Advances in the understanding and management of multiple sclerosis phenotypes

Abstract

Multiple sclerosis is a chronic autoimmune disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. This review synthesizes current understanding of multiple sclerosis subtypes, diagnostic criteria, and the evolving landscape of therapeutic strategies. It highlights advances in imaging modalities and biomarkers that enhance disease characterization and monitoring. Clinically isolated syndrome and radiologically isolated syndrome are recognized as early indicators of multiple sclerosis, with specific magnetic resonance imaging features and cerebrospinal fluid findings aiding in diagnosis and prognosis. Relapsing-remitting multiple sclerosis remains the most prevalent form, with many patients eventually progressing to secondary progressive multiple sclerosis. Primary progressive multiple sclerosis presents unique diagnostic and therapeutic challenges. Recent years have seen a shift toward early aggressive therapy, with monoclonal antibodies like ocrelizumab and ofatumumab demonstrating significant efficacy in reducing disease activity. New oral agents and autologous hematopoietic stem cell transplantation show promise, particularly in refractory or highly active cases. Siponimod and other selective S1P modulators are emerging as treatments for active SPMS, though therapeutic options for non-active progressive forms remain limited. Biomarkers such as neurofilament light are under investigation for their roles in early detection, subtype differentiation, and monitoring disease progression. This review underscores the growing role of precision medicine in multiple sclerosis, driven by improved diagnostics, individualized treatment approaches, and novel therapeutic targets