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Updated: Apr 4, 2026

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS
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Optimizing therapy early in multiple sclerosis: An evidence-based view

Tjalf Ziemssen1, Nicola De Stefano2, Maria Pia Sormani3

  • 1Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany.

Multiple Sclerosis and Related Disorders
|September 9, 2015
PubMed

Insights

Early switching to higher-efficacy therapies is recommended for multiple sclerosis (MS) patients with high disease activity. Optimizing treatment can better control both inflammatory lesions and neurodegeneration, improving long-term disease management.

Area of Science:

  • Neuroimmunology
  • Clinical Neurology
  • Pharmacology

Background:

  • Multiple sclerosis (MS) involves focal (lesions) and diffuse (neurodegeneration) damage.
  • Diffuse damage correlates with disability progression and cognitive decline.
  • First-line MS therapies may not control disease activity in all patients.

Purpose of the Study:

  • To review EU-approved disease-modifying therapies for MS.
  • To assess efficacy on relapses, disability, MRI, and brain volume loss.
  • To evaluate early treatment optimization strategies for active MS.

Main Methods:

  • Review of EU-approved disease-modifying therapies.
  • Analysis of efficacy on conventional MS outcomes and brain volume loss.
  • Examination of evidence for early treatment optimization.

Main Results:

  • Efficacy data on disease-modifying therapies for MS outcomes are presented.
  • Brain volume loss as a measure of diffuse damage is considered.
  • Evidence for early treatment optimization in active MS is reviewed.

Conclusions:

  • Higher-efficacy therapies may be needed for patients with inadequate response to first-line treatments.
  • Targeting both focal and diffuse MS pathology is crucial for long-term control.
  • An algorithm for optimal disease control in MS is proposed.
Keywords:
Breakthrough disease activityMS therapiesOptimizing treatmentOutcome measuresSwitching therapyTreatment algorithm

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