Topic Editors

Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Palermo, Italy
Department of Experimental Medicine and Clinical Neurosciences, Università degli Studi di Palermo, Palermo, Italy

Management of Multiple Sclerosis: Past, Present and Promise

Abstract submission deadline
closed (5 September 2025)
Manuscript submission deadline
5 November 2025
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4737

Topic Information

Dear Colleagues,

Multiple Sclerosis (MS) is an autoimmune and degenerative chronic disease of the central nervous system, representing one of the leading causes of neurological disability in young people. Although the disease phenotype was formerly considered to be characterized by a relapsing–remitting (RRMS) disease course followed by secondary progression in most people with MS, more recently, disease phenotypes have been re-considered in light of improved knowledge of pathogenic mechanisms. MS progression is indeed characterized by an unrelenting neurodegenerative process, accompanied by the loss of compensating mechanisms leading to the gradual decline of neurological functions and the accumulation of brain and spine atrophy. Recent advancements in the field of MS treatments have mitigated its dramatic impact on patient activity, daily living, and quality of life by delaying the transition to the overt progressive course and reducing the likelihood of MS relapses and the degree of acquired disability. Despite the efforts of researchers, to date, there are still several unmet needs among both neurologists and people with MS (pwMS). Indeed, the finding of simple, reliable, and convenient biomarkers able to predict MS prognosis remains a challenge since diagnosis is still controversial. Conversely, many pwMS report dissatisfaction despite the many disease-modifying treatments now available since a clear demonstration of effectiveness is still lacking for treating many symptoms. Patients' unmet needs depend in part on the fact that pwMS complain of subtle and irritating symptoms such as fatigue, spasticity, bladder and bowel dysfunctions or psychiatric symptoms that negatively affect quality of life. Moreover, MS-specific sex differences, management of pregnancy, and breastfeeding widen the spectrum of unmet needs in pwMS, and little or no attention has been paid to the social activities of pwMS and their caregivers. In conclusion, even though there have been great strides in the past, many more issues remain to be addressed in the future to guarantee an adequate quality of life for people with MS. Thus, the objective of this Topic is to present the most recent advances in the treatment and care of people with MS. A special focus will be placed on prognostic indicators, to unravel patient’ and caregivers’ unmet needs, and to explore sex differences related to the diseases management, as well as to propose new strategies aimed at improving the management of pregnancy and breastfeeding and quality of life.

Dr. Salvatore Iacono
Dr. Paolo Ragonese
Topic Editors

Keywords

  • multiple sclerosis prognosis
  • sex or gender differences in MS
  • disease-modifying treatments
  • disability
  • unmet needs
  • caregivers
  • pregnancy and breastfeeding
  • quality of life

Participating Journals

Journal Name Impact Factor CiteScore Launched Year First Decision (median) APC
Brain Sciences
brainsci
2.8 5.6 2011 16.2 Days CHF 2200 Submit
Neurology International
neurolint
3.0 4.8 2009 21.4 Days CHF 1800 Submit
NeuroSci
neurosci
2.0 - 2020 27.1 Days CHF 1200 Submit

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Published Papers (2 papers)

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15 pages, 724 KB  
Article
Multidimensional Impairment in Multiple Sclerosis: Physical Disability, Cognitive Dysfunction, Sleep Disturbance, Fatigue, Depression, and Their Impact on Quality of Life—A Possible Common Pathological Pathway
by Simona Petrescu, Maria-Melania Dumitru-Martoiu and Cristina Aura Panea
Neurol. Int. 2025, 17(11), 174; https://doi.org/10.3390/neurolint17110174 - 22 Oct 2025
Viewed by 274
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, which can lead to physical and cognitive disability, fatigue, depression, and sleep disturbance, all of which may impair quality of life (QoL). While the physical disability is widely known [...] Read more.
Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, which can lead to physical and cognitive disability, fatigue, depression, and sleep disturbance, all of which may impair quality of life (QoL). While the physical disability is widely known to influence the QoL, the relative contributions of cognitive impairment, fatigue, and sleep quality remain incompletely defined. Objectives: To evaluate the relationship between QoL, physical and cognitive disability, sleep quality, fatigue, and depression in people with MS (PwMS), and to explore phenotype-specific differences between relapsing and progressive forms. Methods: In this monocentric cross-sectional study, 112 PwMS underwent physical assessment (EDSS, MSFC), cognitive testing (SDMT, PASAT, MoCA, MMSE), and QoL evaluation (MSIS-29, EQ-5D, EQ-VAS, MSNQ). A subgroup of 29 patients also completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Modified Fatigue Impact Scale (MFIS), and Beck Depression Inventory (BDI). Correlation and group analyses were performed. Results: Progressive MS patients showed greater physical disability (mean EDSS 5.8 vs. 2.6, p < 0.001), poorer cognitive performance, and lower QoL. Across the cohort, QoL strongly correlated with physical disability (EDSS) and cognitive performance (SDMT), with physical measures showing stronger associations. In relapsing MS, physical and cognitive impairment were linked to reduced QoL, whereas in progressive MS, physical disability predominated. In the sleep subgroup, poorer PSQI scores, longer sleep latency, and daytime sleepiness correlated with higher fatigue (MFIS), depressive symptoms (BDI), and reduced QoL (MSIS-29, EQ-5D). Conclusions: QoL in MS reflects the combined burden of physical disability, cognitive impairment, fatigue, depression, and poor sleep quality, with phenotype-specific patterns. While physical disability is the main QoL determinant in progressive MS, cognitive deficits with slowed processing speed play an important role in relapsing MS. Comprehensive, multidimensional assessment, including sleep and mood screening, may support individualized management strategies in MS. Full article
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11 pages, 1149 KB  
Perspective
Neurofilament Light Chain and Multiple Sclerosis: Building a Neurofoundational Model of Biomarkers and Diagnosis
by Rany Aburashed, Ansam Eghzawi, Daniel Long, Robert Pace, Ali Madha and Jeanie Cote
Neurol. Int. 2025, 17(4), 56; https://doi.org/10.3390/neurolint17040056 - 11 Apr 2025
Cited by 3 | Viewed by 3527
Abstract
Neurofilament light chain (NfL), an abundant cytoskeletal protein in neurons, has emerged as a promising serum biomarker that indicates non-specific neuronal damage secondary to various neurologic diseases, including multiple sclerosis (MS). Emerging evidence suggests that serum NfL levels correlate with future disability, brain [...] Read more.
Neurofilament light chain (NfL), an abundant cytoskeletal protein in neurons, has emerged as a promising serum biomarker that indicates non-specific neuronal damage secondary to various neurologic diseases, including multiple sclerosis (MS). Emerging evidence suggests that serum NfL levels correlate with future disability, brain atrophy, predict new disease activity, and decrease in response to various disease-modifying therapies. As research continues to validate NfL’s potential role in clinical practice, the need for a practical model to conceptualize and visualize its relevance to MS pathology becomes evident—not only for healthcare providers but also for patients. To address this, we propose the Neurofoundational Model (NFM), which likens a neuron to a home, with various parts of the home representing distinct regions of the central nervous system (CNS). In this model, the home (neuron) experiences scenarios such as a fire, an earthquake, and a slow flood, representing distinct MS disease states. A fire illustrates an MS relapse with good recovery, where serum NfL levels rise during the relapse and subsequently return near baseline. An earthquake represents an MS relapse with poor recovery, where NfL levels increase and remain elevated above baseline. Finally, a slow flood depicts MS in progressive stages, characterized by sustained and gradually increasing serum NfL levels without abrupt clinical changes. This approach offers a clear and relatable visualization for clinicians and patients alike, illustrating the dynamics of serum NfL levels during CNS damage caused by demyelination. By integrating this model into clinical practice, we aim to enhance understanding and communication regarding the role of NfL in MS pathology and its potential utility as a biomarker. Full article
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