EAN 2022 | The evolving understanding of multiple sclerosis: EBV and silent progression

Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, talks about the exponential growth of knowledge in the field of multiple sclerosis (MS). Today, there is a large interest in understanding the cause of MS, especially regarding the role of the Epstein Barr virus (EBV). After years of speculation, the evidence is now strong enough to consider the virus as part of the etiology of MS. Prof. Comi’s foundation hosted a meeting from 5-8 July for debate on this topic, as the modality by which the virus affects MS is still unclear (e.g., does EBV just influence the risk of the disease, or does it also influence disease evolution?). Prof. Comi also recognizes that the classification of MS has become blurred. Typically, the field has made distinctions between relapsing-remitting, primary progressive, and secondary progressive MS. Recent data suggests that there is a silent progression present from the early phases of MS. Since the mechanisms operating in silent progression are different to the mechanisms of relapsing remitting MS, we must learn how to distinguish between these two states and target treatments accordingly. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.