Advancing Understanding of the Preclinical Phase of Multiple Sclerosis: Christina J. Azevedo, MD

WATCH TIME: 9 minutes

"By the time [patients] come in years later with their first symptom, the biological onset has already happened years ago."

Emerging evidence supports the existence of a preclinical phase in multiple sclerosis (MS), characterized by subtle clinical and biological changes years before the onset of overt symptoms.¹ Although the precise mechanisms driving this phase remain speculative, its recognition offers an opportunity to better understand MS pathophysiology. Challenges such as identifying reliable biomarkers, understanding the duration and variability of prodromal features, and developing validated research criteria remain at the forefront. Addressing these gaps may be critical in advancing early diagnosis and interventions to potentially alter the management of the disease.

At the 2024 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, held September 18-20, in Copenhagen, Denmark, Christina J. Azevedo, MD, presented a talk titled "Patterns of Clinical Disability Progression Differ When Considering The Preclinical Phase of MS” in a scientific session focused on new phenotypes. The session, cochaired by Maria Pia Amato, MD, and Peter Calabresi, MD, featured additional topics such as using big data to identify new clinical subtypes, the impact and characteristics of early progression independent of relapse activity (PIRA) in MS, and moving towards a unified definition of PRIA in relapsing MS.²

At the meeting, Azevedo, a neurologist and associate professor of clinical neurology at Keck School of Medicine of USC, sat down with NeurologyLive^® to discuss how early identification of biomarkers like neurofilament light could reshape the timeline for MS diagnosis and intervention. She also talked about the role brain volume measurements may play in future clinical strategies for MS management and prognosis. Moreover, Azevedo shared her perspective on how the integration of new imaging metrics like the central vein sign enhance the diagnosis and risk stratification of patient with MS.

Click here for more coverage of ECTRIMS 2024.

REFERENCES
1. Makhani N, Tremlett H. The multiple sclerosis prodrome. Nat Rev Neurol. 2021;17(8):515-521. doi:10.1038/s41582-021-00519-3
2. Azevedo C. Patterns of Clinical Disability Progression Differ When Considering The Preclinical Phase of MS. Presented at ECTRIMS Congress; September 18-20, 2024; Copenhagen, Denmark. Scientific Session 1: New diagnostic criteria. Scientific Session 5: New phenotypes.