Smoldering neuroinflammation impacts your patients’ lives from the start of MS1,2

Despite effective control of their relapse and acute lesion activity, many patients may continue to experience disease progression that results in disability accumulation1,3

Over time, as disability accumulation increases, cognitive function declines. RRMS progresses to SPMS
  • Disability accumulation is an important predictor of physical, emotional, and social dysfunction in patients with MS6
  • As time goes on, social emotional function, cognitive reserve, and physical ability decrease as disability accumulation increases4,5

RRMS=relapsing-remitting MS; SPMS=secondary-progressive MS.

Smoldering neuroinflammation, driven primarily by pathogenic microglia found in the CNS, is a driver of both physical and cognitive disability accumulation1,7

Disability accumulation involves decline in physical and cognitive function
  • Disability accumulation may involve decline in physical and/or cognitive function that can be either subtle or overt1

  • Cognitive dysfunction, driven in part by smoldering neuroinflammation and neurodegeneration, may contribute significantly to unemployment, accidents, impairment of daily functions, and loss of social contacts8,10


Which subtle signs or symptoms of smoldering neuroinflammation have you seen in your patients?


Discover the importance of addressing both pathways


  1. 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
  2. Scalfari A. MS can be considered a primary progressive disease in all cases, but some patients have superimposed relapses - Yes. Mult Scler. 2021;27(7):1002-1004.
  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. Inojosa H, Proschmann U, Akgün K, Ziemssen T. A focus on secondary progressive multiple sclerosis (SPMS): challenges in diagnosis and definition. J Neurol. 2021;268(4):1210-1221.
  5. Macías Islas MÁ, Ciampi E. Assessment and impact of cognitive impairment in multiple sclerosis: an overview. Biomedicines. 2019;7(1):22.
  6. 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.
  7. 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.
  8. Ziemssen T, Derfuss T, de Stefano N, et al. Optimizing treatment success in multiple sclerosis. J Neurol. 2016;263(6):1053-1065.
  9. Dillenseger A, Weidemann ML, Trentzsch K, et al. Digital biomarkers in multiple sclerosis. Brain Sci. 2021;11(11):1519.
  10. Halper J, Kennedy P, Miller CM, Morgante L, Namey M, Ross AP. Rethinking cognitive function in multiple sclerosis: a nursing perspective. J Neurosci Nurs. 2003;35(2):70-81.