Experts: MS might be cured/prevented by early and effective treatment 

Thanks! How are you doing after your HSCT?

HOW did you make out with stem cell.@@MSinbeeld

@@bonnieduffy5646, in my case, my MS has not been active up to now (so >6 years).

Indeed, the million-dollar question is who to treat powerfully and who to treat more mildly. The number of people with a genuinely benign disease course that does not need benefit from a DMT is tiny. NFL (neurofilament light chain) might indeed give some more insight. Due to NFL's variability, I don't think that a decision can be made on that alone. By combining information from lumbar puncture, MRI scans, NFL, patient characteristics (sex, age, etc.), neurological examination, patient history, etc., a trained machine learning system might help in the future.

A CIS is a first attack suggestive of MS. This will be diagnosed by a neurologists. It means that many signs point to MS (in most cases including an MRI-scan indicating a typical MS lesion), however even though it looks like MS, at that time there's not enough evidence to fulfill the 'McDonald criteria' for an MS diagnosis.

​@@MSinbeeld what would a "first attack" be like ? What are some signs of it?

Thanks for the comment. A lot is still unknown about this smouldering part of MS. At the moment it is mostly being brought as that part of MS that remains after you stop new lesions being formed on MRI. One important thing to note is that a lesion (a focal damage in the brain tissue) in the model does not necessarily have to be apparent on MRI. If you use a 7Tesla MRI with a sensitive scan protocol you can visualize a lot more damage. That is not to say that there is no neuro-degenerative process happening in the white matter (normal appearing white matter). However, the question is how much of this process is influenced by early use of effective medication stopping lesions from ever forming. To answer this question very early and highly effective treatment (I didn’t come up with that term) needs to be used. To study this the ATTACK-MS trial is interesting. Where they treat MS as early as possible with natalizumab vs regular treatment. I do agree with you that diet, exercise, meditation are important. Thanks again for your comment, it is a very interesting discussion and hopefully they come up with a solution for smouldering MS.

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