EAN 2023 | Recognizing the relevance of smoldering disease in multiple sclerosis

Celia Oreja-Guevara, MD, PhD, University Hospital San Carlos, Madrid, Spain, highlights the relevance of smoldering neuroinflammation in multiple sclerosis (MS). A plethora of treatments have been developed to prevent the occurrence of relapses, originally thought to be the key aspect of MS progression. In recent years, it has come to light that the chronic inflammation that occurs outside of relapses contributes significantly to disability worsening in patients with MS, driving fatigue, cognitive alterations, and neurological decline despite suppression of new lesions. A recent international consensus defined smoldering disease as an umbrella term characterizing chronic pathobiological processes in the central nervous system, beyond acute focal inflammation, associated with neurodegeneration leading to clinical worsening. Given the impact of smoldering disease on disability in MS, there is a great effort to improve our understanding of the underlying biology and to develop treatments able to tackle it. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.

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