A recent study published in European Neurology has revealed that a subgroup of young patients with secondary progressive multiple sclerosis (SPMS) had a higher frequency of radiological disease activity (RDA) unrelated to its clinical symptomatology.

Over 50% of patients with relapsing-remitting multiple sclerosis (MS) eventually develop secondary progressive multiple sclerosis (SPMS), characterized by gradual worsening and irreversible neurological deficits, the researchers said. SPMS is indicated by a score of 4 or higher on the Expanded Disability Status Scale (EDSS), the authors noted. 

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Although there are new criteria for identifying SPMS, assessing patients with this disease is still difficult. Around 1/3 of patients with SPMS experience either clinical or radiological disease activity (RDA). They are characterized as active SPMS.

“In the current study, we retrospectively evaluated the rate of RDA in SPMS patients in both brain and spinal cord MRI (Multiple resonance imaging) examinations and analyzed the related clinical variables associated with neuroaxis ongoing inflammation,” the authors highlighted.

The research team investigated RDA in patients with SPMS between 2015 and 2020 at the Sheba Multiple Sclerosis Center in Israel. The participants included 100 consecutive patients with SPMS consisting of 74 females with a median age of 50 years, disease duration of 19.5 years, and neurological disability having an EDSS score of 6. Moreover, the RDA group consisted of 35 patients, out of which 23 (65.7%) patients revealed only brain MRI activity, while 8 (22.8%) patients exhibited only spinal cord MRI activity, and 4 (11.4%) patients reported both. 

Study results revealed that 35% of patients with SPMS exhibit active MRI lesions in either the spinal cord or brain, unrelated to the clinical worsening during the routine follow-up care of patients. The observed findings suggest the existence of neuroinflammation in a subgroup of patients with SPMS as well, as they support the clinical justification for continuing the immunomodulatory treatments in such patients. Moreover, the researchers found no significant differences in association with the disease duration, EDSS, immunomodulatory treatments exposure, and immunomodulatory treatments duration. 

“The strength of our study is that we examined MRI activity in the brain, cervical, and thoracic spinal cord. To the best of our knowledge, this is the first study to evaluate RDA along the neuroaxis in patients with SPMS,” the authors added.

The study also found that the immunomodulatory treatment was associated with a lower rate of RDA, indicating the efficacy of the treatments in reducing it. In summary, the study findings highlighted the importance of MRI for monitoring disease activity in patients with SPMS

“We demonstrated that RDA exists in SPMS patients unrelated to clinical disease activity, and therefore we suggest following SPMS patients by annual imaging assessment to enable relevant therapeutic decisions,” the authors concluded.


Zohar D, Magalashvili D, Dreyer-Alster S, et al. Radiological disease activity in secondary progressive multiple sclerosis. Eur Neurol. Published online January 3, 2022.