Multiple Sclerosis – Disease Progression: The Evolution of a Concept Between Past and Future

On May 21, 2025, the event “Multiple Sclerosis – Disease Progression: The Evolution of a Concept Between Past and Future” took place in the Aula Magna of the Mangiagalli Clinic – Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan. The meeting was promoted by the “Centro Dino Ferrari” ETS Association in collaboration with AISM.

The event opened with speeches by Dr. Andrea Arighi, Director of the SSD Neurodegenerative Diseases, and Dr. Simona Pappacena from AISM Milan. Institutional greetings were given by Dr. Nicola Orfeo, Medical Director of the Policlinico, Prof. Fabio Blandini, Scientific Director, Prof. Paolo Brambilla, Director of the Department of Neuroscience and Mental Health, and Prof. Giacomo Comi, Director of the Neurology Unit, highlighting the commitment and attention that Fondazione IRCCS Ca’ Granda dedicates to multiple sclerosis and clinical research in neurodegenerative diseases.

The introductory lecture by Dr. Milena De Riz outlined the evolution of the concept of disease progression in MS: whereas in the past discussions focused rigidly on relapsing-remitting and progressive forms, today the vocabulary includes terms such as “silent progression”, PIRA (progression independent of relapse activity), and RAW (relapse-associated worsening), which more accurately describe the clinical reality of patients. This shift is not merely semantic but reflects a new approach to diagnosis and disease management.

The subsequent roundtable – moderated by Dr. Arighi – featured an in-depth discussion among four neurologists from the SSD Neurodegenerative Diseases and a neuro-ophthalmologist. Dr. Anna Pietroboni highlighted the role of MRI in monitoring progression even in the absence of clear clinical relapses, using advanced state-of-the-art sequences. Dr. Tiziana Carandini emphasized the utility of neuropsychological tests for early detection of PIRA, underlining how cognitive aspects, often overlooked, provide valuable insights into disease progression. Dr. Laura Ghezzi discussed currently available biomarkers, such as neurofilaments, and explored the potential role of the gut microbiome in the chronic inflammatory processes underlying silent progression.

An original contribution came from Dr. Laura Dell’Arti, neuro-ophthalmologist, who explained how OCT (optical coherence tomography) enables simple, non-invasive observation of retinal neurodegeneration, suggesting that these evaluations could become integral to patient follow-up. Finally, the discussion addressed prevention, with Dr. De Riz highlighting the impact of lifestyle on disease progression and the potential integration of pharmacological and behavioral interventions.

The Q&A session allowed for further exploration of the topics raised, fostering dialogue between speakers, patients, and healthcare professionals. The event reaffirmed the importance of creating opportunities for discussion and updates on a complex disease such as multiple sclerosis, which is continually evolving both in scientific understanding and therapeutic strategies.