Neural Regeneration Research ›› 2026, Vol. 21 ›› Issue (3): 1134-1135.doi: 10.4103/NRR.NRR-D-24-01308

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Illusion of inactivity: Revisiting progressive multiple sclerosis treatment paradigms

Tal Ganz, Tamir Ben-Hur*   

  1. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Ganz T, Ben-Hur T) The Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah – Hebrew University Medical Center, Jerusalem, Israel (Ganz T, Ben-Hur T)
  • Online:2026-03-15 Published:2025-07-04
  • Contact: Tamir Ben-Hur, MD, PhD, tamir@hadassah.org.il.

Abstract: Active inflammation in “inactive” progressive multiple sclerosis: Traditionally, the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis (PMS) has been framed as an inflammatory versus degenerative dichotomy. This was based on a broad misconception regarding essentially all neurodegenerative conditions, depicting the degenerative process as passive and immuneindependent occurring as a late byproduct of active inflammation in the central nervous system (CNS), which is (solely) systemically driven. This view has been challenged by accumulating evidence suggesting that axonal injury and neurodegeneration begin early in the relapsing stage of MS (Mey et al., 2023). Several studies have shown CNS atrophy in various structures detectable by magnetic resonance imaging (MRI) at early stages of the disease. On the pathological level, axonal loss and neuronal death are present throughout the disease course (Mey et al., 2023). Furthermore, it is increasingly appreciated that neurodegeneration in MS is not only a toxic and dystrophic event but also an active immunemediated process (Yong, 2022; Mey et al., 2023).