Multiple sclerosis is a chronic, immune-mediated demyelinating disorder of the central nervous system characterized by inflammation, myelin loss, and axonal injury within the brain and spinal cord. The disease results from an abnormal immune response directed against components of the myelin sheath, leading to impaired neural transmission and progressive neurological dysfunction. Multiple sclerosis commonly affects young and middle-aged adults and follows a highly variable clinical course.

The clinical presentation of multiple sclerosis depends on the location and extent of demyelinating lesions. Common initial symptoms include visual disturbances such as optic neuritis, sensory symptoms, limb weakness, gait instability, diplopia, and bladder or bowel dysfunction. Cognitive impairment, fatigue, and mood disturbances are increasingly recognized as significant contributors to disease burden. Symptoms may occur in relapses with partial or complete recovery or progress gradually over time.

Multiple sclerosis is classified into distinct disease phenotypes, including relapsing-remitting, secondary progressive, and primary progressive forms. Accurate classification is essential for prognosis and treatment planning. Diagnosis is based on clinical evaluation supported by magnetic resonance imaging demonstrating dissemination of lesions in time and space, along with cerebrospinal fluid analysis when required.

Neurological management of multiple sclerosis focuses on three major pillars: treatment of acute relapses, long-term disease modification, and management of chronic symptoms and complications. Acute relapses are typically managed with short courses of high-dose corticosteroids to reduce inflammation and accelerate recovery. Long-term disease-modifying therapies aim to reduce relapse frequency, delay disability progression, and limit new lesion formation.

Selection of disease-modifying therapy is individualized based on disease activity, imaging findings, patient characteristics, and risk tolerance. Ongoing monitoring is essential to assess treatment response and detect adverse effects. As the disease evolves, treatment strategies may require escalation or modification to maintain disease control.

Symptomatic management plays a critical role in comprehensive multiple sclerosis care. Spasticity, neuropathic pain, fatigue, bladder dysfunction, and cognitive impairment require targeted neurological and supportive interventions. Multidisciplinary involvement enhances functional outcomes and quality of life.

Multiple sclerosis is a lifelong condition requiring continuous neurological follow-up. Early diagnosis, timely initiation of therapy, and proactive management of complications are essential to minimizing long-term disability and preserving neurological function.