Management of Multiple Sclerosis: Past, Present and Promise

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