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Genetic polymorphisms are heritable changes in DNA sequences as consequence of single-nucleotide polymorphisms or stable point mutations that may partially alter enzyme activity, or large deletions in coding sequences resulting in a null phenotype 24,34

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Importantly, with time the majority of relapse-onset patients will transition to a clinically progressive course [known as secondary progressive MS (SPMS)] characterized by cytodegeneration, while the inflammatory component wanes with age (Compston and Coles, 2008)