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Another group independently also concluded that disability progression and brain atrophy occur earlier than in the classical secondary progressive stage, with many relapsing patients exhibiting insidious progression without clinical or radiographic evidence of inflammatory disease activity, coining the term silent progression (Cree et al., 2019)

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Crofford makes the point that many patients with FMS report the onset of their symptom complex after a significant period of emotional stress or a specific traumatic event