BACKGROUND AND PURPOSE: Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. METHODS: A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. RESULTS: Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. CONCLUSIONS: Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe.

Centre for Neuroscience and Trauma Department of Neurology Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK

Department of Neurology Charles University Prague Czech Republic

Department of Neurology Danish Multiple Sclerosis Research Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Neurology Instituto de Investigación Biomédica de Malaga Hospital Regional Universitario Malaga University Malaga Spain

Division of Neurology Karolinska Institute Stockholm Sweden

Klinik für Neurologie Phillipps Universitat Marburg Fachgebiet Indologie und Tibetologie Marburg Germany

Neuroimaging Research Unit Osepdale San Raffaele Milan Italy

Neurological Sciences MS Centre Rome Italy

Neurology and Department of Biomedicine Universitatsspital Basel Basel Switzerland

Neurology D CHU Lille Lille France

Neurology Heinrich Heine University Düsseldorf Düsseldorf Germany

Neurology Institut des Neurosciences Cliniques de Rennes Rennes France

Public Management and Policy SDA Bocconi Scuola di Direzione Aziendale Milano Italy

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