Uncovering disability progression in people with multiple sclerosis: a practical guide

Research output: Contribution to journal › Review article › Contributed › peer-review

Contributors

  • Bart Van Wijmeersch - , Noorderhart Hospitals (Author)
  • Celia Oreja-Guevara - , Complutense University (Author)
  • Melinda Magyari - , Copenhagen University Hospitals (Author)
  • Laura Airas - , Turku University Hospital (Author)
  • Andrew Chan - , Inselspital University Hospital Bern (Author)
  • Florian Deisenhammer - , Innsbruck Medical University (Author)
  • Nikolaos Grigoriadis - , Aristotle University of Thessaloniki (Author)
  • Hans-Peter Hartung - , Palacký University Olomouc (Author)
  • Maura Pugliatti - , University of Ferrara (Author)
  • Patrick Vermersch - , Université de Lille (Author)
  • Tjalf Ziemssen - , Department of Neurology (Author)
  • Jelena Drulovic - , University Clinical Centre of Serbia (Author)
  • Mona Marwan Alkhawajah - , Alfaisal University (Author)
  • Magd Zakaria - , Ain Shams University (Author)
  • Veronica Popescu - , Hasselt University (Author)
  • Carlo Pozzilli - , University of Rome La Sapienza (Author)

Abstract

People with multiple sclerosis (pwMS) often experience disability progression even when receiving disease-modifying therapies that effectively suppress relapses. This phenomenon is commonly referred to as progression independent of relapse activity (PIRA). Currently, it is challenging to characterize pwMS who are experiencing disability progression in clinical practice. Existing definitions of PIRA rely primarily on the Expanded Disability Status Scale (EDSS), which is biased towards ambulation and does not effectively capture the gradual accumulation of symptoms and signs across other clinical areas associated with disability progression. Here, we propose a step-by-step approach that neurologists can use in clinical practice to identify pwMS experiencing disability progression irrespective of age, EDSS, or disease duration. By using this approach, neurologists can assess the presence or absence of specific variables to help determine if disability is stable or progressing. This could enable appropriate treatments to be implemented in a timely manner, particularly as new disability-targeting therapies become available.

Details

Original languageEnglish
JournalJournal of neurology
Volume273
Issue number11
Publication statusPublished - 3 Nov 2026
Peer-reviewedYes

External IDs

PubMedCentral PMC13731484
Scopus 105055539827
ORCID /0000-0001-8799-8202/work/233044999

Keywords

Keywords

  • Humans, Disease Progression, Disability Evaluation, Multiple Sclerosis/diagnosis