Normally, progression in patients with multiple sclerosis is characterized by relapses or just general progression with PPMS (primary progressive M.S.) or SPMS (secondary progressive M.S.). However, there is a phenomenon in certain patients where they will gradually accumulate the disability, without having acute relapses. This is called a ‘silent’ progression, and it’s especially dangerous because of the very fact that it can go unnoticed (due to the absence of the relapses), and can cause irreversible nervous system damage, inflammation, and neuronal loss. The inflammation it causes is primarily compacted to your microglia, astrocytes, B-cells, etc.
Fortunately, neuroimaging can be a solution to identifying this type of progression better. Through measuring chronic, active lesions, PRLs (paramagnetic rim lesions), brain atrophy in certain areas, axonal degeneration and more can help visualize this type of pathology, known as smoldering MS. The name comes from the fact that the disease persistently “smolders” without necessarily “firing” up, going unnoticed but still causing the same amount of, if not more, damage.
Current disease modifying therapies focus on quelling inflammation and reducing relapses, but fail to identify and treat inflammation in the central nervous system and neurodegeneration. Multiple measures of disease activity are being created, from biomarkers (measurable indicators of biological processes) within serums to neuropsychological activity, all providing accurate enough records of disease progress, especially in the case of smoldering M.S.. The challenge is finding a method that can accurately predict the likely outcome of the disease. In other words, there is an ongoing, unmet, need for the creation of biomarkers that can detect M.S. worsening without relapses, and can show how effective other disease modifying therapies are in the treatment of M.S..
Recent collaborations between industry-academia like GMSI and MS-LINK have led to better understanding of how usage of biomarkers and neuroimaging, including MRI and PET, can dissect the pathology of M.S.. However, using neuroimaging in a clinical, laboratory process proves to be challenging chronologically and financially. Accessibility concerns can be addressed through by using readily-available blood biomarkers for complex pathology like smoldering M.S.. Future research anticipates enhancing the accuracy of identifying complex pathologies by a combination of neuroimaging, biomarkers, and even artificial intelligence. With this, patients can have optimal long-term outcomes, as the therapies and treatment options can be more targeted and cater to each patient’s needs, rather than lumping all patients into a one-size-fits-all group.
The integration of these developing technologies will only aid M.S. patients into creating a personally better, more comprehensive management of their disease.
Works Cited:
Oh, Jiwon, et al. “Neuroimaging to Monitor Worsening of Multiple Sclerosis: Advances Supported by the Grant for Multiple Sclerosis Innovation.” Frontiers, Frontiers, 13 Nov. 2023, www.frontiersin.org/articles/10.3389/fneur.2023.1319869/full.
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