MS Report

Evolution of McDonald’s criteria

Przemysław Puz, Karolina Wychowaniec — Mon, 30 Sep 2024 00:00:00 +0200

The McDonald criteria used to diagnose multiple sclerosis have evolved over the past quarter century. They were first promulgated in 2001, and every few years they are revised, allowing to increase the sensitivity and specificity of the criteria and to accelerate the diagnosis of the disease, which significantly affects the earlier inclusion of appropriate disease-modifying therapies. The latest modification was presented at this year’s ECTRIMS congress in September 2024. The basic tenets of the changes to the McDonald criteria include: recognition of a history of relapses as equivalent to clinically isolated syndrome, recognition of radiologically isolated syndrome as a specific situation of multiple sclerosis, inclusion of the optic nerve as the fifth topographic location of lesions typical of multiple sclerosis, and abandonment of the criterion of spread over time as a prerequisite for the diagnosis of multiple sclerosis. In terms of both laboratory and neuroimaging diagnosis, new diagnostic tools have been proposed: central vein sign and paramagnetic rim enhancement lesions on magnetic resonance imaging and the presence of kappa free light chains in cerebrospinal fluid. The use of the newly proposed criteria for diagnosing MS allows for easier diagnosis of the disease in selected patients and diagnosis of the disease for patients who could not be diagnosed with multiple sclerosis based on previous criteria.

Reports from Post-ECTRIMS – reflections on multiple sclerosis phenotypes

Marek Hałas — Mon, 30 Sep 2024 00:00:00 +0200

In current clinical practice, we use the classification of multiple sclerosis proposed by prof. Fred Lublin in 1996, which was subsequently revised in 2013. During the recent ECTRIMS conference (European Committee for Treatment and Research in Multiple Sclerosis), potential new phenotypes of this disease were discussed. New data suggest that multiple sclerosis is a condition with a broad spectrum of symptoms, and factors influencing its course can occur at any stage of the disease, with varying severity. Progression plays a key role in the course of the disease and may begin even before the diagnosis is made. New classifications might include clinical, radiological, neuropsychological factors, and biomarkers, enabling more accurate disease course predictions and optimal timing of treatment implementation.

Epstein–Barr virus infection and the risk of developing multiple sclerosis

Ewelina Kuczko-Piekarska — Mon, 30 Sep 2024 00:00:00 +0200

Despite increasing amounts of data regarding the pathogenesis of multiple sclerosis (MS), its etiology remains unknown. MS is believed to develop by interplay of genetic predispositions and environmental factors, including infectious ones, which disturb proper immune surveillance. More and more data indicate that the infectious agent is the Epstein–Barr virus (EBV). Although infection with it is usually asymptomatic in childhood, the ability of the virus to convert into a latent form with limited gene expression allows it to avoid host immune surveillance. It initiates a cascade of immunological processes leading to severe clinical implications, e.g., in the development of autoimmune diseases. Previous studies have shown that anti-EBV antibodies exist in almost all patients with multiple sclerosis. The most extensive population-based study in recent years covered US Army conscripts and found that the risk of developing multiple sclerosis is 32 times higher after infection with this virus. Determining the exact relationship between the Epstein–Barr virus and multiple sclerosis, including assessing the influence of genetic and environmental factors on this correlation, may be very important for understanding pathogenesis of multiple sclerosis and other autoimmune diseases. Such insights will also enable the identification of targets for future personalized therapies, especially in the context of increasingly widely used B cell depletion therapies.

Pharmacological treatment options for inhibiting progression independent of relapse activity in multiple sclerosis

Natasza Blek — Mon, 30 Sep 2024 00:00:00 +0200

The article presents an overview of current pharmacotherapeutic options for inhibiting relapse-independent progression in multiple sclerosis. It discusses the paradigm shift in multiple sclerosis treatment, which stems from the growing awareness of progression independent of relapse activity. The mechanisms of action and clinical trial results for several drugs, including ocrelizumab, siponimod, natalizumab, ibudilast, simvastatin, biotin, masitinib, and others, are presented. The complexity of progression independent of relapse activity pathophysiology translates into the need for a multidirectional therapeutic approach. Developing effective therapies is challenging due to the complexity of pathomechanisms in the course of the disease and the need for long-term observations. The evolution of methods for assessing disease progression and the importance of identifying reliable biomarkers are also discussed. A promising direction is the possibility of using combination therapies and personalization of treatment.