#148: Recognizing silent progression in MS with Prof. Dr. Heinz Wiendl

In this episode, Prof. Dr. Heinz Wiendl discusses why disease progression can occur even when relapses are well controlled and MRI scans appear stable. The conversation focuses on how subtle changes can develop over time, how they can be recognized earlier, and what this means for people living with MS.

This episode was supported by Sanofi S.A. and is an English translation of the original German interview.

You can find the full blog article with all questions, answers, and additional context here:
👉 https://ms-perspektive.de/en/148-heinz-wiendl/

Topics discussed in this episode

• why disease progression can occur even when relapses are well controlled

• how often this affects people and why most patients remain stable

• what progression independent of relapse activity (PIRA) means in everyday practice

• the importance of invisible symptoms such as fatigue, cognitive changes, bladder dysfunction, and spasticity

• why commonly used scales often fail to capture subtle but relevant changes

• what MRI can reveal, where its limits lie, and why it should not be interpreted in isolation

• why long-term observation over months matters more than day-to-day fluctuations

• how patients can actively contribute by observing and documenting changes

• what current research tells us about silent inflammatory processes and endophenotypes

• why reliable biomarkers are still missing and what research is focusing on

• the therapeutic idea behind BTK inhibitors and which patient groups may benefit

• a realistic and hopeful outlook on future developments in MS care

Is there anything you would like to share with our listeners as a final message?

Prof. Dr. Heinz Wiendl:
I believe my most important message is this: we can be hopeful.
The developments of recent years show that we are far from reaching the end of the road. On the contrary, we have learned that progress continues — new therapies are being developed, and our understanding of the disease is steadily improving.

At the same time, there are still cases that are frustrating, because patients are not treated early or effectively enough, or because the disease course is particularly challenging.
That is precisely why we must continue to do research, continue to improve, and continue to refine our approaches.

My hope is that in five years' time, we will be able to say: now everyone truly benefits from these advances.

And I hope this sends a positive signal — one of courage and optimism for the future.

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I would like to thank Prof. Heinz Wiendl for this insightful interview and for his encouraging outlook on current developments and future perspectives.

See you soon and try to make the best out of your life,
Nele

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