{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:13:18Z","timestamp":1777936398286,"version":"3.51.4"},"reference-count":9,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2011,10,1]],"date-time":"2011-10-01T00:00:00Z","timestamp":1317427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2011,10]]},"abstract":"<jats:p>Primary progressive multiple sclerosis (PPMS), relapsing remitting MS (RRMS) and acute disseminated encephalomyelitis (ADEM) are clinically and immunopathogenetically distinct phenotypes of inflammatory demyelinating disorders of the central nervous system. Progression following RRMS is well described as secondary progressive MS. We report a patient with unexpected transition from long established PPMS to clinically and radiologically active RRMS after an ADEM-like fulminant demyelinating episode despite an immunosuppressive treatment preceding relapses. We note clearly accelerated brain atrophy after the RRMS course ensues. The unique disease course in this patient illustrates the dissociation of the biology and disability impact of relapses and progression.<\/jats:p>","DOI":"10.1177\/1352458510387183","type":"journal-article","created":{"date-parts":[[2010,12,7]],"date-time":"2010-12-07T00:31:20Z","timestamp":1291681880000},"page":"1262-1264","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["A patient with established primary progressive multiple sclerosis transitions to \u2018secondary\u2019 relapsing\u2013remitting disease course following a fulminant demyelinating episode"],"prefix":"10.1177","volume":"17","author":[{"given":"Melih","family":"Tutuncu","sequence":"first","affiliation":[{"name":"Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuri O","family":"Demirci","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cerrahpasa School of Medicine, Istanbul, Turkey."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feriha","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haseki Training and Research Hospital, Istanbul, Turkey."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabahattin","family":"Saip","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cerrahpasa School of Medicine, Istanbul, Turkey."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orhun H","family":"Kantarci","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aksel","family":"Siva","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cerrahpasa School of Medicine, Istanbul, Turkey."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,5,16]]},"reference":[{"key":"bibr1-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410370108"},{"key":"bibr2-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000145561.08973.4F"},{"key":"bibr3-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1019130"},{"key":"bibr4-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.3.765"},{"key":"bibr5-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awl007"},{"key":"bibr6-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/122.10.1941"},{"key":"bibr7-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.4.907"},{"key":"bibr8-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181c1e44f"},{"key":"bibr9-1352458510387183","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.59.10.1572"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1352458510387183","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1352458510387183","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1352458510387183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:29:43Z","timestamp":1777692583000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1352458510387183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10]]},"references-count":9,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2011,10]]}},"alternative-id":["10.1177\/1352458510387183"],"URL":"https:\/\/doi.org\/10.1177\/1352458510387183","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,10]]}}}