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How to Uncover Subtle Progression in Multiple Sclerosis (EACCME accredited)

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This e-learning course addresses an identified need to talk more and provide more information about the subtle progression in MS and the mechanisms behind uncovering it.

This module has two lead authors, both of them neurologists with extensive expertise in multiple sclerosis and members of ParadigMS Foundation.

You will receive a ParadigMS certificate upon completing the e-learning and successfully passing the exam. Should you not be able to download the certificate, or need any further information, please contact:

About this module

In this e-Learning section, ParadigMS Experts and highly respected MS neurologists, Prof. Carlo Pozzilli (IT) and Prof. Bart Van Wijmeersch (BE), provide an overview of the subtle progression in multiple sclerosis (MS) disease. The current approach to multiple sclerosis management is effective in controlling acute neuroinflammation, which drives relapse and acute lesions. Nowadays, relapses have become infrequent. In the absence of relapse, other important mechanisms are implicated in the disease progression, resulting in disability accumulation, known as smoldering neuroinflammation.

By the end of this e-learning module, participants will:

  • Differentiate between subclinical and subtle MS progression
  • Distinguish between progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW)
  • Recognise smouldering multiple sclerosis in the absence of clinical relapses
  • Understand PIRA frequency and its underlying pathological mechanisms as compared to RAW
  • Differentiate between pure PIRA and missed relapse activity
  • Understand the interdependencies of MS symptoms
  • Understand isolated cognitive relapses (ICRs)
  • Recognise Acute Pelvic floor dysfunctions
  • Differentiate between pure PIRA and missed MRI activity
  • Review promising MRI markers to identify PIRA

This module has been peer-reviewed by the following experts of ParadigMS Foundation: Prof. Laura Airas (FI), Prof. Florian Deisenhammer (AT), Prof. Nikolaos Grigoriadis (GR), Prof. Melinda Magyari (DE), Prof. Veronica Popescu (BE), Prof. Magd Zakaria (EG) and Prof. Patrick Vermersch (FR).

This elearning has been made possible thanks to the financial support of Sanofi without any influence on the content.


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