Deep Learning Modeling to Differentiate Multiple Sclerosis From MOG Antibody-Associated Disease.

Background And Objectives: Multiple sclerosis (MS) is common in adults while myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is rare. Our previous machine-learning algorithm, using clinical variables, ≤6 brain lesions, and no Dawson fingers, achieved 79% accuracy, 78% sensitivity, and 80% specificity in distinguishing MOGAD from MS but lacked validation. The aim of this study was to (1) evaluate the clinical/MRI algorithm for distinguishing MS from MOGAD, (2) develop a deep learning (DL) model, (3) assess the benefit of combining both, and (4) identify key differentiators using probability attention maps (PAMs).

MOGAD-related epilepsy: a systematic characterization of age-dependent clinical, fluid, imaging and neurophysiological features.

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare central nervous system (CNS) demyelinating disease presenting heterogeneously across lifespan. Although frequent, epilepsy remains a poorly characterized MOGAD-associated manifestation.

Methods: To describe age-related clinical, fluid, imaging, and neurophysiological features in MOGAD patients with epilepsy, we systematically reviewed online repositories up to April 2025, identifying 178 eligible studies.

Tolebrutinib for non-relapsing secondary progressive multiple sclerosis: a critical therapeutic gap.

Bruton tyrosine kinase inhibitors (BTKi) represent a promising strategy to limit disability accumulation in multiple sclerosis (MS). Results from the HERCULES trial showed that tolebrutinib, a brain-penetrant BTKi, reduced by 31% the risk of disability progression in non-relapsing secondary progressive MS patients, with a good safety profile. Tolebrutininb may represent a major advance for this MS population with no treatment currently approved.

Early Intensive Versus Escalation Approach: Ten-Year Impact on Disability in Relapsing Multiple Sclerosis.

Objective: To evaluate the long-term impact of early intensive treatment (EIT) versus escalation (ESC) strategies using high-efficacy disease-modifying therapies (HE-DMTs) on disability progression in relapsing multiple sclerosis (RMS).

Methods: This observational study included 4878 RMS patients from the Italian Multiple Sclerosis Register. Eligible participants initiated their first disease-modifying therapy (DMT) within 3 years of disease onset and had ≥ 5 years of follow-up with at least three Expanded Disability Status Scale (EDSS) evaluations.

Perivascular spaces in multiple sclerosis: Markers of neuroinflammation or footprints of vascular pathology?

Perivascular spaces (PVS) are interstitial fluid-filled structures that surround penetrating cerebral vessels and play critical roles in brain waste clearance, immune surveillance, and vascular health. When enlarged (ePVS), they are detectable on magnetic resonance imaging (MRI) and have been implicated in various neurological diseases, including multiple sclerosis (MS). Patients with MS consistently show higher PVS and ePVS number, size, and volume than healthy controls (HC), often in brain regions such as the centrum semiovale and midbrain.

Contribution of Polygenic Scores to Progression Independent of Relapse Activity in Multiple Sclerosis.

Background: Despite effective therapeutic control of relapses, many patients with multiple sclerosis (MS) experience, from the earliest phases of disease, disability accrual, which mostly occurs as progression independent of relapse activity (PIRA). In this observational study, we aimed at evaluating the genetic contribution to PIRA, using polygenic risk scores (PRS) in a cohort of 1162 Italian patients.

Methods: PRS were derived from the largest multi-centric genome-wide association study on MS severity, conducted on more than 20,000 patients.

Long-term effectiveness and safety of ocrelizumab: a single-centre real-world study.

Background: This retrospective single-centre study evaluated the effectiveness and safety of ocrelizumab (OCR) in relapse-onset multiple sclerosis (RMS) and primary progressive MS (PPMS) and identified predictors of treatment response.

Methods: We included 260 RMS and 73 PPMS patients treated with ocrelizumab for ≥ 1 year at our MS Centre until May 2024.

Results: Median follow-up was 3.

Glymphatic System May Mediate the Relation Between Choroid Plexus and Brain Damage in Multiple Sclerosis.

Background And Objectives: The choroid plexus (CP) regulates immune functions and produces most CSF that circulates in the brain parenchyma through perivascular spaces, part of the glymphatic system. In multiple sclerosis (MS), CP enlargement and glymphatic dysfunction are associated with inflammatory activity, clinical disability, and brain damage, but their interrelation is unclear. We investigated whether glymphatic system dysfunction mediates the association between CP enlargement and brain damage in patients with MS.

TSPO PET in multiple sclerosis: Emerging insights into pathophysiology, prognosis, and treatment monitoring.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation, demyelination and neurodegeneration. The 18 kDa translocator protein (TSPO) is overexpressed on activated microglia, a key mediator of acute and chronic inflammation in MS. Positron emission tomography (PET) targeting TSPO enables in vivo detection of microglial activation in MS, revealing a high proportion of active white matter (WM) lesions.

Beyond EDSS: multidomain impairments are detectable and associated with walking disorders in low-disabled people with multiple sclerosis.

Introduction: Multiple sclerosis is characterized by a spectrum of motor, sensory, and cognitive impairments often overlooked in low-disabled people with multiple sclerosis (PwMS). The assessment of subtle functional deficits in this population is crucial to track the evolution of impairments and treatments effects. This study aims to explore the prevalence of multidomain impairments and their association with walking disorders in minimally disabled PwMS.

New approaches to lesion assessment in multiple sclerosis.

Purpose Of Review: To summarize recent advancements in artificial intelligence-driven lesion segmentation and novel neuroimaging modalities that enhance the identification and characterization of multiple sclerosis (MS) lesions, emphasizing their implications for clinical use and research.

Recent Findings: Artificial intelligence, particularly deep learning approaches, are revolutionizing MS lesion assessment and segmentation, improving accuracy, reproducibility, and efficiency. Artificial intelligence-based tools now enable automated detection not only of T2-hyperintense white matter lesions, but also of specific lesion subtypes, including gadolinium-enhancing, central vein sign-positive, paramagnetic rim, cortical, and spinal cord lesions, which hold diagnostic and prognostic value.

Clinical integration of brain and cord MRI features improves differential diagnosis of multiple sclerosis.

Objective: To explore the role of brain and spinal cord MRI features in differentiating patients with suspected central nervous system (CNS) inflammatory diseases.

Material And Methods: Prospective data from 125 patients undergoing diagnostic evaluation, including 1.5 T brain and spinal cord MRI scans from February 2021 and March 2024 were analyzed.

Correlates of Processing Speed Change With Combined Cognitive Rehabilitation and Exercise in Progressive MS: Secondary Analysis of the CogEx Trial.

BackgroundCognitive rehabilitation and exercise training are promising approaches for improving cognition in persons with progressive multiple sclerosis (MS). Identifying heterogeneity of change and factors that influence the effects of cognitive rehabilitation and/or exercise training on cognitive outcomes at the individual level have direct relevance for developing tailored and optimized rehabilitation interventions for improving cognition in progressive MS.ObjectiveThis study involved a secondary data analysis from the CogEx trial in progressive MS.

Spinal Cord Abnormalities in Early Pediatric Multiple Sclerosis.

Spinal cord lesions and atrophy in the cervical region are common in adult multiple sclerosis (MS) and correlate with disability. Whether similar abnormalities occur in pediatric MS patients is largely unknown. Clinical and MRI evaluations were performed in 38 pediatric MS patients and 13 healthy controls (HC).

A cross-sectional multicentre study of multishell diffusion MRI in multiple sclerosis.

Background And Objectives: White matter (WM) microstructural properties from advanced multishell diffusion MRI (dMRI) have been linked to clinical disability in multiple sclerosis (MS). This multicentre study used multishell dMRI to compute WM metrics and test for differences between people with MS (pwMS) and healthy controls (HCs).

Methods: We included multishell dMRI data from 251 pwMS or clinically isolated syndrome (CIS) (mean age 40.

Clinical and MRI features contributing to the clinico-radiological dissociation in a large cohort of people with multiple sclerosis.

Background: People with Multiple Sclerosis (PwMS) often show a mismatch between disability and T2-hyperintense white matter (WM) lesion volume (LV), that in general is referred to as the clinico-radiological paradox.

Objectives: This study aimed to understand how an extensive clinical, neuropsychological, and MRI analysis could better elucidate the clinico-radiological dissociation in a large cohort of PwMS.

Methods: Clinical scores, such as Expanded Disability Status Scale (EDSS), 9 Hole Peg Test (9HPT), 25-foot Walking Test (25-FWT), Paced Auditory Serial Addition Test at 3 s (PASAT3), Symbol digit Modalities Test (SDMT), demographics, and 3 T-MRI of 717 PwMS and 284 healthy subjects (HS) were downloaded from the INNI database.

Recall vaccination increases detectable B-cell reactivity in persons with multiple sclerosis treated with ocrelizumab.

Background: Utility of repeated boosts of anti-SARS-CoV-2 vaccination in persons with MS (pwMS) treated with ocrelizumab is questioned.

Objective: Investigate antiviral antibody and T-cell responses after mRNA vaccination for SARS-CoV-2 in ocrelizumab-treated pwMS.

Methods: Peripheral blood mononuclear cells were stimulated with SARS-CoV-2 peptide pools and T-cell reactivity was assessed by ELISPOT for IFN-γ detection, and by multiparametric flow cytometry analyses for assessment and characterization of T-cell activation.

Advances in neuroimaging of multiple sclerosis.

Purpose Of Review: To summarize recent advancements in understanding multiple sclerosis (MS) pathophysiology, predicting disease course, and monitoring treatment responses using MRI.

Recent Findings: Paramagnetic rim lesions (PRLs) are highly specific to MS and clinically relevant. Detected from the earliest disease phases, PRLs aid in distinguishing MS from other conditions, improving diagnostic accuracy.

Sex hormone-related factors and the risk of PIRA in women with multiple sclerosis.

Background: Sex-related differences affect multiple sclerosis (MS), but the impact of sex hormones on disease progression remains unclear. We investigated whether sex hormone-related factors influence progression independent of relapse activity (PIRA) in women with MS over a long-term follow-up.

Methods: The study analysed 1210 female MS patients from the San Raffaele MS Center using data from an environmental survey (2019-2023).

Cervical spinal cord gray matter damage predicts disability worsening in multiple sclerosis: a longitudinal study.

Objective: Cervical spinal cord (cSC) gray matter (GM) damage is associated with current disability in multiple sclerosis (MS), but its prognostic value remains unexplored. We aimed to investigate whether cSC GM damage may predict disability worsening in MS.

Materials And Methods: Seventy-nine MS patients and 49 healthy controls (HC) underwent 3 T brain and cSC MRI at baseline and two neurological evaluations after median follow-up of 1.

Effects of rhythmic-cued gait training on gait-like task related brain activation in people with multiple sclerosis.

Background: Walking impairment is one of the most debilitating symptoms of multiple sclerosis (MS). A better understanding of brain mechanisms underlying successful gait training could help to improve development of targeted therapy. We therefore investigated changes in brain activation associated with improvements in walking function after rhythmic-cued gait training.