Progression independent of relapse activity explains why certain patients with MS continue to worsen clinically without MRI evidence of new lesions.
At the 2023 Fall Conference of The American Academy of Neurology Institute (AAN), Augusto Miravalle, MD, FAAN, delivered a presentation titled, “Test Your Knowledge: Multiple Sclerosis” The presentation took place in Las Vegas and virtually.
PW spoke with Dr. Miravalle to learn more about his presentation, which focused on brain health in multiple sclerosis (MS)
PW: What makes the topic of your presentation, “Test Your Knowledge: Multiple Sclerosis” an important one to study?
Augusto Miravalle, MD, FAAN: The intent of this presentation was to provide neurologists with an update on MS and neuroimmunology in an attempt to contribute to their continuous medical education efforts. The topics included a review of the current standards for the diagnosis of MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
The concept of progression independent of relapse activity (PIRA) in MS, a critical aspect of the disease pathogenesis in MS not being addressed by our current disease modifying therapies, was also a focus of the presentation. PIRA, the clinical manifestation of chronic or smoldering inflammation, is a process that explains why certain patients with MS continue to worsen clinically without MRI evidence of new lesions.
This clinico-radiologic paradox is due to pathology that our current standard MRI techniques are not able to capture. Therefore, this pathological process differs from the “acute inflammation” that leads to new lesions and relapses in MS.
Additionally, I pointed out the importance of recognizing symptoms like fatigue and incorporating nonpharmacologic approaches aimed at maximizing brain health in our patients.
PW: What findings from your study are important to stress to our physician readers, particularly neurologists who treat patients with MS?
Augusto Miravalle, MD, FAAN: Regarding NMOSD, I associated the importance of using sensitive assays (cell-based assay) for the identification of aquaporin-4 (AQP4) antibody, a marker of autoimmunity and the main driver of the disease process in NMOSD. Clinical differences between NMOSD and MOGAD were explained to enhance early and accurate diagnosis of complex neuroimmunologic disorders.
PW: What is the primary takeaway message you sought to convey?
Augusto Miravalle, MD, FAAN: The primary takeaway from this presentation is that a need exists to continue to improve the accuracy and sensitivity of our diagnostic efforts in the care of patients with neuroimmunologic disorders (MS, NMOSD, and MOGAD).
