DEMYELINATING DISEASES: Edited by Roland MartinDisease-modifying treatments for early and advanced multiple sclerosis: a new treatment paradigmGiovannoni, Gavin Author Information Blizard Institute, Barts and The London School of Medicine and Dentistry and Department of Neurology, Royal London Hospital, Barts Health NHS Trust, Queen Mary University London, London, UK Correspondence to Professor Gavin Giovannoni, MBBCh, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry and Department of Neurology, Queen Mary University London, 4 Newark Street, London E1 2AT, UK. Tel: +44 20 7882 2579; fax: +44 20 7882 2180; e-mail: [email protected] Current Opinion in Neurology: June 2018 - Volume 31 - Issue 3 - p 233-243 doi: 10.1097/WCO.0000000000000561 Buy Metrics Abstract Purpose of review The treatment of multiple sclerosis is evolving rapidly with 11 classes of disease-modifying therapies (DMTs). This article provides an overview of a new classification system for DMTs and treatment paradigm for using these DMTs effectively and safely. Recent findings A summary of research into the use of more active approaches to early and effective treatment of multiple sclerosis with defined treatment targets of no evident disease activity (NEDA). New insights are discussed that is allowing the field to begin to tackle more advanced multiple sclerosis, including people with multiple sclerosis using wheelchairs. However, the need to modify expectations of what can be achieved in more advanced multiple sclerosis are discussed; in particular, the focus on neuronal systems with reserve capacity, for example, upper limb, bulbar and visual function. Summary The review describes a new more active way of managing multiple sclerosis and concludes with a call to action in solving the problem of slow adoption of innovations and the global problem of untreated, or undertreated, multiple sclerosis. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.