Advancement and Challenges in Multiple Sclerosis: Understanding the Disease from Etiology to Treatment

Multiple Sclerosis (MS) is a chronic immune-mediated neurodegenerative disorder of the Central Nervous System (CNS) that affects more than 2.8 million people worldwide. It is recognized as one of the leading causes of non-traumatic neurological disability among young adults. It is an inflammatory demyelination disease with axonal damage and progressive neurological disability, which creates high personal, social, and economic costs. The development of neuroimaging, immunobiology, and molecular biology has significantly enhanced the accuracy of diagnosis, disease monitoring, and therapeutic development, enabling earlier intervention and better relapse management with disease-modifying therapeutic agents. These innovations have improved clinical training, retention, and optimization of treatment for relapsing forms of the disease. The Pathophysiology of MS is complex, and the factors that lead to the condition are a complicated interplay of genetic risk, environmental exposure (Epstein-Barr virus, vitamin D deficiency, and smoking), and impaired immunological responses. Despite these gains, there are some significant limitations. There are limited therapeutic interventions that are effective against progressive multiple sclerosis; remyelination failure still plays a role in irreversible disability. Predicting treatment response in this disorder is yet to be identified. The existing literature has identified gaps in understanding immune dysregulation, neurodegeneration, and new modulators, including viral exposures, the gut microbiota, and cell signalling pathways. These unaddressed gaps impede the design of individual and neuroprotective therapeutic approaches that can modify the disease course over the long term. This review critically examines the recent developments and current issues in multiple sclerosis, including etiology and Pathophysiology and diagnostic and therapeutic interventions, with a particular focus on highlighting critical areas of knowledge gaps as well as future research directions that may be used in support of multidisciplinary and integrative approaches to enhance the quality of life and multiple sclerosis clinical outcomes in patients.