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Multiple Sclerosis Understanding Multiple Sclerosis Better in 2014 – Environmental Factors, Remyelination, Diagnostic Techniques, Treatment Decisions and the Future Focus of Multiple Sclerosis Treatment Report of the MS Days Meeting Held in Istanbul, Turkey, Friday 31 October to Sunday 2 November 2014 Expert review by: Hüsnü Efendi, 1 Rana Karabudak, 2 Orhun Kantarci 3 and Aksel Siva 4 1. Kocaeli University, School of Medicine, Kocaeli, Turkey; 2. Hacettepe University, School of Medicine, Ankara, Turkey; 3. Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota, US; 4. Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey Abstract Epidemiological factors, such as vitamin D, Epstein–Barr virus, smoking and adolescent obesity, are associated with multiple sclerosis (MS) susceptibility and may be involved in MS aetiology. There is also evidence of gene–environment interactions. Both validated predictive biomarkers and gene-expression data will play a crucial role in future diagnosis of MS and prognosis facilitating early treatment and improving management. Understanding the mode of action of disease-modifying therapies (DMTs) should also enhance MS management by identifying the best treatment for different stages of the disease course. Magnetic resonance imaging (MRI) plays a significant role in both diagnosis and monitoring of patients and is likely to become part of the daily MS practice using standardised protocols and software to increase reproducibility. A future goal of MS treatment is to facilitate neuron repair and remyelination. In this respect, animal models of remyelination could be useful in identifying potential therapies. Diagnosis of radiological syndrome is now simpler, but its management is controversial and it does not always convert to MS. In addition, treatment for progressive MS is problematic as current DMTs are indicated only for relapsing- remitting MS. Symptomatic treatment is a neglected aspect of MS management, which is often the main concern of both patients and neurologists. Neurologists need to collaborate in trials and consider repurposed drugs that could provide treatment for these symptoms. The second MS Days meeting provided a valuable platform for these critical topics to be discussed and novel solutions to be considered. Keywords Epidemiological factors, gene/environment interactions, radiological isolated syndrome, MRI, remyelination, progressive MS, diagnosis Disclosure: Hüsnü Efendi has received travel funding and/or speaker honoraria from Bayer Schering, Biogen, Genzyme, Merc Serono, Novartis and Teva. Rana Karabudak has received honorary fees and grants for consultation and educational presentations and manuscripts from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey, Teva, Bayer-Schering and Genzyme, and travel grants for annual ECTRIMS and AAN meetings from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey, Teva, Bayer-Schering and Genzyme. Orhun Kantarci receives research support from the European Regional Development Fund (FNUSA-ICRC CZ.1.05/1.1.00/02.0123) and the National Multiple Sclerosis Society and has given scientific presentations at meetings supported by Teva and Novartis Pharmaceuticals, but has received no personal fees or personal compensation for this activity (all compensation for consulting activities paid directly to Mayo Clinic). Aksel Siva’s department has received research grants from The Scientific and Technological Research Council Of Turkey – Health Sciences Research Grants numbers: 109S070 and 112S052; and also unrestricted/unconditional research grants from Merck-Serono to his Clinical Neuroimmunology Unit. Aksel Siva has received honoraria for giving educational presentations and consultation fees and travel and registration coverage for attending several national or international congresses or symposia, from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey, Teva, Genzyme and Excemed. Acknowledgement: Medical writing support was provided by Ray Ashton, Touch Medical Media, funded by Novartis Pharmaceuticals. This article reports the proceedings of a sponsored satellite symposium and as such has not been subject to the journal’s usual peer-review process. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 13 October 2015 Published Online: 10 November 2015 Citation: European Neurological Review, 2015;10(2):148–56 Correspondence: Hüsnü Efendi, Kocaeli University faculty of Medicine, 41380 Kocaeli, Turkey. E: Support: The publication of this article was supported by Novartis Pharmaceuticals. The views and opinions expressed in the article are those of the authors and not necessarily those of Novartis Pharmaceuticals. Understanding MS Better in 2014 Contribution of Epidemiological factors Multiple sclerosis (MS) is considered to be an immune-mediated neuro-inflammatory and neurodegenerative disease of the central nervous system (CNS) with heterogeneous clinical presentation and course, neuroimaging and pathological findings. Several genetic and environmental factors have been shown to show some association 148 with MS; gene–environment interactions are hypothesised to have a stronger effect and the interplay between these factors might be due to common pathogenic mechanisms. Epidemiological factors are involved in the causality of MS and affect the disease course. Several well-validated environmental factors have been identified that are associated with MS susceptibility including vitamin D, viral infections (especially Epstein Bar virus [EBV]), smoking and adolescent obesity. TOU C H ME D ICA L ME D IA