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Title: | Smouldering multiple sclerosis: the ‘real MS’ | Authors: | Giovannoni, Gavin POPESCU, Veronica Wuerfel, Jens Hellwig, Kerstin Iacobeus, Ellen Jensen, Michael B. Garcia-Dominguez, Jose Manuel Sousa, Livia De Rossi, Nicola Hupperts, Raymond Fenu, Giuseppe Bodini, Benedetta Kuusisto, Hanna-Maija Stankoff, Bruno Lycke, Jan Airas, Laura Granziera, Cristina Scalfari, Antonio |
Issue Date: | 2022 | Publisher: | SAGE PUBLICATIONS LTD | Source: | Therapeutic Advances in Neurological Disorders, 15 , p. 1 -18 | Abstract: | 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. | Notes: | Giovannoni, G (corresponding author), Queen Mary Univ London, Barts & London Sch Med & Dent, Blizard Inst, 4 Newark St, London E1 2AT, England. g.giovannoni@qmul.ac.uk |
Keywords: | multiple sclerosiss;mouldering multiple sclerosis;progression independent of relapse activity;progressive multiple sclerosis | Document URI: | http://hdl.handle.net/1942/36659 | ISSN: | 1756-2856 | e-ISSN: | 1756-2864 | DOI: | 10.1177/17562864211066751 | ISI #: | WOS:000751390500001 | Rights: | The Author(s), 2022. Article reuse guidelines: sagepub.com/journalspermissions Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Smouldering multiple sclerosis_ the ‘real MS’.pdf | Published version | 1.58 MB | Adobe PDF | View/Open |
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