The so-called silent progression of multiple sclerosis has become one of the "great current challenges" of this pathology, as it can continue to advance even in the absence of visible relapses or clear signs of worsening. This discreet evolution directly impacts the social and personal lives of those who suffer from it, as pointed out by Irene Gómez, a neurologist specializing in demyelinating diseases at the San Carlos Clinical Hospital in Madrid, during the presentation of the "JaquEMate to Multiple Sclerosis" initiative, promoted by Sanofi.
Coinciding with World Multiple Sclerosis Day, which is commemorated every May 30, the biopharmaceutical company has resorted to chess as a metaphor to underline the importance of long-term planning and anticipating the disease's movements. The purpose is to help patients, healthcare professionals, and society as a whole understand that the best way to slow progression is by anticipating it.
Until relatively recently, it was assumed that the disability associated with multiple sclerosis was primarily due to relapses. However, advances in treatments have significantly reduced, and in some cases even eliminated, these episodes, and yet the existence of a "silent progression" capable of generating disability independently of relapses has been confirmed.
In this context, the specialist emphasized that "early identification of subtle symptoms, such as cognitive alterations, persistent fatigue, or minor mobility problems, is fundamental to being able to act sooner and preserve patients' quality of life in the long term."
In Spain, it is estimated that more than 58,000 people live with multiple sclerosis and that around 2,500 new cases are diagnosed each year. It usually begins between the ages of 20 and 40 and affects women more frequently, during their prime working, family, and personal years.
For decades, the understanding of this disease has been articulated almost exclusively around outbreaks. Today, specialists warn that limiting oneself to observing them is "not seeing half the board." Early detection continues to be one of the major challenges, as discreet manifestations, such as more intense fatigue than usual, mild cognitive problems, or small balance difficulties, can go unnoticed. However, identifying them in time can "make a difference in the course of the disease."
This autoimmune and neurodegenerative pathology compromises the central nervous system by damaging myelin, the protective sheath of nerve fibers. This deterioration alters the transmission of information between the brain and the rest of the body, generating a wide variety of symptoms: extreme fatigue, gait disorders, cognitive problems, visual disturbances, and emotional changes.
Therefore, it is a disease with a strong impact both physically and psychologically. Its approach goes beyond strictly healthcare and is also supported by the work of specialized entities, such as patient associations, which offer resources and support.
Close monitoring and continued support
Beatriz del Río, a nurse specializing in multiple sclerosis and coordinator of the Spanish Society of Neurological Nursing (SEDEN), has explained that, in clinical practice, they detect small changes—more fatigue, some slowness, or difficulties with memory and concentration—that are often normalized or attributed to stress, although they can be indicators that something is evolving. That is why she insists that close monitoring and continued support are "so important in multiple sclerosis," as these symptoms have repercussions on the personal and social spheres.
As she has detailed, "there are patients who give up doing things socially because they lose the thread of the conversation or because they feel they can no longer do things in the same way."
Furthermore, many affected individuals express concern because they feel that society does not understand their illness and fear that professionals may not fully understand it either. Faced with this reality, del Río emphasizes that it is "very important not only to educate about the treatment but also about the disease."
The deputy director of the Multiple Sclerosis Foundation Madrid, Laura García Ruano, has emphasized that the impact of the pathology goes "far beyond physical symptoms".
"It affects the work, family, emotional, and social life of those who live with the disease. Therefore, accompaniment, information, and specialized support are essential to help both patients and their environment face the challenges of daily life," she added.
As García Ruano pointed out, patient organizations play a key role in being able to measure and objectify aspects that are not always visible, such as the loss of physical capacity or cognitive deterioration.
At the same time, she stressed that private companies must strive to understand each person's particular situation and adapt working conditions to the reality of each patient.
Along with pharmacological treatments, adopting healthy lifestyle habits—following a balanced diet, practicing regular physical exercise, or avoiding tobacco consumption—can help patients get ahead of this silent progression.
There are no two games or two patients alike
Multiple sclerosis is compared, in this initiative, to a game of chess that requires strategy, foresight, and the ability to react to the unexpected. Each person living with the disease plays their "own game and no two moves are the same, just as there are no two identical ways of experiencing the disease".
In this regard, the event was attended by International Chess Grandmaster Miguel Illescas, who drew a parallel between the concepts of strategy and anticipation.
"Chess and multiple sclerosis share something fundamental: it is not always the one who reacts best who wins, but the one who is capable of anticipating. In both cases, thinking long-term and detecting signs before the problem becomes evident can completely change the game. Through the 'Checkmate Multiple Sclerosis' initiative, we wanted to convey that idea to society in an accessible and experiential way," he explained.