MS – Subclinical MRI Activity and NEDA — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Subclinical MRI Activity and NEDASCE Neurology

A 35-year-old woman with MS on ocrelizumab develops a new T2 lesion on annual MRI but has had no clinical relapses and no change in EDSS. How is this classified?

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Correct answer: A — MRI activity (subclinical disease activity)

Subclinical (radiological) disease activity — new or enlarging T2 lesions on surveillance MRI without corresponding clinical symptoms — represents ongoing inflammatory MS activity despite treatment. This is increasingly recognised as important and may prompt treatment review or escalation. The concept of NEDA (No Evidence of Disease Activity) requires no relapses, no disability progression, AND no MRI activity (no new/enlarging T2 lesions and no gadolinium-enhancing lesions). Subclinical MRI activity breaks NEDA status. A: No clinical symptoms to constitute a relapse. C: RIS applies to incidental findings without a prior MS diagnosis. D: MRI activity indicates incomplete disease control. E: Pseudoprogression is a different phenomenon (post-treatment inflammatory response).

Reference: ABN MS Guidelines (2022); NEDA Concept