigator: Refik Pul, MD         
Universitätsklinikum Carl Gustav Carus an der TU Dresden Recruiting
Dresden, Sachsen, Germany, 01307
Principal Investigator: Tjalf Ziemssen, MD         
Universitätsklinikum Leipzig A.ö.R. Recruiting
Leipzig, Sachsen, Germany, 04103
Principal Investigator: Wolfgang Köhler, MD         
Fachkrankenhaus Hubertusburg Recruiting
Wermsdorf, Sachsen, Germany, 04779
Principal Investigator: Piotr Sokolowski, MD         
Caritas Krankenhaus Recruiting
Bad Mergentheim, Germany, 97980
Principal Investigator: Mathias Buttmann, MD         
Charité - Universitätsmedizin Berlin / NeuroCure Clinical Research Center Recruiting
Berlin, Germany, 10117
Principal Investigator: Friedemann Paul, MD         
Universitätsklinikum Düsseldorf Recruiting
Dusseldorf, Germany, 40225
Principal Investigator: Aktas Orhan, MD         
MultipEL Studies Institut für klinische Studien GbR Recruiting
Hamburg, Germany, 22179
Principal Investigator: Birte Elias-Hamp, MD         
Neuro Centrum Science GmbH Recruiting
Hessen, Germany, 64711
Principal Investigator: Gerd Reifschneider, MD         
Ludwig-Maximilians Universität München Recruiting
München, Germany, 81377
Principal Investigator: Tania Kümpfel, MD         
Neuropoint GmbH Recruiting
Ulm, Germany, 89073
Principal Investigator: Daniela Rau, MD         
Poliklinik für Neurologie Universitätsklinikum Ulm Recruiting
Ulm, Germany, 89081
Principal Investigator: Tumani Hayrettin, MD         
Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpo Recruiting
Szeged, Csongrád, Hungary, 6725
Principal Investigator: Lászlo Vécsei, MD         
Uzsoki Utcai Korhaz Recruiting
Budapest, Hungary, H-1145
Principal Investigator: Gabor Jakab, MD         
MH Egeszsegugyi Kozpont Recruiting
Budapest, Hungary
Principal Investigator: Zoltán Szakacs, MD         
Valeomed Kft Recruiting
Esztergom, Hungary
Principal Investigator: Mária Sátori, MD         
Pecsi Tudomanyegyetem Klinikai Kp Recruiting
Pécs, Hungary
Principal Investigator: Sámuel Komoly, MD         
Ospedale San Raffaele, IRCCS Recruiting
Milano, Italy, 20127
Principal Investigator: Giancarlo Comi, MD         
AO S.Andrea, Università degli Studi di Roma La Sapienza Recruiting
Roma, Italy, 00189
Principal Investigator: Carlo Pozzilli, MD         
SP Zaklad Opieki Zdrowotnej w Dzialdowie Recruiting
Dzialdowo, Warminsko-mazurskie, Poland, 13-200
Principal Investigator: Marek Zalisz, MD         
Nasz Lekarz Ośrodek Badań Klinicznych Recruiting
Bydgoszcz, Poland, 85-794
Principal Investigator: Jozef Koscielniak, MD         
COPERNICUS PL sp z o.o.,Szpital im. M.Kopernika Oddział Neurologiczny Recruiting
Gdansk, Poland, 80-803
Principal Investigator: Waldemar Fryze, MD         
Krakowska Akademia Neurologii Recruiting
Krakow, Poland, 31-505
Principal Investigator: Andrzej Szczudlik, Pr.         
Twoja Przychodnia Centrum Medyczne Nowa Sol Recruiting
Nowa Sol, Poland, 71-270
Principal Investigator: Agata Klosek, MD         
Miedzyleski Szpital Specjalistyczny w Warszawie Recruiting
Warsawa, Poland
Principal Investigator: Jacek Zaborski, MD         
Centrum Medyczne Pratia Warszawa Recruiting
Warszawa, Poland, 01-868
Principal Investigator: Malgorzata Zajda, MD         
Hospital Santa Caterina Recruiting
Girona, Gerona, Spain, 17190
Principal Investigator: Lluís Ramió i Torrentá, MD         
Hostipal Universitario Quirónsalud Madrid Recruiting
Pozuelo de Alarcón, Madrid, Spain, 28223
Principal Investigator: Rafael Arroyo, MD         
Servicio de Neurología Hospital Vithas Nisa Recruiting
Castilleja de la Cuesta, Sevilla, Spain, 41950
Principal Investigator: Guillermo Izquierdo Ayuso, MD         
Hospital del Mar Servicio de Neurología Recruiting
Barcelona, Spain, 08003
Principal Investigator: Jose Martínez Rodríguez, MD         
Hospital Universitari Vall d'Hebron Recruiting
Barcelona, Spain, 08035
Principal Investigator: Xavier Montalbán, MD         
Hospital Clínico San Carlos Recruiting
Madrid, Spain, 28040
Principal Investigator: Celia Oreja Guevara, MD         
Hospital Regional Universitario de Málaga Recruiting
Malaga, Spain, 29010
Principal Investigator: Victoria Fernández Sánchez, MD         
Sahlgrenska Universitetssjukhus Recruiting
Göteborg, Sweden, 416 85
Principal Investigator: Jan Lycke, MD         
Karolinska Institutet Recruiting
Stockholm, Sweden, SE-171 77
Principal Investigator: Lou Brundin, MD         
Hacettepe University Medical Faculty Recruiting
Ankara, Turkey, 06230
Principal Investigator: Rana Karabudak, MD         
Ondokuz Mayis University Medical Faculty Recruiting
Samsun, Turkey, 55139
Principal Investigator: Murat Terzi, MD         
Karadeniz Technical university Medical Faculty Recruiting
Trabzon, Turkey, 61081
Principal Investigator: Cavit Boz, MD         
United Kingdom
The University of Edinburgh Recruiting
Edinburgh, United Kingdom, EH16 4SB
Principal Investigator: Don Mahad, MD         
Institute of Neurological Sciences Recruiting
Glasgow, United Kingdom, G51 4TF
Principal Investigator: Webb Stewart, MD         
Barts And The London School Of Medicine And Dentistry Institute Recruiting
London, United Kingdom, E1 2AT
Principal Investigator: Schmierer Klaus, MD         
University College London Institute of Neurology / National Hospital for Neurology & Neurosurgery Recruiting
London, United Kingdom, WC1N 3BG
Principal Investigator: Ahmed Toosy, MD         
Tyne Hospitals NHS Foundation Recruiting
Newcastle upon Tyne, United Kingdom, NE7 7DN
Principal Investigator: Joe Guadagno, MD         
Salford Royal Hospital Recruiting
Salford, United Kingdom, M6 8HD
Principal Investigator: Adrian Pace, MD         
Sponsors and Collaborators
MedDay Pharmaceuticals SA
Principal Investigator: Bruce Cree, MD, PHD University of California, San Francisco
Study Director: Frederic Sedel, MD, PHD Medday Pharmaceuticals

Additional Information:
Responsible Party: MedDay Pharmaceuticals SA Identifier: NCT02936037     History of Changes
Other Study ID Numbers: MD1003CT2016-01MS-SPI2
First Posted: October 18, 2016    Key Record Dates
Last Update Posted: May 16, 2018
Last Verified: May 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by MedDay Pharmaceuticals SA:
progressive multiple sclerosis
multiple sclerosis

Additional relevant MeSH terms:
Multiple Sclerosis
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases