Disability-relevant demyelination in multiple sclerosis: five-year evolution following diagnosis

In 62 people with relapsing-remitting multiple sclerosis within 6 months of diagnosis, early MTsat-detected demyelination in NAWM and WML is linked to disability progression over the first year.

• Why it matters: Conventional MRI inflammatory activity may not capture disability-relevant myelin damage, limiting targeted therapy design and the ability to stratify or power clinical trials.
• What they did: Participants had baseline and 1-year MRI using MTsat and T1 relaxometry plus EDSS, then were followed to 5 years; progression used EDSS increases of ≥1.5, ≥1.0, or ≥0.5 from prior scores.
• The result: One-to-five-year MTsat change and baseline-to-1-year MTsat change were not associated with 1-to-5-year disability progression (FDR-corrected p>0.05), and neither baseline nor baseline-to-1-year MTsat predicted later progression.

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