Multiple sclerosis (MS) is a disease where the body’s immune system mistakenly attacks the protective coating around nerve cells in the brain and spinal cord. Scientists have discovered that MS develops from a combination of factors: genes you inherit, environmental triggers like certain viruses and vitamin D deficiency, and problems with how your immune system works. This new review brings together everything we know about what causes MS and explains why current treatments help some patients but not others. Understanding these causes could lead to better treatments that not only calm the immune system but also help repair damaged nerves.

The Quick Take

  • What they studied: Scientists reviewed all the research about what causes multiple sclerosis, including genes, environmental factors, and how the immune system goes wrong in MS patients.
  • Who participated: This is a review article that analyzed existing research rather than studying new patients directly. It summarizes findings from thousands of previous studies on MS.
  • Key finding: MS develops when multiple factors combine: certain genes make you vulnerable, environmental triggers (like viruses or low vitamin D) activate the disease, and the immune system attacks nerve protective coating. Current medicines reduce flare-ups but don’t stop long-term disability, especially in progressive MS.
  • What it means for you: Understanding MS causes suggests future treatments should do two things: control the immune system AND protect and repair damaged nerves. This dual approach may work better than current single-target treatments. However, this is a scientific review, not a clinical trial, so new treatments are still being developed.

The Research Details

This is a comprehensive review article, which means scientists read and analyzed hundreds of existing research studies about multiple sclerosis. Rather than conducting new experiments, the authors organized what we already know about MS into a complete picture. They examined research on three main areas: genetic factors (the genes that increase MS risk), environmental triggers (things in your environment that can start the disease), and immunological problems (how the immune system malfunctions in MS). The review also looked at newer discoveries about the gut bacteria and how genes are turned on and off in MS patients.

The authors then evaluated current MS treatments and explained why they work partially but have limitations. They reviewed eight different FDA-approved medications and discussed how they reduce disease flare-ups and brain inflammation but often don’t prevent the gradual disability that develops over time, especially in progressive forms of MS.

This type of review is valuable because it brings together scattered information from many studies into one organized summary, helping doctors and researchers see the bigger picture of how MS develops.

Review articles like this are important because MS is extremely complicated. No single study can explain everything about the disease. By combining findings from thousands of studies, scientists can identify patterns and connections that wouldn’t be obvious from looking at individual studies. This comprehensive view helps researchers develop better treatment strategies. The review specifically highlights a major problem: current treatments only partially work, so understanding all the causes of MS is essential for creating better medicines.

This review was published in Inflammopharmacology, a peer-reviewed scientific journal, meaning other experts checked the work before publication. The authors appear to have thoroughly examined the scientific literature on MS. However, as a review article rather than a new research study, it doesn’t provide new experimental data. The strength of the conclusions depends on the quality of the studies reviewed. The authors acknowledge that MS is complex and that no single treatment approach has solved the problem, which shows scientific honesty about current limitations.

What the Results Show

The review identifies three main categories of MS causes working together. First, genetic factors: certain genes, especially one called HLA-DRB1*15:01, increase MS risk significantly. However, having these genes isn’t enough to cause MS—many people with these genes never develop the disease. Second, environmental triggers include Epstein-Barr virus infection (a common virus that causes mononucleosis), vitamin D deficiency, and smoking. These environmental factors appear to activate MS in people who are genetically vulnerable. Third, the immune system malfunction involves two types of immune cells (T-cells and B-cells) that mistakenly attack myelin, the protective coating around nerves.

The review also highlights newer discoveries about the gut microbiome (bacteria in your digestive system) and epigenetic changes (how genes are turned on or off without changing the DNA itself). These factors appear to influence whether someone develops MS and how severe it becomes.

Regarding current treatments, the review confirms that eight different FDA-approved medications reduce how often MS flare-ups occur and decrease inflammation visible on brain scans. These medications work through different mechanisms: some calm the immune system, others block immune cells from entering the brain, and others reduce specific immune cell types. However, the critical finding is that none of these treatments consistently prevent the gradual disability that develops over time, particularly in progressive MS where the disease slowly worsens without clear flare-ups.

For acute flare-ups, high-dose corticosteroids are the standard treatment, with plasma exchange (filtering the blood) reserved for severe cases that don’t respond to steroids.

The review emphasizes that nerve damage and failure to repair damaged nerves are major problems in MS that current treatments don’t adequately address. Even when inflammation is controlled, the nerves continue to deteriorate. The authors stress that future treatments need to focus on neuroprotection (protecting nerve cells from damage) and remyelination (helping the body repair the protective coating around nerves). The review also notes that progressive MS, where disability gradually worsens, is particularly difficult to treat with current medications, suggesting this form of the disease may require different treatment approaches.

This review builds on decades of MS research and confirms what scientists have suspected: MS is not caused by a single factor but by multiple factors working together. The review incorporates newer discoveries about the gut microbiome and epigenetic factors that weren’t well understood in earlier research. The finding that current treatments reduce flare-ups but don’t prevent long-term disability has been recognized for years, but this review emphasizes that solving this problem requires understanding all the biological causes of MS. The comprehensive approach suggested here represents an evolution in thinking about MS treatment.

As a review article, this study doesn’t provide new experimental evidence—it summarizes existing research. The strength of the conclusions depends on the quality of studies reviewed. The review doesn’t provide specific statistics about how many MS patients benefit from current treatments or how much disability progression is prevented. Additionally, while the review identifies multiple causes of MS, it doesn’t explain exactly how these causes interact or which factors are most important for each individual patient. The review also doesn’t discuss cost, side effects, or practical challenges of implementing new dual-target treatment approaches. Finally, some of the newer discoveries about the microbiome and epigenetics are still emerging, so their clinical importance isn’t yet fully established.

The Bottom Line

Based on this review, people with MS should: (1) Work with a neurologist to stay on a disease-modifying therapy (DMT) to reduce flare-ups and inflammation—moderate confidence that this helps prevent some disability; (2) Maintain adequate vitamin D levels through sun exposure or supplements—moderate confidence this may help, as vitamin D deficiency is identified as a risk factor; (3) Avoid smoking, as it’s identified as an environmental trigger—high confidence this is beneficial; (4) Discuss with your doctor whether your current treatment is adequately controlling your disease, as current medications have limitations—moderate to high confidence. Patients should understand that current treatments are helpful but not complete solutions, and new approaches are being researched.

People with MS or at high risk for MS (family history) should care about this research. Family members of MS patients may want to know about risk factors like vitamin D deficiency and smoking. Healthcare providers treating MS patients should understand these findings to explain treatment limitations to patients. Researchers developing new MS treatments should use this comprehensive overview to guide their work. People without MS don’t need to make changes based on this review, though maintaining vitamin D levels and avoiding smoking are healthy practices for everyone.

Current MS treatments typically show benefits within weeks to months in reducing flare-ups. However, preventing long-term disability progression takes years to evaluate. New treatments combining immune control with nerve protection are still in development, so it may be 5-10 years before such approaches become available. Patients should expect that managing MS is a long-term process requiring ongoing treatment and monitoring.

Want to Apply This Research?

  • Track MS flare-ups (relapses) monthly, noting date, symptoms, severity (mild/moderate/severe), and duration. Also track vitamin D levels (if tested) and any changes in disability or function. This data helps identify patterns and assess whether current treatment is working.
  • Use the app to set reminders for: (1) Taking MS medications consistently as prescribed; (2) Maintaining vitamin D levels through supplementation or sun exposure; (3) Avoiding smoking triggers; (4) Scheduling regular neurologist appointments. Create a symptom log to share with your doctor to assess disease progression.
  • Establish a baseline of your current disability level and symptoms. Monthly, rate your overall function on a simple scale (1-10). Track any new symptoms or worsening of existing symptoms. Every 3-6 months, review trends with your healthcare provider to determine if your current treatment is adequately controlling your disease. This long-term tracking helps identify whether you’re progressing and whether treatment adjustments are needed.

This article summarizes scientific research about multiple sclerosis causes and current treatments. It is not medical advice and should not replace consultation with a qualified healthcare provider. If you have MS or suspect you might, please work with a neurologist for diagnosis and treatment. Treatment decisions should be made with your doctor based on your individual situation, medical history, and disease type. Current MS medications have different benefits and risks that your doctor can discuss with you. This review discusses emerging research directions, but new treatments are still in development and not yet available. Always consult your healthcare provider before making changes to your MS treatment plan.