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Lesion location might turn out to be an important factor in long-term disability prediction in patients with primary progressive multiple sclerosis (MS). Using a lesion probability mapping approach, researchers have identified brain regions where the presence of MS lesions predicts an early need for bilateral walking support.

In this Consensus statement, the Magnetic Resonance Imaging in MS (MAGNIMS) study group reviews the application of brain and spinal cord atrophy in clinical practice in the management of MS and makes consensus statements and recommendations for future research.

Recently published findings from the ENDORSE study provide 5 years of randomized safety and efficacy data for two doses of dimethyl fumarate (DMF) in multiple sclerosis. The report complements results from the pivotal CONFIRM and DEFINE trials; however, postmarketing data from clinical practice is needed to complete the risk–benefit profile of DMF.

In clinical trials, outcome measures might determine whether a drug is worthy of further development; in the clinic, they might guide important treatment decisions. Here, Tur and colleagues help clinicians and researchers navigate the maze of options for clinical, neuroimaging, patient-reported and composite outcome measures in multiple sclerosis.

In this Review, Chard and colleagues consider the effects that multiple sclerosis pathology has on brain networks and discuss the ways in which knowledge of brain network changes could inform the targeting of treatments for the condition.

Myelin oligodendrocyte glycoprotein antibody-associated disease is an immune-mediated demyelinating disease that is distinct from multiple sclerosis but shares some of its characteristics. This Expert Recommendation, based on a Magnetic Resonance Imaging in MS workshop, proposes a diagnostic algorithm for the differential diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease and multiple sclerosis, using serological, imaging and clinical features.

The development of treatment for multiple sclerosis over the past 25 years is a success of translational medicine. In this Timeline article, Tintore et al. chart major developments and discuss the implications for current and future patient management.

Approximately half of the people currently with multiple sclerosis (MS) are ≥50 years of age, yet guidelines for management of MS in older age are lacking. This Consensus statement presents the outcomes of an International Advisory Committee on Clinical Trials (IACCT) in MS workshop on ageing and MS, including recommendations for advancing research, care and awareness.

In this Review, MAGNIMS provides an update on the imaging features that differentiate multiple sclerosis (MS) from its most common imaging mimics and a summary of the red-flag MRI features that indicate a diagnosis other than MS.