#183: Silent progression in MS. Can we really detect it early?

Can we detect gradual MS progression before it becomes obvious?

In this episode, I look at what current research can — and cannot — tell us about subtle worsening without an obvious relapse.

The key distinction is important: noticing a change, detecting a trend, confirming progression and understanding its biological cause are four different steps.

We look at why a single clinic visit cannot prove irreversible progression, what the EDSS may miss, and how patient-reported outcomes and self-administered tests could help identify meaningful changes earlier.

I also discuss what MRI, OCT, neurofilament light chain (NfL), GFAP and newer approaches such as BrainAGE can add — and why none of them currently functions as a stand-alone "progression detector".

In this episode Why gradual worsening can occur without an obvious relapse Why one abnormal measurement does not prove progression What the EDSS may miss How patient-reported outcomes and self-administered tests can add important information The difference between PIRA and smouldering MS Why "independent of a recognised relapse" does not necessarily mean "independent of inflammation" What MRI, OCT, NfL and GFAP can — and cannot — tell us Why different biomarkers may give different answers Why repeated measurements over time matter more than one snapshot What people with MS can realistically observe in everyday life without constantly monitoring themselves Read the full article Silent progression in MS: Can we really detect it early? 👉 https://ms-perspektive.de/en/183-silent-progression/

Infographic: four steps towards confirming progression

Research papers behind this episode Voigt I, Ziemssen T. Detecting progressing events in multiple sclerosis clinics in real-time is possible: No. Multiple Sclerosis Journal. 2026;32(6):570–572. https://doi.org/10.1177/13524585251409547

Key role in this episode: Why earlier detection is not the same as real-time confirmation of irreversible progression.

Reinders EM, Masot-Llima A, Otero-Romero S, et al. Assessing progression independent of relapse activity in multiple sclerosis using a patient-reported disability measure and self-administered neuroperformance outcomes. Annals of Neurology. 2026;100:525–546. https://doi.org/10.1002/ana.78275 Key role: Evidence from 9,088 people with MS showing that patient-reported and self-administered measures can capture clinically meaningful change, while only partly overlapping with EDSS-based PIRA.

Bsteh G, Dal-Bianco A, Krajn