Progression and Management of Multiple Sclerosis

Multiple sclerosis is a chronic immune-mediated disorder characterised by focal inflammatory demyelination and diffuse neurodegeneration within the central nervous system. Disease trajectories range from relapsing-remitting episodes to gradual progression, often with an overlap of both processes. Irreversible disability accrual may occur during acute clinical relapses or insidiously between them in the form of progression independent of relapse activity. Modern management combines early initiation of disease-modifying therapies to reduce inflammatory activity with symptomatic, rehabilitative and multidisciplinary care to preserve function and quality of life. Neuroimaging remains central to diagnosis, prognostication and treatment monitoring, while fluid and digital biomarkers are emerging to refine individual risk stratification. A precision-medicine approach aims to match therapy intensity to individual disease activity and progression risk, seeking to prevent long-term disability and optimise outcomes across diverse healthcare settings.

Research from Nature Portfolio

Consensus guidelines have standardised magnetic resonance imaging protocols for monitoring disease course and treatment response. Advanced volumetric measures of brain and spinal cord atrophy, together with detection of cortical and leptomeningeal lesions, now inform individual prognosis and trial design. Recommendations advocate harmonised acquisition parameters and reporting criteria to reduce inter-centre variability and support earlier detection of smouldering pathology. Imaging biomarkers of neurodegeneration and residual inflammatory activity are poised to guide therapeutic escalation and de-escalation, fostering a more agile approach to long-term disease surveillance and therapeutic decision-making.

Progression and Management of Multiple Sclerosis publication trend

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

Technical terms

Progression independent of relapse activity (PIRA): Accumulation of irreversible disability in the absence of new clinical relapses.

Expanded Disability Status Scale (EDSS): A standardized scale to quantify neurologic impairment and ambulation in multiple sclerosis.

T2-weighted lesion: Hyperintense areas on MRI reflecting focal demyelination and inflammation.

Brain atrophy: Reduction in brain volume over time, indicating neurodegenerative change.

Oligoclonal bands: Immunoglobulin bands in cerebrospinal fluid signalling intrathecal B-cell activation.

Soluble CD27: A cleaved T-cell receptor component measurable in cerebrospinal fluid as a marker of active lesion formation.

References

1. Association of Early Progression Independent of Relapse Activity With Long-term Disability After a First Demyelinating Event in Multiple Sclerosis. JAMA Neurology (2023).
2. Association of Brain Atrophy With Disease Progression Independent of Relapse Activity in Patients With Relapsing Multiple Sclerosis. JAMA Neurology (2022).
3. Soluble CD27 is an intrathecal biomarker of T-cell-mediated lesion activity in multiple sclerosis. Journal of Neuroinflammation (2024).
4. MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—establishing disease prognosis and monitoring patients. Nature Reviews Neurology (2015).