Purpose of review: The expanding portfolio for multiple sclerosis treatment, together with the consensus that neurodegenerative processes occur since the early disease phases, has increased the need for paraclinical tests with prognostic value on disease evolution and treatment response.
Recent findings: On the one hand, we face the development of MRI technology, from lesion detection, to global and regional volumetric measures, to tissue damage quantification within brain and spinal cord lesions and in normal appearing tissue, together with increased knowledge about their application. On the other hand, traditional neurophysiological techniques, such as evoked potentials, are being recently analyzed with a quantitative approach allowing us to reveal their correlation with actual and future disability, and are being complemented by more recent technical advancements, such as multifocal visual evoked potentials and optical coherence tomography, for the assessment of demyelination/remyelination and axonal loss, respectively.
Summary: The increased value of MRI and neurophysiological tools in predicting disease evolution and treatment response will impact the therapeutic management of multiple sclerosis, from the choice of the first treatment to the type and frequency of monitoring toward a tailored, time-adapting treatment approach.