2024 Top Story in Neurology: Management and Diagnosis of Multiple Sclerosis

As of 2024, there have been significant developments in MS research that impact the management of individuals with the disease. The use of immunomodulatory therapies often results in a wearing-off effect between infusions. It was unknown whether this has a detrimental effect. A study involving patients receiving ocrelizumab showed that the wearing-off effect was associated with increased neuroaxonal damage, as shown by increased serum neurofilament levels and a reduced immunomodulatory response, which could be noted as early as within the first week of the symptoms.¹ Thus, it is important to adjust the interval between the infusions to prevent the wearing-off effect. This has implications not only for ocrelizumab but probably for all other immunomodulatory drugs as well.

An interesting study looked at the effect of sun exposure on disease progression in patients with MS. This builds upon previous observations that MS is more prevalent in high altitudes, where there is less exposure to sun, and that vitamin D may have protective effects against this illness. This study showed that low levels of sun exposure were associated with worse disease progression.² Based on this observation, clinicians could advise their patients to increase sun exposure. Sun exposure also has other benefits in preventing bone disease. However, one has to be careful because too much exposure to ultraviolet light can increase the risk for skin cancer.

Currently, there are no good biomarkers other than MRI-based markers for the diagnosis of MS. Many immune abnormalities have been described, but they are nonspecific. A study that created whole proteome antibody profiles of hundreds of patients with MS found that a subgroup (10%) had a unique antibody signature that predicted the development of MS symptoms by several years. They also had high serum neurofilament levels. This suggests that this antibody panel can be used to identify patients at a high risk for developing the illness.³ Although the panel is not currently available commercially, it is something to look out for in the near future.