title: Shifting paradigms in multiple sclerosis: from disease-specific, through population-specific toward patient-specific.
abstract: In recent years we notice paradigm shifts in the understanding of multiple sclerosis (MS), leading to important transition in the patients' management. This review discusses some of the recent findings and developments underlying the conceptual changes being translated from 'treating the disease' to 'treating the patient' with MS (PwMS).
  
  
  
  Applying advanced technologies combined with cross-disciplinary efforts in the fields of neuropathology, neuroimmunology, neurobiology, and neuroimaging, together with clinical neurology provided support for the notion that MS is not a single disease but rather a spectrum. Predictive markers of disease subtypes, disease activity and response to therapy are being developed; some already applied to practice, allowing informed management. In parallel, population-specific issues, some genetic-driven, others caused by environmental (sun-exposure, life-style, etc.), gender-related (hormones) and epigenetic factors, are being elucidated. Additionally, patient empowerment-based approaches, including integration of patient-reported outcome measures (PRO) as well as tools to enhance patients' adherence to medications, are being developed, some already provided as part of emerging mobile-health technologies.
  
  
  
  Developments in the MS field, elucidating disease subtypes and interpopulation diversities, together with integration of patient-centered approaches, allow transition toward precision medicine in MS clinical trials and patient care.
authors.affiliation: aDivision of Neuroimmunology & Multiple Sclerosis Center, Lady Davis Carmel Medical Center bRuth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Golan
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Staun-Ram
authors.forename: Ariel
authors.initials: A
authors.lastname: Miller
mesh_terms: D019468:Disease Management; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000209:etiology; D057285:Precision Medicine
chemical_list: D007155:Immunologic Factors