Should We Use Clinical Tools to Identify Disease Progression?

Area of Science:

• Neurology
• Neuroimmunology
• Clinical Neuroscience

Background:

• Multiple sclerosis (MS) is characterized by disability progression, with a significant transition from relapsing-remitting (RRMS) to secondary progressive MS (SPMS).
• This transition impacts patient quality of life and disease perception, potentially opening new therapeutic avenues.
• Structural biomarkers like MRI and neurofilament light chain show promise but lack definitive thresholds for differentiating MS phenotypes.

Purpose of the Study:

• To discuss the importance of clinical markers in detecting secondary progressive MS (SPMS).
• To explore the role of clinical evaluation in characterizing progressive disease activity.
• To advocate for the use of comprehensive clinical tools beyond the Expanded Disability Status Scale (EDSS) for early identification of disability progression.

Main Methods:

• Review of existing literature and clinical research on MS progression.
• Discussion of the limitations of current structural biomarkers (e.g., MRI, neurofilament light chain).
• Emphasis on the value of clinical assessment, including functional tests (e.g., MSFC) and patient history.

Main Results:

• Structural biomarkers alone are insufficient for definitive differentiation between RRMS and SPMS.
• Clinical evaluation, including patient history and functional tests, plays a pivotal role in identifying disability progression.
• Evidence suggests MS phenotypes exist on a continuum with shared pathophysiological mechanisms.

Conclusions:

• Clinical markers are essential for the early detection and characterization of progressive multiple sclerosis.
• Integrating tools beyond the EDSS, such as the MSFC and digital resources, can enhance diagnostic accuracy.
• A comprehensive clinical approach is vital for managing MS progression and informing therapeutic strategies.