Reframing Multiple Sclerosis as a Spectrum of Progression

Weekly Neurology Deep Dive - A review of recent impactful publications in the field of Neurology · Oct 4, 2026 · 47m

This academic review proposes a unified spectrum model for multiple sclerosis (MS) that challenges traditional, rigid phenotype classifications like RRMS, SPMS, and PPMS. The authors argue that disability often accumulates through progression independent of relapse activity (PIRA) and "smouldering" disease processes, which frequently occur silently long before a formal progressive diagnosis. By integrating the role of neurologic reserve and biological ageing, the text explains how the clinical transition to progressive states reflects a declining capacity to compensate for ongoing tissue…