How to detect progression in Multiple Sclerosis

A practical framework to identify subtle progression in Multiple Sclerosis (MS) beyond relapses and inflammation.

Celia Oreja-Guevara presented a clinically focused overview of how to detect disease progression in Multiple Sclerosis (MS). As therapeutic advances increasingly target progression, this keynote highlights the need to move beyond traditional markers of inflammation and adopt a multidimensional approach integrating clinical assessment, imaging, cognition, and biomarkers.

Key Insights from the Lecture:

Disease progression in MS can occur independently of relapses and may remain undetected using conventional inflammatory markers.
Patients may continue to accumulate disability despite effective control of relapses and MRI activity.
Progression consists of both relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA).
Early detection of progression is essential to guide timely therapeutic intervention.
The Expanded Disability Status Scale (EDSS) alone is insufficient to capture subtle clinical worsening.
Simple functional tests (e.g. 9-Hole Peg Test, Timed 25-Foot Walk) can detect clinically meaningful progression.
Patient-reported changes (fatigue, cognition, daily function) are critical for identifying early progression.
Cognitive decline is a key indicator of progression and should be routinely monitored.
Advanced MRI markers, including slowly expanding lesions and paramagnetic rim lesions (PRLs), are associated with progression.
Optical coherence tomography (OCT) and blood biomarkers (e.g. GFAP) provide accessible tools to monitor neurodegeneration and progression.

“How to detect progression in Multiple Sclerosis”.

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About the speaker:

Celia Oreja-Guevara

Professor of Neurology at Heinrich-Heine-Uice Chair of Neurology and Head of Multiple Sclerosis Center at the University Hospital San Carlos, Madridniversity Düsseldorf