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Peer-reviewedCC BY-NC-ND 4.0Journal of Neurology

Uncovering disability progression in people with multiple sclerosis: a practical guide

  • Bart Van Wijmeersch1,2
  • Celia Oreja-Guevara3,4
  • Melinda Magyari5,6,7
  • Laura Airas8
  • Andrew Chan9
  • Florian Deisenhammer10
  • Nikolaos Grigoriadis11
  • Hans-Peter Hartung12,13,14
  • Maura Pugliatti15
  • Patrick Vermersch16
  • Tjalf Ziemssen17
  • Jelena Drulovic18
4 more authors
  • Mona Marwan Alkhawajah19,20
  • Magd Zakaria21
  • Veronica Popescu2,22
  • Carlo Pozzilli23
23 affiliations
  1. 1University MS Centre, Hasselt-Pelt, Belgium
  2. 2Noorderhart Hospitals, Rehabilitation & MS, Pelt, Belgium
  3. 3Department of Neurology, Hospital Clínico Universitario San Carlos IdISSC, Madrid, Spain
  4. 4Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
  5. 5Department of Neurology, The Danish Multiple Sclerosis Registry, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
  6. 6Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
  7. 7Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  8. 8University of Turku and Turku University Hospital, Turku, Finland
  9. 9Department of Neurology, Inselspital, University Hospital Bern, Bern University, Bern, Switzerland
  10. 10Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
  11. 11Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  12. 12Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
  13. 13Brain and Mind Center, University of Sydney, Sydney, NSW Australia
  14. 14Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
  15. 15Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
  16. 16University of Lille, Inserm U1172, Lille Neuroscience & Cognition, Centre Hospitalier Universitaire de Lille, Fédération Hospitalo-Universitaire Precision Medicine in Psychiatry, Lille, France
  17. 17Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine, University Hospital Carl Gustav Carus and Centre for Tactile Internet With Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
  18. 18Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
  19. 19Neuroscience Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
  20. 20College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
  21. 21Department of Neurology, Ain Shams University, Cairo, Egypt
  22. 22Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
  23. 23Department of Human Neurosciences, Sapienza University, Rome, Italy
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Abstract

People with multiple sclerosis (pwMS) often experience disability progression even when receiving disease-modifying therapies that effectively suppress relapses. This phenomenon is commonly referred to as progression independent of relapse activity (PIRA). Currently, it is challenging to characterize pwMS who are experiencing disability progression in clinical practice. Existing definitions of PIRA rely primarily on the Expanded Disability Status Scale (EDSS), which is biased towards ambulation and does not effectively capture the gradual accumulation of symptoms and signs across other clinical areas associated with disability progression. Here, we propose a step-by-step approach that neurologists can use in clinical practice to identify pwMS experiencing disability progression irrespective of age, EDSS, or disease duration. By using this approach, neurologists can assess the presence or absence of specific variables to help determine if disability is stable or progressing. This could enable appropriate treatments to be implemented in a timely manner, particularly as new disability-targeting therapies become available.

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Cite

BibTeXRIS
BibTeX
@article{wijmeersch2026uncovering,
  title = {{Uncovering disability progression in people with multiple sclerosis: a practical guide}},
  author = {Bart Van Wijmeersch and Celia Oreja-Guevara and Melinda Magyari and Laura Airas and Andrew Chan and Florian Deisenhammer and Nikolaos Grigoriadis and Hans-Peter Hartung and Maura Pugliatti and Patrick Vermersch and Tjalf Ziemssen and Jelena Drulovic and Mona Marwan Alkhawajah and Magd Zakaria and Veronica Popescu and Carlo Pozzilli},
  journal = {Journal of Neurology},
  year = {2026},
  month = nov,
  doi = {10.1007/s00415-026-14212-2},
  url = {https://doi.org/10.1007/s00415-026-14212-2},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Uncovering disability progression in people with multiple sclerosis: a practical guide
AU  - Bart Van Wijmeersch
AU  - Celia Oreja-Guevara
AU  - Melinda Magyari
AU  - Laura Airas
AU  - Andrew Chan
AU  - Florian Deisenhammer
AU  - Nikolaos Grigoriadis
AU  - Hans-Peter Hartung
AU  - Maura Pugliatti
AU  - Patrick Vermersch
AU  - Tjalf Ziemssen
AU  - Jelena Drulovic
AU  - Mona Marwan Alkhawajah
AU  - Magd Zakaria
AU  - Veronica Popescu
AU  - Carlo Pozzilli
PY  - 2026
DA  - 2026/11/03
JO  - Journal of Neurology
DO  - 10.1007/s00415-026-14212-2
UR  - https://doi.org/10.1007/s00415-026-14212-2
AB  - People with multiple sclerosis (pwMS) often experience disability progression even when receiving disease-modifying therapies that effectively suppress relapses. This phenomenon is commonly referred to as progression independent of relapse activity (PIRA). Currently, it is challenging to characterize pwMS who are experiencing disability progression in clinical practice. Existing definitions of PIRA rely primarily on the Expanded Disability Status Scale (EDSS), which is biased towards ambulation and does not effectively capture the gradual accumulation of symptoms and signs across other clinical areas associated with disability progression. Here, we propose a step-by-step approach that neurologists can use in clinical practice to identify pwMS experiencing disability progression irrespective of age, EDSS, or disease duration. By using this approach, neurologists can assess the presence or absence of specific variables to help determine if disability is stable or progressing. This could enable appropriate treatments to be implemented in a timely manner, particularly as new disability-targeting therapies become available.
SN  - 0340-5354
SN  - 1432-1459
ER  -