So maybe let's, as a starting point, talk about that and how potentially then we could use technology to overcome some of those, those challenges and barriers that exist.

Well, one thing that we notice is that anything that requires active input from a person, uh, whether a person living with MS or just in general, is fraught with, uh, potential for missing this.

So for example, whether in the clinic or in the real world, if you're asking people to fill out a patient-reported outcome or PRO with any periodicity, there's the opportunity for the person to simply skip filling that out.

And when people skip filling it out, it's usually not random.

Usually, there's something related to the person's condition, whether they're extremely well and not experiencing fatigue, as in this example, or they're extremely fatigued and feel overburdened.

Uh, there's usually something that essentially leads to a bias in the data that are delivered.

And so I think that is one challenge that studies that have tried to incorporate technologies embedding PROs have noticed.

But if there was one piece of technology or innovation that you are most excited about, that you're most looking forward to following updates on, what would it be?

And what were some of the main points?

Dr. Okuda provided a really nice section on the treatment of acute relapses in multiple sclerosis, and it's important to understand what we talk about when we are saying relapse.

For people with MS, many symptoms can fluctuate and occur and then get better over time, and sometimes people with MS use the same term of relapse to describe those symptom fluctuations.

As neurologists, when we're thinking about relapse, we're really trying to think about symptoms that can be attributed to new focal inflammatory events somewhere in the central nervous system.

Typically, these are accompanied, if you were to get an MRI at the same time, by a new lesion or MS spot, as I like to call them, on MRI scan.

And so it's important to distinguish when somebody is talking about symptoms, whether they are true new symptoms that could be mapped to a place in the central nervous system, because alternatively, a lot of people who've had attacks or relapses in the past can have what we call pseudo-relapses, and these are essentially recrudescence of old symptoms, typically in a similar pattern as what had occurred in the past.

And these can be brought out by things like fever or infection, sometimes stressAnd pseudorelapses are not thought to be due to new development of immune system induced injury, and therefore would be less likely to respond to treatment, and in fact, treatment may be contraindicated for those events.

What are the pearls to advance to more high efficacy therapies?