Smouldering disease in paediatric-onset multiple sclerosis

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Smouldering disease in multiple sclerosis (MS) involves chronic central nervous system processes contributing to long-term disability.
• While current MS therapies manage acute inflammation and lesions, many patients experience progression unrelated to relapses.
• Subclinical smouldering disease biology is active even in paediatric-onset MS, necessitating early intervention.

Purpose of the Study:

• To review the role of MRI and fluid biomarkers in detecting smouldering disease in paediatric-onset MS.
• To discuss the application of these detection methods in therapeutic decision-making for young MS patients.

Main Methods:

• Review of advanced Magnetic Resonance Imaging (MRI) techniques for detecting chronic active lesions and subtle brain damage.
• Analysis of fluid biomarkers, including neurofilament light chain and glial fibrillary acidic protein, as indicators of neuroaxonal injury and inflammation.

Main Results:

• Conventional MRI has limitations in detecting subtle, smouldering damage in MS.
• Advanced MRI techniques offer improved sensitivity for identifying chronic active lesions and overall brain damage.
• Fluid biomarkers provide non-invasive measures of ongoing neuroaxonal damage and inflammation.

Conclusions:

• Advanced MRI and fluid biomarkers are crucial for detecting subclinical smouldering disease in paediatric MS.
• Early identification of smouldering disease is essential for timely therapeutic intervention to preserve neurological function.
• These tools can support informed therapeutic decisions in managing paediatric-onset MS.