Multiple sclerosis: 2026 update

Multiple sclerosis (MS) is the inflammatory-demyelinating disease of the CNS with the highest prevalence. Despite significant progress in reducing relapse activity by immunomodulatory or immunosuppressive treatments, there are ongoing challenges in understanding its initiation and predicting disease evolution. Furthermore, since we only partially understand the mechanisms driving disease progression, its successful treatment represents a major challenge. Therefore, this review article summarizes key research findings from the last 18 months, covering advances in the understanding of pathophysiology including the effects of aging on glial and immune cells as well as the functional role of tissue-resident memory cells. Additionally, we discuss advances in imaging technologies and biomarkers as well as the use of AI to predict disease evolution. Finally, we report the most recent findings from clinical trials targeting immune cells within the CNS.