Directions for advancing prognostic assessments in multiple sclerosis: Qualitative Insights from MS specialist Interviews

Authors

Sofie Aerts^a,b,c,d, Lotte Geys^a,b,e, Deborah Severijns^a,c,d, Mona Alkhawajah^f, Thomas Berger^g,h, 

Alexey Boyko^i,j, Nikolaos Grigoriadis^k, Hans-Peter Hartung^g,l,m,n, Melinda Magyari^o,p

 Celia OrejaGuevara^q,r, Carlo Pozzilli^s, Patrick Vermersch^t, Bassem Yamout^u 

Magd Zakaria^v, Tjalf Ziemssen^w, Veronica Popescu^a,b,c, Liesbet M. Peeters^a,b,e, Bart Van Wijmeersch^a,b,c,d

a.University MS Centre (UMSC), Hasselt – Pelt, Belgium/ b. UHasselt, Biomedical Research Institute (BIOMED), Diepenbeek, Belgium/ c. Noorderhart, Rehabilitation and MS Centre, Pelt, Belgium/ d. UHasselt, Rehabilitation Research Centre (REVAL), Diepenbeek, Belgium / e. UHasselt, Data Science Institute (DSI), Diepenbeek, Belgium/ f. Section of Neuroimmunology, Department of Neuroimmunology and Neuromuscular Disease, Neuroscience Center of Excellence, KFSH&RC and Alfaisal University, Riyadh, Saudi Arabia/ g. Department of Neurology, Medical University of Vienna, Vienna, Austria/ h. Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/ i. Pirogov Russian National Research Medical University, Moscow, Russian Federation/ j. Federal Center of Brain Research and Neurotechnologies, Moscow, Russian Federation / k. Second Department of Neurology, Special Unit for Biomedical Research and Education (S.U.B.R.E.), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece/ l. Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany/ m. Brain and Mind Centre, University of Sydney, Sydney, Australia/ n. Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic/ o. Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Denmark/ p. Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Denmark/ q. Department of Neurology, IdISSC, Hospital Clinico San Carlos, Madrid, Spain/ r. Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain/ s. Department of Human Neuroscience, Sapienza University, Rome, Italy/ t. Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France/ u. Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates/ v. Department of Neurology, Ain Shams University, Cairo, Egypt/ w. Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

Abstract

Background

Reliable prognostication in multiple sclerosis (MS) is essential for personalized care, yet remains challenging. In the absence of widely implemented prognostic tools, how MS specialists today formulate prognostic judgments and manage related challenges in routine practice is underexplored.

Methods

Twelve MS specialists from European and Middle Eastern regions participated in semi-structured interviews. Data were qualitatively analyzed using a two-phase content analysis. Priorities were topics mentioned by more than 50% of participants.

Results

Nine priority questions were identified for improving prognosis-informed MS care: 1) What minimal data are needed to estimate prognosis early?, 2) How should prognostic factors be combined and weighted?, 3) How can subclinical progression be detected and addressed?, 4) How can (less experienced) neurologists be better supported?, 5) How should prognosis-based decisions align with reimbursement and patient preferences?, 6) How can clinical intuition be used alongside evidence?, 7) How can prognosis be communicated, supporting patient optimism and empowerment?, 8) How to develop prognostic tools for MS?, 9) How can quality of life be integrated as a core prognostic outcome?.

Conclusions

MS prognostication in current practice remains fragmented and experience-driven. Addressing these questions could guide future research and the development of prognostic tools that embed prognosis-informed care into MS management.

Keywords:

Multiple sclerosis Prognosis Prognostication Neurologist Personalized care Prognostic tools

Publication History:

Received August 25, 2025; Revised December 8, 2025; Accepted January 12, 2026; Published online January 13, 2026

DOI: 10.1016/j.jns.2026.125756 External LinkAlso available on ScienceDirect External Link

Copyright: © 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

We value your opinion.

think How colleague?

How likely are you to recommend this material to a friend or colleague?

Selected Value: 1

Give a score from 1 (= not at all likely) to 10 (extremely likely)

Tell us what you think or ask a question to the expert.

Give your opinion on the quality of the material and send us your comments, questions or feedback. Where relevant, we'll liaise with the Expert and get back to you.

Email

If you have submitted a question above, leave your email so we can get back to you.

Submit