Cognition

Patrick Vermersch: Detecting progression independent of relapse activity in Multiple Sclerosis

Patrick Vermersch discusses practical strategies for detecting progression independent of relapse activity (PIRA) through comprehensive clinical assessment, advanced imaging and emerging biomarkers.

Watch the interview

In this interview, Patrick Vermersh discusses how clinicians can identify subtle progression through detailed patient questioning, multidimensional clinical assessment, advanced imaging and selected biomarkers.

Key points discussed include:

Why early detection of PIRA is important for anticipating further disability progression.
The need to ask targeted questions about fatigue, walking, sensory symptoms, work, family life and daily activities.
The limitations of relying on the Expanded Disability Status Scale (EDSS) alone.
The value of assessing walking, upper-limb function, vision and cognition.
The potential role of susceptibility-weighted imaging in detecting paramagnetic rim lesions.
The possible contribution of neurofilament measurements in selected patients.

Which clinical or imaging metrics do you find most sensitive for picking up early PIRA before disability becomes obvious?

* Please note that all the captions were generated automatically. If they do not appear, click on CC in the navigation.

Key messages from Patrick Vermersch

Early PIRA may predict future disability progression. Clinical follow-up should therefore look beyond relapses and conventional magnetic resonance imaging activity.
Patients may not spontaneously report subtle changes. More precise questions about daily function can help identify early signs of progression.
Assessment should not rely on EDSS alone. Composite evaluations may include timed walking tests, the Six-Minute Walk Test, the Nine-Hole Peg Test, low-contrast visual acuity and the Symbol Digit Modalities Test.
Advanced imaging may support the detection of chronic inflammatory activity. Susceptibility-weighted imaging can help identify paramagnetic rim lesions, which may be associated with future disability progression.
Clinical findings, imaging results and biomarkers should be interpreted together. Neurofilament levels may offer additional information in selected patients when progression remains difficult to detect.