AAN Expert Exchange: Advances in Progressive Multiple Sclerosis

WATCH TIME: 3 minutes

Transcript below. Edited for clarity.

Regina Berkovich, MD, PhD: I believe that one of the major breakthroughs on understanding progressive MS is our understanding that progression may come in different forms and shapes. It is not necessarily just based on ambulatory abilities because that would be very diminishing to think about humans as just ambulating individuals. Most of all, we are thinking individuals, so cognitive limitations and cognitive issues are being recognized as major evidence of progression. I think that is a great breakthrough because we got to understand that the majority of adults with MS become disabled while they physically are fully functional. They become disabled due to cognitive deficiencies. From that standpoint, our approach to the research on progressive disease really has shown a lot of light and hope that we now recognize that progression starts much earlier than we used to think.

Probably, one of the reasons why the first clinical trials on progressive disease did not show much of efficacy was because we were looking only at the patients [who were] in the wheelchair. That's, basically, not representative of all the groups of patients experiencing progression, if you think about progression from the standpoint of disability, or inability to work. So, I think that with that approach—and also with understanding that inflammation is not something that disappears with progression, but takes a different shape and intensity, becoming not an acute, but a smoldering chronic type of inflammation—that also opens up a lot of doors for as potential pharmacologic targets for treatment.

I think that future is bright in research and treatment of progressive disease because we got to understand that it's more optimistic than we used to think at the beginning, and again, earlier intervention is extremely important. That's what we get to see, looking at the clinical trial results. That, obviously, requires a very active role from us—from the neurologist—and of course, an active role from the patients, to be on the same page with us, and be ready to be engaged in that mutual fight against the disease.