[Initial axonal lesion in multiple sclerosis. Reasons for early treatment]

Area of Science:

• Neurology
• Immunology

Context:

• Multiple sclerosis (MS) lacks curative treatments and precise prognostic data.
• Early inflammatory phases are critical, leading to axonal damage and potential neurodegeneration.
• Current MS treatments primarily target inflammation with limited efficacy in later stages.

Purpose:

• To advocate for early intervention in multiple sclerosis (MS) management.
• To highlight the importance of patient risk stratification for treatment decisions.

Summary:

• Initiating treatment, such as interferon beta-1a intramuscular (IFN b 1a IM), after the first demyelinating attack is suggested for high-risk MS patients.
• High lesion load on magnetic resonance imaging (MRI) is a key criterion for identifying high-risk individuals.
• Early treatment focuses on managing the initial inflammatory phase to mitigate long-term sequelae.

Impact:

• Informed treatment decisions can be made following the first demyelinating attack.
• Early management may alter the disease course and reduce permanent neurological deficits.
• This strategy aligns with recent approvals for early MS treatment in the European Union.