Forty years of progress in multiple sclerosis: Consortium of Multiple Sclerosis Centers reflects upon transformative advances in care and research

Kathy Costello, CMSC, and Bonnie Blain, IOMS, join together to discuss four decades of innovation in MS, from MRI and DMTs, to emerging neuroprotective strategies and personalized care.

As the Consortium of Multiple Sclerosis Centers (CMSC) celebrates its 40th anniversary, we are joined by Kathy Costello, Chief Executive Officer of CMSC, and Bonnie Blain, President of the International Organization of Multiple Sclerosis Nurses (IOMSN), to discuss the field of multiple sclerosis (MS), and how it continues to evolve rapidly, driven by advances in diagnostics, therapeutics, biomarker research and multidisciplinary care.

Kathy Costello, Chief Executive Officer of CMSC, reflects on the major milestones that have transformed the treatment landscape over the past four decades and discusses the future direction of MS care and research.

“More recently, our understanding of MS has continued to evolve, recognizing that while relapses are an important aspect of disease activity, chronic inflammation and neurodegeneration are also occurring within the CNS.”

Bonnie Blain, President of the IOMSN, also joins us to reflect on four decades of progress in MS care and discussed the future of personalized treatment, multidisciplinary care and emerging technologies in MS management.

“If used thoughtfully, AI will not replace clinical judgment. It will strengthen it and help us deliver more proactive, individualized care.”

As CMSC celebrates its 40th anniversary, which moments in MS research and care do you see as the most transformative over the past four decades?

Kathy Costello:

Over the past four decades, the field of multiple sclerosis has undergone remarkable progress. What was considered a disease with few treatment options and limited understanding is now an area with recently updated diagnostic criteria, improved disease understanding, highly effective therapies, and growing optimism for the future.

One of the earliest breakthroughs came in the 1980s with the introduction of MRI, which revolutionized the diagnosis and monitoring of MS by allowing clinicians to visualize lesions within the central nervous system. This fundamentally changed how the disease was diagnosed and monitored. In 1993, the first FDA-approved disease-modifying therapy demonstrated for the first time that the course of MS could be altered, changing the future for people living with the disease. Research in the late 1990s revealed that irreversible nerve damage begins much earlier in the disease than previously believed, shifting the focus toward early intervention to improve long-term outcomes. Over the following decades treatment efficacy improved, and options expanded, with the additions of monoclonal antibodies and oral therapies.

Scientific understanding of MS also evolved substantially. Researchers identified the important role of B cells in disease activity, discovered hundreds of genetic factors associated with MS risk, and gained greater insight into chronic inflammation and neurodegeneration. Lifestyle behaviors were demonstrated to be helpful for symptom management, functional abilities and possibly impactful on the MS disease process.

Today, research continues with a focus on continued understanding of MS biology as well as treatments for progressive MS, and treatments that may promote remyelination. Artificial intelligence is beginning to accelerate drug discovery, imaging analysis, and personalized care strategies.

Together, these advances have fundamentally changed the outlook for people living with MS, transforming the disease from one with few options to one where earlier diagnosis, more effective treatment, and improved quality of life are increasingly achievable.

Bonnie Blain:

Over the past 40 years, MS care has changed in ways we could not have imagined. The introduction of disease-modifying therapies truly shifted the trajectory of the disease, giving patients real hope. Advances in MRI and updated diagnostic criteria have allowed us to diagnose and treat MS earlier.

Just as important has been the move toward team-based, holistic care, with MS nurses playing a key role, alongside a stronger focus on symptom management, quality of life and supporting patients in living well with Multiple sclerosis.

The landscape of MS treatment has evolved dramatically, from the first disease-modifying therapies to today’s more targeted and personalized approaches. What paradigm shifts stand out as defining progress, and how have they changed the lived experience of people with MS?

Kathy Costello:

As I mentioned earlier, 1993 marked the first approval of a therapy capable of modifying the immunopathology of MS. Once it became clear that axonal injury and loss were occurring early in the disease process, it fundamentally changed thinking around when to initiate DMT treatment. The goal became to treat as early as possible following diagnosis.

As monoclonal antibodies and many oral therapies emerged, new considerations around risk and benefit also developed, including the risk of serious infections and the need for ongoing monitoring. At the same time, research on lifestyle factors, including exercise, physical activity and smoking cessation, encouraged people to take a more active role in managing their disease.

The emergence of highly effective DMTs has also transformed the experience of relapses. Some people diagnosed more recently may not even be able to clearly define a relapse because they have not experienced new symptoms meeting traditional relapse criteria since diagnosis.

Bonnie Blain:

One of the biggest changes has been the shift from a “wait and see” approach to treating MS early and more proactively. When disease-modifying therapies first became available, it changed everything.

Now, with more targeted and higher-efficacy options, we can be much more intentional about treatment choices. We are no longer taking a one-size-fits-all approach, but really thinking about what is right for each person.

For people living with MS, this has meant fewer relapses for many, a slower disease course and more confidence in being able to plan their lives.

What milestones in diagnostic and monitoring technology do you believe have had the most significant influence on clinical decision-making?

Bonnie Blain:

MRI has likely had the biggest impact on how we diagnose and manage MS. It has allowed us to identify the disease earlier and follow it over time in a way we could not before. The evolution of the diagnostic criteria has really built on that.

More recently, biomarkers such as neurofilament light are beginning to enter clinical practice, adding another layer to how we monitor disease activity and make treatment decisions.

Kathy Costello:

I also think MRI has had the greatest influence on diagnosis, helping clinicians make more timely and accurate diagnoses.

More recently, research into serum biomarkers has emerged and will likely play an increasingly important role in ongoing disease monitoring.

Looking ahead, what emerging areas do you believe hold the greatest promise for the next decade of MS care?

Kathy Costello:

Continued advances in understanding the biology of MS will help identify new treatment targets. There is also major interest in therapies that target progression, including neuroprotective and remyelinating approaches.

From a clinical standpoint, there is increasing focus on identifying progression earlier, along with earlier recognition and management of mood and cognitive changes.

New therapies capable of slowing progression could significantly change the future for people living with MS, while aggressive symptom management will remain important for preserving function and quality of life.

Bonnie Blain:

I think AI is going to have a major impact on how we care for people with MS. We are already seeing it used to interpret MRI scans more precisely and identify subtle changes earlier.

Looking ahead, AI will help us integrate clinical data, imaging and biomarkers to guide more personalized treatment decisions. It also has the potential to support remote monitoring and flag early signs of disease activity.

If used thoughtfully, AI will not replace clinical judgment. It will strengthen it and help us deliver more proactive, individualized care.

From your perspective, how important has community and shared learning been in driving progress in MS science and care, and where do you see that role evolving at CMSC?

Bonnie Blain:

Community and shared learning have really been at the heart of progress in MS care. So much of what we do has grown through collaboration and relationships across disciplines, across countries and with people living with MS.

Consortium of Multiple Sclerosis Centers has been a major part of that, creating a place for meaningful connection and exchange. It is truly a great organization to be involved with, and I would encourage anyone working in MS care to become engaged.

Those shared experiences and conversations are what continue to move the field forward.

Kathy Costello:

CMSC focuses on comprehensive care for people with MS and, as such, brings multidisciplinary teams together to learn with and from each other.

Supporting community providers and rural providers to improve expertise is essential to ensuring access to high-quality care.

It is also critically important that people living with MS are well educated and confident in their ability to communicate and collaborate with their healthcare professionals on treatment decisions. Improved communication and shared decision-making ultimately support adherence, outcomes and quality of care.