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Ellen is a 48-year-old elementary teacher with a history of migraine dating back to her twenties. She is perimenopausal with hot flashes and fatigue, and a recent increase in migraine frequency to 5-6 headaches per month. Her family physician diagnosed depression two years ago and started Ellen on a trial of sertraline. Read More
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Michael P. is a 55-year-old male diagnosed with relapsing MS five years ago. He presented with a spinal cord relapse that resulted in residual sensory and mild bladder dysfunction in his lower limbs and EDSS 2.5. His MRI had a thoracic lesion and more than 10 brain lesions meeting McDonald 2017 criteria. He was started on teriflunomide 14 mg/day but reported poor tolerability. Read More
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SPECIAL REPORT
Effect of HE DMTs on PIRA
Anti-CD20 therapy and PIRA
Future use of PIRA
Progression independent of relapse activity (PIRA) has emerged as a means of identifying neurodegenerative processes that can occur at the earliest stages of the MS disease process and which contribute to disability accrual even when there is no evidence of disease activity. PIRA is generally defined as confirmed disability progression (CDP) during a relapse-free period (e.g. >30 days before and >90 days after relapse). Unfortunately, over 300 permutations of this definition have been described (Muller et al. JAMA Neurol 2025;82:614-625), which has made it difficult to compare the prevalence of PIRA and the impact of treatments across studies. Read More
Tuesday Edition
Monday Edition
The following summarizes some of the highlights from Day 3 of the American Academy of Neurology annual meeting (AAN), Chicago, Illinois, April 18-22, 2026.