Disease Activity Monitoring in Multiple Sclerosis

Disease activity monitoring in multiple sclerosis encompasses clinical assessment, magnetic resonance imaging and emerging biomarkers to capture ongoing neuroinflammation and neurodegeneration. Traditional measures include the frequency of clinical relapses and change in disability as quantified by the Expanded Disability Status Scale. Imaging studies focus on T1 and T2 lesion load, gadolinium enhancement and measures of brain volume to detect new or enlarging lesions and global atrophy. Composite endpoints such as no evidence of disease activity (NEDA) integrate these dimensions to provide a concise summary of treatment response and subclinical activity. Advances in cerebrospinal fluid and serum biomarkers, notably neurofilament light chains, offer a window on axonal injury and promise more sensitive detection of disease progression. Quantitative volumetric techniques and automated image analysis enable longitudinal tracking of brain and spinal cord changes. Integrating clinical, radiological and molecular data is essential for personalised management, early treatment escalation and optimal long-term outcomes. In routine practice, a combination of relapse tracking, disability scoring, MRI surveillance and fluid biomarkers underpins decisions on therapy initiation, adjustment or switch, reflecting a shift towards proactive rather than reactive management of multiple sclerosis globally.

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Disease Activity Monitoring in Multiple Sclerosis publication trend

The graph below shows the total number of articles in disease activity monitoring in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

No Evidence of Disease Activity (NEDA): A composite measure denoting absence of relapses, disability progression and MRI lesion activity.

Expanded Disability Status Scale (EDSS): An ordinal scale quantifying neurological impairment and disability in multiple sclerosis.

Annualised Brain Volume Loss (a-BVL): The percentage reduction in whole brain volume per year, reflecting neurodegeneration.

Neurofilament Light Chains (NfL): Neuronal cytoskeletal proteins released into biofluids during axonal damage, serving as a biomarker of disease activity.

References

1. Prospective Assessment of No Evidence of Disease Activity-4 Status in Early Disease Stages of Multiple Sclerosis in Routine Clinical Practice. Frontiers in Neurology (2019).
2. Rebaseline no evidence of disease activity (NEDA-3) as a predictor of long-term disease course in a Norwegian multiple sclerosis population. Frontiers in Neurology (2022).
3. Predictive value of brain atrophy, serum biomarkers and information processing speed for early disease progression in multiple sclerosis. Frontiers in Neurology (2023).