Multiple sclerosis.

Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.

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Declaration of interests DJ has received consulting fees from AstraZeneca; and serves as an Associate Editor for Clinical Neurology and Neurosurgery and is compensated by Elsevier. SB has received funding support for this manuscript by the German Research Foundation (CRC-TR-128 and CRC-TR-355) and the Hermann and Lilly Schilling Foundation; and consulting fees, payments, or honoraria from Merck Healthcare, Sanofi, Novartis, Roche, Biogen, TEVA, and Bristol Myers Squibb. RZ has received funding support from Mapi Pharma, EMD Serono, Novartis, Bristol Myers Squibb, Octave, V-VAWE Medical, and Protembis; and consulting fees, payments, or honoraria from EMD Serono, 415 Capital, Sanofi, Novartis, Janssen, and Bristol Myers Squibb. RHBB has received funding support from Biogen, Bristol Myers Squibb, Celgene, Genzyme, Genentech, Latin American Committee for Treatment and Research in Multiple Sclerosis, Novartis, and Verasci; royalties from the Psychological Assessment Resources; and consulting fees, payments, or honoraria from Biogen, Accorda, EMD Serono, Novartis, Bristol Myers Squibb, Immunic Therapeutics, Merck, Roche, and Sanofi. SAM has received funding support from the Multiple Sclerosis Society of Canada, Canadian Institutes of Health Research, EMD Serono, Roche, Novartis, Sanofi, Biogen, and Bristol Myers Squibb; and consulting fees, payments, or honoraria from Biogen, Bristol Myers Squibb, EMD Serono, Novartis, Roche, and Sanofi. FZ has received funding support by the German Research Foundation, German Federal Ministry of Education and Research, Novartis Cyprus, and Progressive Multiple Sclerosis Alliance; consulting fees from Actelion, Biogen, Bristol Meyers Squibb, Celgene, Janssen, Max Planck Society, Merck Serono, Novartis, Roche, Sanofi, Genzyme, and Sandoz. BW-G has received funding from Biogen, Bristol Myers Squibb, Celgene, Genentech, and Novartis; and consulting fees from Biogen, Bayer, Bristol Myers Squibb, Janssen, Horizon Therapeutics, Genzyme, and Sanofi; and payment or honoraria as a speaker from Biogen and Janssen.