Episodi

  • #187: Aging in multiple sclerosis: relapses, progression and treatment choices with Dr. Yi Chao Foong

    #187: Aging in multiple sclerosis: relapses, progression and treatment choices with Dr. Yi Chao Foong
    Oct 14 2026

    Aging in multiple sclerosis brings new questions about relapses, gradual progression and treatment choices. In episode 187, Dr. Yi Chao Foong, an MS neurologist and researcher in Tasmania, explains why fewer relapses do not necessarily mean that MS has stopped changing.

    We discuss:

    • What changes in the aging immune system and what PIRA means.
    • Why late-onset MS needs careful diagnosis and individual treatment decisions.
    • Why stopping treatment can carry risks despite years of stability.
    • How rehabilitation, practical support and social connections can support independence.
    • What future biomarkers might add to treatment monitoring.

    Explore Dr. Foong's research and listen to episode 49 with Anthony Feinstein on CogeX. Further study links are included in the accompanying blog article.

    Links and resources

    • Read the interview and listen to episode 187 on the blog: https://ms-perspektive.de/en/187-aging-in-ms-yi-chao-foong/
    • Dr. Yi Chao Foong — MS Australia
    • Aging better with MS — research project
    • Late-onset MS treatment study
    • Ocrelizumab versus interferon/glatiramer acetate in people over 60
    • DISCOMS trial
    • DOT-MS trial
    • Clinically silent MRI lesions and treatment escalation
    • National Disability Insurance Scheme — Australia
    • Episode 049: CogeX study with Prof. Anthony Feinstein
    • English podcast archive

    Chapters

    00:00 Episode introduction
    00:45 Introducing Dr. Yi Chao Foong and aging in MS
    03:29 Why aging matters
    04:36 The aging immune system and PIRA
    06:56 Late-onset MS: diagnosis and treatment
    08:55 Higher-efficacy treatment in older people
    10:53 Stopping treatment: risks and uncertainties
    13:59 Why silent MRI lesions matter
    14:47 Personalizing treatment decisions
    16:30 Extended interval dosing and de-escalation
    18:00 Lifestyle, brain health and practical support
    19:52 Supporting independence
    22:39 Biomarkers and future monitoring
    24:38 Hopes for prevention research
    25:47 Takeaways for people with MS and families
    26:49 Following Dr. Foong's research
    27:37 Farewell

    ---

    See you soon and try to make the best out of your life,
    Nele

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    Click here for an overview of all podcast episodes published so far.
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    29 min
  • #186: Protecting nerve cells in multiple sclerosis: A new path toward neuroprotection with Prof. Manuel Friese

    #186: Protecting nerve cells in multiple sclerosis: A new path toward neuroprotection with Prof. Manuel Friese
    Oct 7 2026
    Why can multiple sclerosis progress even when relapses are well controlled? In episode 186, I speak with Prof. Manuel Friese about the next challenge in MS research: protecting nerve cells from damage and preserving function over time. Read the full interview on my blog: https://ms-perspektive.de/en/186-manuel-friese/ Manuel is a neurologist and clinician scientist who directs the Institute of Neuroimmunology and Multiple Sclerosis in Hamburg. His team's research explores why some nerve cells withstand inflammation while others degenerate. One unexpected finding was a protective role for complement factor H inside neurons, beyond its familiar role in regulating the immune system. We discuss how smoldering inflammation can keep nerve cells under stress, why oxidative damage matters and how ferroptosis, an iron-dependent form of cell death, fits into the picture. Manuel explains possible ways to strengthen the cells' own defenses and why getting a promising mechanism into a treatment remains a major challenge. We also talk about alpha-lipoic acid, the Octopus trial and the importance of careful clinical testing. Early research signals can be encouraging, but they do not yet prove that a treatment safely slows disability progression. Table of contents Opening & introductionUnderstanding neurodegeneration in MSThe new discovery: Complement factor HFrom discovery to potential therapyThe bigger picture: Protecting the brain in progressive MSLooking aheadClosing Introduction: Who is Prof. Manuel Friese? Prof. Manuel Friese: I'm a clinician scientist based in Hamburg, Germany, and I direct an institute for neuroimmunology and multiple sclerosis. The main focus of my research nowadays is to understand why progression in MS happens. That is also why we want to understand in much more depth how nerve cells react to inflammation. It is not so much about how inflammation occurs in the central nervous system. I think we have a fairly good understanding of that, but we still have not understood why neurons die. This extract has been edited for readability. Links and resources INIMS: follow the team's research Prof. Manuel Friese's UKE profileStudy: Intracellular complement factor H protects neurons during CNS inflammation, Nature, 2026Related paper: STING orchestrates the neuronal inflammatory stress response in multiple sclerosis Octopus interim results: alpha-lipoic acid moves to the next stage Octopus trial information Manuel Friese's research post on LinkedIn Related episodes #146: Chronic smoldering inflammation in MS with Dr. Klarissa Stürner#148: Recognizing silent progression in MS with Prof. Heinz Wiendl#050: The future of MS treatment with Prof. Tjalf Ziemssen Time stamps 00:32 Episode introduction00:45 Opening & introduction03:39 Understanding neurodegeneration in MS15:14 The new discovery: Complement factor H25:36 From discovery to potential therapy31:55 The bigger picture: Protecting the brain in progressive MS37:35 Looking ahead39:41 Closing41:11 Where to follow Manuel's research42:02 Next episode and farewell The contents are for information and do not replace individual medical advice. See you soon and try to make the best out of your life, Nele For more information and positive thoughts, subscribe to my newsletter for free. Click here for an overview of all podcast episodes published so far.
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    44 min
  • #185: Living with MS in Mexico – who gets diagnosed, who gets treated, and who gets left behind?

    #185: Living with MS in Mexico – who gets diagnosed, who gets treated, and who gets left behind?
    Sep 30 2026

    An MS diagnosis can depend on where you live, whether you can reach a neurologist and how quickly you can get an MRI. In this episode, Nele speaks with neurologist and neuroimmunologist Dr. Enrique Gomez Figueroa about the gaps in MS care across Mexico. Enrique explains why official case numbers may miss people, what delays diagnosis and why access to an effective treatment can require a lengthy approval process. He also shares what research on switching therapies can tell us—and why listening to people with MS is essential.

    In this episode:

    • Why MS may be underdiagnosed in parts of Mexico
    • Barriers to diagnosis and distinguishing MS from NMOSD and MOGAD
    • Differences between treatments available on paper and in practice
    • When moving to a more effective therapy may be needed
    • How research, patient voices and advocacy can improve access
    Links and resources
    1. Read the full interview and blog post – https://ms-perspektive.de/185-ms-in-mexico/
    2. Atlas of MS: Mexico factsheet
    3. Enrique Gomez Figueroa's publications on PubMed
    4. Enrique Gomez Figueroa on LinkedIn
    5. MSBase study comparing treatment switches — einschließlich des Wechsels zu einer wirksameren Therapie
    6. MEXCTRIMS guideline: part I and part II
    7. 2024 revisions to the McDonald diagnostic criteria

    ---

    See you soon and try to make the best out of your life,
    Nele

    For more information and positive thoughts, subscribe to my newsletter for free.

    Click here for an overview of all podcast episodes published so far.
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    36 min
  • #184: MS treatment across the disease course – treat early, think long-term, don't give up too soon with Prof. Klaus Schmierer

    #184: MS treatment across the disease course – treat early, think long-term, don't give up too soon with Prof. Klaus Schmierer
    Sep 23 2026
    Read the full blog post and interview here: https://ms-perspektive.de/en/184-klaus-schmierer/ How early should MS treatment start, how strongly should we treat, and is there ever a point when it becomes "too late" to protect meaningful function? In this episode, I speak with Prof. Klaus Schmierer, Professor of Neurology at Queen Mary University of London and honorary consultant neurologist at Barts Health NHS Trust, about MS treatment across the entire disease course. We look at the very beginning of MS, different treatment strategies, advanced disability, and the question of what can still be preserved at each stage. In this episode, we discuss: why MS treatment should start as early as possible once the diagnosis is sufficiently securewhy diagnostic accuracy remains essential, especially when MRI findings can be misleadingwhat the AttackMS trial is investigating with very early high-efficacy treatmentwhy the traditional escalation approach may sometimes allow avoidable damage to occurthe difference between continuous treatment and immune reconstitutionfor whom immune reconstitution approaches may be particularly suitablehow to balance treatment risks against the risks of insufficiently controlled MSwhy "mild MS" is difficult to predict reliably in an individual personwhy people with advanced disability are still underrepresented in MS trials what ChariotMS is investigating in people with advanced MSwhy arm and hand function can be crucial for independence even when walking is already severely limitedwhy a high EDSS score alone should not automatically be a reason to stop disease-modifying treatment whether there may be several different treatment windows across the disease course which developments Klaus would like to see in the next five years, including better biomarkers, neuroprotection, repair and more equitable access to treatment Klaus' key message is: treat early, think long-term and don't give up too soon. Links & resources Full blog post and interview: https://ms-perspektive.de/en/184-klaus-schmierer/ AttackMS – how early should we use highly effective DMTs? MS Society UK: https://www.mssociety.org.uk/research/latest-research/research-blog/attackms-how-early-should-we-use-highly-effective-dmts ChariotMS – can cladribine slow worsening in advanced MS? MS Society UK: https://www.mssociety.org.uk/research/explore-our-research/search-our-research-projects/chariotms-can-cladribine-slow-worsening #002: How can a rapid and clear MS diagnosis be made? https://ms-perspektive.de/en/002-diagnosis/ #179: Multiple sclerosis without the noise – Dominic Shadbolt https://ms-perspektive.de/en/179-dominic-shadbolt/ #125: The MS Brain Health Strategy with Prof. Barbara Willekens https://ms-perspektive.de/en/125-barbara-willekens/ #040: Autologous stem cell therapy (aHSCT) in MS with Prof. Roland Martin https://ms-perspektive.de/en/40-ahsct-roland-martin/ #049: CogeX study insights for progressive MS with Prof. Anthony Feinstein https://ms-perspektive.de/en/049-cogex-anthony-feinstein/ --- See you soon and try to make the best out of your life, Nele For more information and positive thoughts, subscribe to my newsletter for free. Click here for an overview of all podcast episodes published so far.
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    42 min
  • #183: Silent progression in MS. Can we really detect it early?

    #183: Silent progression in MS. Can we really detect it early?
    Sep 16 2026
    Can we detect gradual MS progression before it becomes obvious? In this episode, I look at what current research can — and cannot — tell us about subtle worsening without an obvious relapse. The key distinction is important: noticing a change, detecting a trend, confirming progression and understanding its biological cause are four different steps. We look at why a single clinic visit cannot prove irreversible progression, what the EDSS may miss, and how patient-reported outcomes and self-administered tests could help identify meaningful changes earlier. I also discuss what MRI, OCT, neurofilament light chain (NfL), GFAP and newer approaches such as BrainAGE can add — and why none of them currently functions as a stand-alone "progression detector". In this episode Why gradual worsening can occur without an obvious relapseWhy one abnormal measurement does not prove progressionWhat the EDSS may missHow patient-reported outcomes and self-administered tests can add important informationThe difference between PIRA and smouldering MSWhy "independent of a recognised relapse" does not necessarily mean "independent of inflammation" What MRI, OCT, NfL and GFAP can — and cannot — tell usWhy different biomarkers may give different answersWhy repeated measurements over time matter more than one snapshot What people with MS can realistically observe in everyday life without constantly monitoring themselves Read the full article Silent progression in MS: Can we really detect it early? 👉 https://ms-perspektive.de/en/183-silent-progression/ Infographic: four steps towards confirming progression Research papers behind this episode Voigt I, Ziemssen T. Detecting progressing events in multiple sclerosis clinics in real-time is possible: No. Multiple Sclerosis Journal. 2026;32(6):570–572. https://doi.org/10.1177/13524585251409547 Key role in this episode: Why earlier detection is not the same as real-time confirmation of irreversible progression. Reinders EM, Masot-Llima A, Otero-Romero S, et al. Assessing progression independent of relapse activity in multiple sclerosis using a patient-reported disability measure and self-administered neuroperformance outcomes. Annals of Neurology. 2026;100:525–546. https://doi.org/10.1002/ana.78275 Key role: Evidence from 9,088 people with MS showing that patient-reported and self-administered measures can capture clinically meaningful change, while only partly overlapping with EDSS-based PIRA. Bsteh G, Dal-Bianco A, Krajnc N, Berger T. Biomarkers of progression independent of relapse activity—Can we actually measure it yet? International Journal of Molecular Sciences. 2025;26:4704. https://doi.org/10.3390/ijms26104704 Key role: Overview of EDSS, functional testing, MRI, OCT, NfL, GFAP and multimodal approaches, including the important distinction between predicting future PIRA and measuring ongoing progression. Ciccarelli O, Barkhof F, Calabrese M, et al., MAGNIMS Study Group. Using the progression independent of relapse activity framework to unveil the pathobiological foundations of multiple sclerosis. Neurology. 2024;103:e209444. https://doi.org/10.1212/WNL.0000000000209444 Key role: Why PIRA is a useful clinical framework but not a single biological process, and why PIRMA is difficult to establish in routine care. Pawlitzki M, Kirschner P, Masanneck L, et al. Brain age gap in multiple sclerosis: associated with disability but independent of serum biomarkers. Therapeutic Advances in Neurological Disorders. 2026;19:1–13. https://doi.org/10.1177/17562864261458516 Key role: An example of why different biomarkers may capture different aspects of MS rather than providing one universal measure of progression. Kappos L, Wolinsky JS, Giovannoni G, et al. Contribution of relapse-independent progression vs relapse-associated worsening to overall confirmed disability accumulation in typical relapsing multiple sclerosis in a pooled analysis of 2 randomized clinical trials. JAMA Neurology. 2020;77(9):1132–1140. https://doi.org/10.1001/jamaneurol.2020.1568 Key role: Historical context for why relapse-independent disability accumulation became such an important topic in relapsing MS. See you soon and try to make the best out of your life, Nele For more information and positive thoughts, subscribe to my newsletter for free. Click here for an overview of all podcast episodes published so far.
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    34 min
  • #182: How excercise can influence multiple sclerosis – interview with Prof. Dr. Dr. Philipp Zimmer

    #182: How excercise can influence multiple sclerosis – interview with Prof. Dr. Dr. Philipp Zimmer
    Sep 9 2026
    This episode is the English translation and adaptation of my original German interview with Prof. Dr. Dr. Philipp Zimmer, first published in August 2023. Prof. Zimmer is a sports scientist, neuroscientist and expert in exercise immunology. In our conversation, we explore how physical activity and structured exercise can influence multiple sclerosis, what happens in the immune system when we exercise, and why strength, endurance and balance training can all play an important role for people living with MS. We also talk about fatigue, cognition, mobility, recovery and the question of how much exercise is actually helpful. You will learn: how exercise can influence the immune systemwhy natural killer cells and regulatory T cells are importantwhich MS symptoms may benefit from regular physical activitywhy aerobic exercise is particularly interesting from an immunological perspectivewhy strength and balance training also matterhow much exercise is generally recommendedwhy more exercise is not always betterhow recovery and individual adaptation influence traininghow people with MS can get started even if they have not exercised much beforewhy enjoying your chosen activity is so important for long-term motivationwhere to find exercise ideas and evidence-based resources for different levels of mobility Prof. Zimmer also explains why exercise is particularly valuable because it gives people with MS something they can actively contribute to their own health and wellbeing. Please note that this interview was originally recorded and published in 2023. Research continues to evolve, so I have added current and internationally relevant resources to the accompanying blog article and link list. The information in this episode is for educational purposes and does not replace individual medical advice. Links and resources Blog article Read the full English interview and accompanying resources on MS-Perspektive: https://ms-perspektive.de/en/ Note: Please replace this with the final direct URL of the English Prof. Zimmer article once it has been published. Original German interview Wie Sport die MS beeinflussen kann mit Prof. Dr. Dr. Philipp Zimmer: https://ms-perspektive.de/210-philipp-zimmer/ Prof. Dr. Dr. Philipp Zimmer English profile at TU Dortmund University: https://sport.kmst.tu-dortmund.de/en/institute/personnel/prof-dr-dr-philipp-zimmer/ WHO recommendations on physical activity World Health Organization – physical activity recommendations: https://www.who.int/europe/news-room/fact-sheets/item/physical-activity Exercise and physical activity resources for people with MS MS International Federation – Physical activity for people with MS: https://www.msif.org/resource/physical-activity-for-people-with-ms/ MS International Federation / European Multiple Sclerosis Platform – Keep moving with MS: https://www.msif.org/resource/keep-moving-with-ms/ MS Society UK – Simple exercises for MS: https://www.mssociety.org.uk/living-with-ms/physical-and-mental-health/staying-active/simple-exercises-for-ms Research PubMed – Fitness, physical activity, and exercise in multiple sclerosis: https://pubmed.ncbi.nlm.nih.gov/35084560/ Related English interviews and articles on MS-Perspektive How exercise boosts your immune system: What people with MS should know with David Walzik: https://ms-perspektive.de/en/153-exercise/ Multiple sclerosis and pain: How exercise and physical activity can help with Rasmus Christian Jungersen: https://ms-perspektive.de/en/175-rasmus/ Movement limitations in MS – how to maintain strength, balance and mobility: https://ms-perspektive.de/en/018-movement-limitations/ EBV insights: Shedding light on its impact on MS with Prof. Christian Münz: https://ms-perspektive.de/en/52-christian-muenz/ German exercise consultation mentioned in the interview DMSG Nordrhein-Westfalen – Sport-Sprechstunde: https://dmsg-nrw.de/sport-sprechstunde/ Please note that this service is primarily aimed at the German-speaking MS community. International listeners may find the MSIF, EMSP and MS Society UK resources above more directly useful. --- Until next time – make the most of your life, and ideally include some regular movement along the way. Nele For more information and positive thoughts, subscribe to my newsletter for free. Click here for an overview of all podcast episodes published so far.
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    39 min
  • #181: Stress and MS: factors, challenges and perspectives with Prof. Sigrid Arnade and Prof. Christoph Heesen

    #181: Stress and MS: factors, challenges and perspectives with Prof. Sigrid Arnade and Prof. Christoph Heesen
    Sep 2 2026

    This episode is the English translation of my original German interview with Prof. Sigrid Arnade and Prof. Christoph Heesen, first published in April 2025. We explore what research currently tells us about stress and MS, where the evidence is still limited, and why psychological and social factors deserve a stronger place alongside biological aspects of multiple sclerosis care.

    We discuss:

    • how severe stress and traumatic experiences may influence MS risk and disease activity
    • why everyday stress is so difficult to study scientifically
    • the difference between traumatic events and chronic stress
    • resilience, self-efficacy and empowerment
    • stress-management interventions and psychotherapy
    • gaps in current MS research
    • practical strategies for coping with stress
    • why MS care should follow a genuinely biopsychosocial approach
    Useful links
    • English blog article: https://ms-perspektive.de/en-181-stress/
    • Original German interview and blog article: Stress und MS. Faktoren, Herausforderungen und Perspektiven
    • Lebensnerv Foundation: www.lebensnerv.de
    • Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Hamburg: www.inims.de

    "What is good for me, what is not good for me? And how can I strengthen the things that are good for me?"
    — Prof. Sigrid Arnade

    ---

    See you soon and try to make the best out of your life,
    Nele

    For more information and positive thoughts, subscribe to my newsletter for free.

    Click here for an overview of all podcast episodes published so far.
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    35 min
  • #180: Cannabis and multiple sclerosis. Benefits, risks, CHS and what you should know

    #180: Cannabis and multiple sclerosis. Benefits, risks, CHS and what you should know
    Aug 26 2026

    Cannabis is a popular and often emotional topic in the MS community. Some people hope it may help with spasticity, pain, sleep or other symptoms, while others are concerned about side effects, cognitive changes, dependency, high-potency THC products or complications such as cannabinoid hyperemesis syndrome, or CHS.

    In this solo episode, I take a balanced look at what we currently know about cannabis and multiple sclerosis. I explain the difference between medical cannabinoid treatments such as Sativex/nabiximols, THC, CBD, recreational cannabis, edibles, concentrates and synthetic cannabinoid products. I also discuss where the evidence is strongest, where it is still uncertain, and why product type, dose and frequency matter.

    The episode was inspired in part by reporting from National Geographic on CHS and modern high-potency cannabis products. I also include current MS-specific research and practical questions you can discuss with your neurologist.

    In this episode
    • Why cannabis is such a popular topic in the MS community
    • What THC, CBD and other cannabinoids are
    • Why cannabis is not one single treatment
    • What Sativex/nabiximols is and where it is already used in MS
    • What the evidence says about spasticity
    • What we know, and do not yet know, about pain, sleep and bladder symptoms
    • Why current research comparing THC and CBD is so interesting
    • Why CBD should not automatically be considered an MS treatment
    • Why cannabinoids do not replace disease-modifying MS therapy
    • Possible effects on cognition in people with MS
    • What cannabinoid hyperemesis syndrome, or CHS, is
    • Why CHS can be difficult to recognize
    • Why symptoms may continue for some time after stopping cannabis
    • A practical CHS self-check
    • Why high-potency THC products deserve special caution
    • Why edibles can be difficult to dose
    • The difference between prescription cannabinoids, recreational cannabis and synthetic cannabinoid receptor agonists such as K2 or Spice
    • Why delta-8 THC deserves particular attention in the US
    • A brief look at the legal situation in the US, Germany and other countries
    • Practical questions to ask your neurologist before trying a cannabinoid-based treatment
    • How to monitor whether a treatment is actually improving your quality of life
    Read the full blog post

    You can find the full article on: https://ms-perspektive.de/en/180-cannabis/

    The blog post includes the detailed discussion behind this episode as well as the studies, reviews, official guidance and original sources used for the podcast, including research on MS spasticity, cognition, THC versus CBD, CHS and high-potency cannabis products.

    Important note

    This episode is intended to inform, not to promote or discourage cannabis use in general. Cannabinoid-based medicines may be helpful for some people with MS, particularly for certain symptoms, but benefits and risks depend on the exact substance, formulation, dose, frequency of use and individual situation.

    Please discuss any cannabinoid-based treatment with your neurologist or another qualified healthcare professional, especially if you already take other medications or experience cognitive problems, dizziness, balance issues, recurrent nausea or vomiting.

    The information in this episode does not replace individual medical advice.

    ---

    See you soon and try to make the best out of your life,
    Nele

    For more information and positive thoughts, subscribe to my newsletter for free.

    Click here for an overview of all podcast episodes published so far.
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    42 min