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Publications

Journal Article Review Ahead of print

PubMed: 42660264 DOI: 10.1016/j.autrev.2026.104169

Modern diagnosis and treatment of multiple sclerosis: advances, challenges, and future directions.

Autoimmun Rev

Authors: Pakeeran Siriratnam, Mineesh Datta, Katherine Buzzard, Robb Wesselingh, Wei Yeh, Nabil Seery, Michael Zhong, Anna He, Vilija Jokubaitis, Tissa Wijeratne, Olga Skibina, Helmut Butzkueven, Saif Huda, Anneke Van der Walt, Mastura Monif

Affiliations

  • Department of Neurology, Eastern Health, Melbourne, Victoria, Australia; Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, Sunshine Hospital, Melbourne, Victoria, Australia.
  • Medical Imaging Eastern Health (Imaging Associates), Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
  • Department of Neurology, Eastern Health, Melbourne, Victoria, Australia; Department of Neurosciences, Eastern Health Clinical School, Box Hill Hospital, Monash University, Box Hill, Victoria, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
  • Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.
  • Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, UK; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
  • Department of Neurology, Sunshine Hospital, Melbourne, Victoria, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
  • Department of Neurology, Eastern Health, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurosciences, Eastern Health Clinical School, Box Hill Hospital, Monash University, Box Hill, Victoria, Australia.
  • Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK.
  • Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.

Abstract

The diagnosis and treatment of multiple sclerosis (MS) remain an evolving challenge in modern neurology. Recent advances are reflected in the 2024 revision of the McDonald criteria, which aim to facilitate earlier, more accurate and biologically informed diagnosis of MS. Key updates include expansion of dissemination in space to incorporate the optic nerve, integration of relapsing and progressive onset MS within a unified diagnostic framework, provision for diagnosis in selected asymptomatic individuals, dispensing with the requirement for dissemination of time in certain situations and incorporation of more specific imaging biomarkers. These include specific radiological features such as the central vein sign and paramagnetic rim lesions, visual pathway assessments using optical coherence tomography, magnetic resonance imaging and visual evoked potentials. Furthermore, oligoclonal bands and kappa free light chain index are now acknowledged as alternative cerebrospinal fluid biomarkers of intrathecal immunoglobulin synthesis. These revisions acknowledge the evolving understanding of MS biology alongside the substantial advances in disease modifying therapies. This review uses the 2024 McDonald criteria as an overarching framework to synthesise and contextualise the recent developments in MS diagnosis and treatment, highlighting their clinical implications, current limitations and future directions.

MeSH

Sclerosis, Multiple Sclerosis, Biomarkers, Diagnosis, Therapeutics, Autoimmunity