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CONy 2024 | Is MS progressive from onset? Challenging the classical understanding of progression

Emerging evidence is challenging the classical view of multiple sclerosis (MS), characterized in more than 90% of cases by a relapsing/remitting phase followed by a secondary progressive phase. Observations of progression independent from relapse activity (PIRA) occurring very early in the disease course is blurring the lines between these phases. Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, took part in a debate at CONy 2024, arguing that MS is not progressive from onset. Firstly, post-mortem brain examinations have revealed MS patterns in individuals without clinical MS history, suggesting a disconnect between pathology and disease progression. Secondly, MRI scans have uncovered lesions in individuals with no prior MS symptoms, indicating a preclinical phase. However, not all with these findings progress to clinical MS or its progressive forms. Prof. Comi’s third argument addresses recent observations of silent progression in some patients early on. He emphasizes that while this phenomenon is significant, it does not apply universally, highlighting the complexity of MS progression. This interview took place at the 18th Annual Congress on Controversies in Neurology (CONy 2024) in London, UK.

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