Smouldering multiple sclerosis: the ‘real MS’.Giovannoni G, Popescu V, Wuerfel J, Hellwig K, Iacobeus E, Jensen MB, García-Domínguez JM, Sousa L, De Rossi N, Hupperts R, Fenu G, Bodini B, Kuusisto HM, Stankoff B, Lycke J, Airas L, Granziera C, Scalfari A.Ther Adv Neurol Disord. 2022 Jan 25;15:17562864211066751. doi: 10.1177/17562864211066751. eCollection 2022.
This is an open source paper so if you want a read about smouldering MS, have a read.
Using a philosophical approach or deductive reasoning, we challenge the dominant clinico-radiological worldview that defines multiple sclerosis (MS) as a focal inflammatory disease of the central nervous system (CNS). We provide a range of evidence to argue that the ‘real MS’ is in fact driven primarily by a smouldering pathological disease process. In natural history studies and clinical trials, relapses and focal activity revealed by magnetic resonance imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs) were found to be poor predictors of long-term disease evolution and were dissociated from disability outcomes. In addition, the progressive accumulation of disability in MS can occur independently of relapse activity from early in the disease course. This scenario is underpinned by a more diffuse smouldering pathological process that may affect the entire CNS. Many putative pathological drivers of smouldering MS can be potentially modified by specific therapeutic strategies, an approach that may have major implications for the management of MS patients. We hypothesise that therapeutically targeting a state of ‘no evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent disability accumulation in MS, meaning that treatment should also focus on other brain and spinal cord pathological processes contributing to the slow loss of neurological function. This should also be complemented with a holistic approach to the management of other systemic disease processes that have been shown to worsen MS outcomes.
We normally don,t cover reviews and today is no exception :=)
Title: Smouldering MS
Sourced From: multiple-sclerosis-research.org/2022/02/smouldering-ms/?utm_source=rss&utm_medium=rss&utm_campaign=smouldering-ms
Published Date: Thu, 03 Feb 2022 13:36:00 +0000
Did you miss our previous article...