Delivering high-quality multiple sclerosis care in Germany: challenges and regional models

Multiple sclerosis (MS) care in Germany has entered a phase in which therapeutic progress is increasingly constrained by delivery capacity. Earlier diagnosis, broader access to high-efficacy disease-modifying therapies (DMTs), and more refined monitoring strategies have improved the potential for favourable long-term outcomes. At the same time, these advances have increased the need for specialised expertise, infusion and monitoring infrastructure, rapid imaging access, structured safety procedures, and cross-sector coordination. Real-world evidence from Germany indicates a shift towards early high-efficacy treatment but also shows regional variation in treatment initiation, therapy intensity, and the proportion of people with MS who remain DMT-untreated. This expert-informed narrative review combines a non-systematic literature review with selected regional implementation examples from German MS care. This review synthesises key delivery challenges in German MS care and maps regional models whose underlying organisational principles may be transferable across healthcare settings, while their specific implementation depends on the local regulatory and reimbursement context. The central argument is that high-quality MS care should be understood not only as a therapeutic decision but as a system property: evidence-based treatment must be embedded in reliable pathways for diagnosis, monitoring, escalation, de-escalation, rehabilitation, and long-term support. Regional models such as ambulatory specialist care structures, hub-and-spoke networks, Germany´s inpatient MS complex treatment programme, delegated task models, telemedical consultation pathways, and digital monitoring infrastructures provide practical building blocks. Implementation at scale will require measurable quality indicators, financing of coordination work, formalised skill-mix models, digital interoperability, and explicit strategies for ageing and multimorbid MS populations. For neurological practice, the challenge is therefore not whether modern MS care is possible, but how to make it reproducible, safe, and equitable across regions.