Have you ever wondered why you experience things like balance issues, fatigue, or brain fog even when your MS appears stable?^1-5

Until now, stability in MS has been understood as having control over relapses and MRI activity. Now it’s becoming clear that for your MS to be stable, you also need control of your physical and cognitive symptoms.^1,2

What do scientists now know?

Fortunately, scientists now know why people experience those physical and cognitive challenges in MS.

That’s because there are 2 processes that explain how MS works: the acute process and the chronic smouldering process. The acute process causes relapses and MRI activity, while the chronic smouldering process causes changes to your physical and cognitive abilities over time.^1,2

What should I look out for?

These changes to physical and cognitive abilities are referred to as disability progression by healthcare providers. It doesn’t mean you’re disabled or that you have a disability. It just means your MS may be progressing.^3,5,6 Here are a few ways disability progression can affect normal, everyday activities:

• Struggling to find the right words
• Difficulty remembering names
• Lacking the energy to do usual activities
• Being unable to exercise the way you used to
• Parking closer to your destination
• Forgetting if you already did something
• Tripping or losing balance unexpectedly^2,4-8

Because MS changes so slowly, you might have to think back a long way to notice the signs. Think back to your birthday 3 years ago—what were you doing then? Perhaps you felt great, or maybe you were tired or lost your balance. Did you forget words back then? Now think about today. If you can see changes to what you’re able to do between now and then, it’s important to talk about it with your healthcare provider.^3,6

Even if you think it could be aging, stress, or just a bad day, it’s important to keep track of changes now and talk to your doctor.^2,6,9

What can I do about disability progression now?

When you notice the changes to your physical and cognitive abilities, you can start to do something about it. Here are a few things you could try to help deal with these challenges:

• Rehab led by a speech, occupational, and/or physical therapist^10,11
• Therapy, meditation, mindfulness, and/or other mental health practices^12-14
• A healthy diet and regular exercise^10,15
• Support groups that connect you to others with MS¹²

What might change in the future of MS?

There’s research happening right now that could change the future of MS. So far, it has revealed an enzyme that plays a role in both the acute process and the chronic smouldering process.^3,16 In the future, scientists could use what they’re learning about these processes to address relapses, MRI activity, and the physical and cognitive changes that happen in MS.^1,2

References: 1. Häusser-Kinzel S, Weber MS. The role of B cells and antibodies in multiple sclerosis, neuromyelitis optica, and related disorders. Front Immunol. 2019;10:201. 2. Giovannoni G, Popescu V, Wuerfel J, et al. Smouldering multiple sclerosis: the 'real MS.' Ther Adv Neurol Disord. 2022;15:17562864211066751. doi:10.1177/17562864211066751 3. Frisch ES, Pretzsch R, Weber MS. A milestone in multiple sclerosis therapy: monoclonal antibodies against CD20—yet progress continues. Neurotherapeutics. 2021;18(3):1602-1622. 4. Dillenseger A, Weidemann ML, Trentzsch K, et al. Digital biomarkers in multiple sclerosis. Brain Sci. 2021;11(11):1519. 5. Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms—a narrative review. Neurol Ther. 2021;10(1):75-98. 6. Cree BAC, Hollenbach JA, Bove R, et al; University of California, San Francisco MS-Epic Team. Silent progression in disease activity-free relapsing multiple sclerosis. Ann Neurol. 2019;85(5):653-666. 7. Bass A, Greenberg B, et al. Smouldering Disease: Hiding in Plain Sight. Slide deck presented at: Congress of the European Committee for Treatment and Research in Multiple Sclerosis; October 27th, 2022; Amsterdam, The Netherlands. 8. Bayas A, Schuh K, Christ M. Self-assessment of people with relapsing-remitting and progressive multiple sclerosis towards burden of disease, progression, and treatment utilization-results of a large-scale cross-sectional online survey (MS Perspectives). Mult Scler Relat Disord. 2022;68:104166. doi:10.1016/j.msard.2022.104166 9. LaRocca NG, King M. Managing Cognitive Problems in MS. National Multiple Sclerosis Society; 2016. 10. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis – an integral component of disease management. EPMA J. 2012;3(1):2. doi:10.1007/s13167-011-0136-4 11. National Multiple Sclerosis Society. Speech & Swallowing. National Multiple Sclerosis Society; 2014. 12. Gil-González I, Martín-Rodríguez A, Conrad R, Pérez- San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open. 2020;10(11):e041249. doi:10.1136/bmjopen2020-041249 13. Blankespoor RJ, Schellekens MPJ, Vos SH, Speckens AEM, de Jong BA. The effectiveness of mindfulness-based stress reduction on psychological distress and cognitive functioning in patients with multiple sclerosis: a pilot study. Mindfulness. 2017;8(5):1251-1258. doi:10.1007/s12671-017-0701-6 14. National Multiple Sclerosis Society. What to Expect from Mental Healthcare: A Guide for People with MS. National Multiple Sclerosis Society; 2022. 15. Kheirouri S, Alizadeh M. Dietary inflammatory potential and the risk of neurodegenerative diseases in adults. Epidemiol Rev. 2019;41(1):109-120. doi:10.1093/epirev/mxz005 16. Keaney J, Gasser J, Gillet G, Scholz D, Kadiu I. Inhibition of Bruton's Tyrosine Kinase modulates microglial phagocytosis: therapeutic implications for Alzheimer's disease. J Neuroimmune Pharmacol. 2019;14(3):448-461.