Neuroinflammation and Disability Progression: Evolving Insights in Multiple Sclerosis

This episode, titled, Neuroinflammation and Disability Progression: Evolving Insights in Multiple Sclerosis features neurology pharmacists discussing the role of neuroinflammation and clinical considerations for evaluating disease progression in MS.

Multiple sclerosis (MS) is driven by complex immune processes that extend beyond acute inflammatory relapses. Current understanding recognizes neuroinflammation as a persistent, compartmentalized immune response within the central nervous system that contributes to chronic tissue injury and neurodegeneration. Unlike focal inflammation, which is characterized by discrete episodes of immune cell infiltration leading to new lesions and clinical relapses, neuroinflammation involves sustained activation of microglia and astrocytes, chronic oxidative stress, and gradual axonal damage. This distinction helps explain why patients may continue to experience disability progression even when relapse activity and new MRI lesions appear controlled.

As the disease advances, monitoring disability progression becomes a central component of patient management. Clinically relevant signs include worsening mobility and balance, increased spasticity or weakness, changes in gait speed, declining manual dexterity, cognitive impairment, fatigue, and bladder or bowel dysfunction. These changes may develop gradually and can be overlooked without structured assessment.

Led by the moderator, Ryan Fuller, PharmD, and Aimee Banks, PharmD, BCPS, MSCS, examine the following critical questions:

What is the current understanding of the role of neuroinflammation in patients with multiple sclerosis?

How is the pathophysiology of neuroinflammation different from focal inflammation?

When considering disability progression in MS, what clinical signs are most relevant, and how are these typically monitored over time?

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, Bridging Diagnostic Gaps and Advancing Endpoints to Address Smoldering Progression in Multiple Sclerosis, panelists will continue their discussion on multiple sclerosis and highlight limitations of current MS diagnostic tools and clinical trial endpoints in detecting smoldering progression, their real-world applicability, and the unmet need for therapies targeting neuroinflammation beyond focal inflammatory disease activity.