How well do we really understand Smouldering MS?

A new neurology review on ‘smouldering’ MS and disability raises questions on accepted concepts

An exciting and interesting academic review on MS recently appeared in the journal “Therapeutic Advances in Neurological Disorders” earlier this year.  Smouldering multiple sclerosis: the ‘real MS’ was written by a Europe-wide team of 20 highly respected MS experts, mostly Neurologists, with many years of experience in MS research and treatment, radiologists and other experts. The coordinator for this work was Professor Gavin Giovannoni, who many will know from his frequent activity on MS.


The review critically evaluates our current understanding of how damage in the Central Nervous System (CNS) occurs in MS. It argues for a proposal for new concepts to help explain the many anomalies that have come to light between accepted opinions on the underlying mechanisms causing MS-related CNS damage, and their link to developing disability over time.


From accepted thinking to innovative research

The original thinking on the causes of MS-related disability were based largely on the idea that in Relapsing-Remitting MS (RRMS), relapses were the main drivers of changes to bodily function and observed increases in areas of damage in the brain and spine. Three decades of extensive routine use of Disease-Modifying Drugs/Treatments (DMDs DMTs) to suppress relapses in RRMS has benefitted patients. However, examination of the real-life experience of MS has revealed a more complex picture of how MS symptoms evolve over time.


The new review, however, proposes alternative concepts to explain why current interpretations of long-term data on MS-related nerve damage and severity of symptoms do not always provide a full explanation of the lived experience of MS. Using published data from advanced imaging studies, individual MS case studies and observations from recent research, the review proposes new potential interpretations of how CNS damage develops and evolves.


Referred to as “Smouldering MS” the research implies a much more continuous ongoing damage process within the CNS than previously considered. The review puts forward persuasive arguments for re-thinking our present understanding of the nature of MS.   


Research in context 

The publication is an opinion paper - extensive, complex and peppered with words like “might”, “maybe” and “perhaps”, indicating the potential for new concepts to be tested and evaluated. The opinions may be challenged, this is the nature of research. Most importantly, new research avenues will be triggered to clarify exactly how much we really understand the true nature of MS. This may lead to a clearer understanding of what needs to be done to control CNS nerve damage and arrest the progress of MS.  


Whatever the findings indicate in future, it is likely they will impact all aspects of MS management and treatment, be they medical, clinical, therapeutic, and psychological. Watch this space!


Read the full study in Therapeutic Advances in Neurological Disorders here:


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