Advancing Early Diagnosis and Treatment Strategies in Multiple Sclerosis

Diagnosing multiple sclerosis (MS) has changed considerably in recent years for neurologists in the field, with revised criteria now allowing clinicians to identify the disease earlier and with greater confidence.¹ These shifts, along with a broader move toward early high-efficacy treatment, will be among the topics addressed for patients with MS at the 4th Annual Updates in Neurology CME Symposium, hosted by Northwestern Medicine on October 9, 2026, in Chicago, Illinois.

The 1-day course is designed to give clinicians a concise, evidence-based refresher across the full scope of neurology, with sessions spanning movement disorders, sleep medicine, headache, neuromuscular disease, epilepsy, Alzheimer disease, neuro-ophthalmology, and neuroradiology in addition to MS. Leading the MS portion of the agenda is neurologist Hannah Kopinsky, MD, whose talk, titled "Updates in Multiple Sclerosis Diagnosis and Management," will walk attendees through the latest diagnostic revisions, evolving treatment sequencing, and where the field still falls short for patients with progressive MS.

Ahead of her session, Kopinsky, a clinical assistant professor of neurology, specializing in MS and neuroimmunology, at Northwestern Medicine, spoke with NeurologyLive^®. In the conversation, she talked about what's changed in MS diagnosis, how treatment decisions are being made differently today, and a misconception about the disease she still hears from clinicians.

NeurologyLive: What are the biggest changes in MS diagnostic criteria that clinicians should be aware of right now, and how might they affect who gets diagnosed earlier?

Hannah Kopinsky, MD: There were several changes implemented in the 2024 revision to the McDonald diagnostic criteria for diagnosing MS.¹ The biggest changes to highlight are:

1) The addition of the optic nerve as a fifth anatomical site in the central nervous system (CNS) to fulfill dissemination in space.

2) The utilization of paraclinical biomarkers such as kappa free light chain index in the cerebrospinal fluid, and central vein sign and paramagnetic rim lesions on MRI, which increase the specificity of the diagnosis of MS and can contribute to the diagnosis in patients meeting other appropriate criteria.

3) No longer requiring patients to present with a typical clinical syndrome to be diagnosed with MS if they meet the diagnostic criteria by fulfilling dissemination in space (historically known as radiologic isolated syndrome) and dissemination in time, or fulfilling dissemination in space in addition to other paraclinical markers as mentioned above.

There are also several other changes implemented that I plan to discuss further in my talk. Each of these changes allows for earlier diagnosis by broadening our diagnostic criteria, while enhancing specificity, without waiting for neurologic worsening. This will allow patients to be started on disease-modifying therapies (DMTs) sooner which will not only prevent neurologic disability through relapses but also through reducing disease progression.

How has the treatment landscape shifted in terms of choosing and sequencing DMTs for newly diagnosed patients?

Over the years, the treatment landscape has shifted largely to favor an early high-efficacy DMT approach over an escalation approach.² This means initiating treatment with a high efficacy therapy after new diagnosis of MS rather than initiating treatment with a lower efficacy therapy and escalating treatment to higher efficacy therapy after breakthrough disease activity.

The early high-efficacy approach not only significantly reduces the occurrence of relapses, but also is thought to reduce the risk of progressive disease. This means more patients are being put on infusion and injection therapies earlier after MS diagnosis rather than oral medications, however, there is certainly still a role for lower and moderate efficacy DMTs based on each patient’s age, comorbidities, and personal preferences.

What emerging data on MS management do you think clinicians haven't fully caught up with yet?

Currently there is a large unmet need in the field to stop or slow the progression of disease in patients with progressive MS. The only FDA approved medication for progressive MS at this time is ocrelizumab. A promising potential drug class that is being actively explored is Bruton’s Tyrosine Kinase (BTK) inhibitors, which are better able to penetrate the CNS than the majority of our current DMTs.³ I will be discussing more of the current data on this DMT class during my talk.

Are there any persistent misconceptions or outdated practices in MS diagnosis or management that you hope to correct during your session?

A persistent misconception is that relapsing MS and progressive MS are 2 separate disease entities, however more and more data is showing that MS exists on more of a spectrum and should be thought of as one disease entity that can exhibit both relapsing and progressive disease activity. The predominant disease activity that we see is largely correlative with biological age and the length of time that a patient has had MS.

What's one key takeaway you want attendees to walk away with and apply in their own practice from your session?

We have made large strides in the field of MS over the years both in terms of diagnosis and management. The current standard of care DMTs are also fantastic at preventing relapses. However, there remains several unmet needs, including the need for effective therapies that target progression independence of relapse activity. We are also not able to accurately predict those that may be more at risk to develop progressive MS who could potentially benefit from more aggressive and experimental therapies such as CAR-T cell therapy. However, there are several potential biomarkers being studied to help predict this as well.

Transcript edited for clarity. For more information and to register for the symposium, click here.

REFERENCES
1. Montalban X, Lebrun-Frénay C, Oh J, et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria. Lancet Neurol. 2025;24(10):850-865. doi:10.1016/S1474-4422(25)00270-4
2. Cross A, Riley C. Treatment of Multiple Sclerosis. Continuum (Minneap Minn). 2022;28(4):1025-1051. doi:10.1212/CON.0000000000001170
3. Dybowski S, Torke S, Weber MS. Targeting B Cells and Microglia in Multiple Sclerosis With Bruton Tyrosine Kinase Inhibitors: A Review. JAMA Neurol. 2023;80(4):404-414. doi:10.1001/jamaneurol.2022.5332