During the COVID-19 pandemic, people with multiple sclerosis (MS) and their healthcare providers have faced unique challenges related to the interaction between SARS-CoV-2, underlying neurological disease and the use of disease-modifying treatments (DMTs). Key concerns arose, primarily related to the possibility that SARS-CoV-2 infection could trigger the initial demyelinating event or exacerbate disease activity. Another major concern was the safety and efficacy of the COVID-19 vaccines, especially for patients undergoing specific treatments that could weaken their antibody responses. In the post-infection phase, identifying long COVID in patients with MS has been complicated due to the large overlap between post-infection sequelae and MS symptoms. In addition, disruptions in health and rehabilitation services have made it difficult for MS patients to access care. This Series article explores current evidence on the interaction between MS and SARS-CoV-2, identifies the challenges posed by the COVID-19 pandemic in the care of patients with MS, and discusses the significant adoption of digital health solutions, including telemedicine and new technology-based rehabilitation approaches. Based on lessons learned, recommendations and future directions are offered for managing patients with MS, rethinking healthcare systems and improving health outcomes in the post-COVID-19 pandemic era.

Center of Clinical Neuroscience Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Germany

DAI Internal Medicine Geriatric and Neurology University Hospital Luigi Vanvitelli Naples Italy

Department of Health Sciences University of Genoa Genoa Italy

Department of Neurology Amsterdam University Medical Centers Amsterdam the Netherlands

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia

Department of Neurology Oslo University Hospital Oslo Norway

Institute of Clinical Medicine University of Oslo Norway

IRCCS Ospedale Policlinico San Martino Genova Italy

KU Leuven Department of Rehabilitation Sciences Leuven Belgium

MS Centre Department of Neurosciences S Camillo Forlanini Hospital Rome Italy

National Multiple Sclerosis Center Melsbroek Belgium

Neurology Neuroimmunology Department Multiple Sclerosis Centre of Catalonia Vall d'Hebron Barcelona Hospital Campus Universitat Autònoma de Barcelona Barcelona Spain

Section of Neurology Department of Medicine and Surgery University of Perugia Italy

Sorbonne Université Paris Brain Institute ICM CIC Neurosciences Hôpital de la Pitié Salpêtrière Assistance Publique Hôpitaux de Paris INSERM CNRS FCRIN4MS Paris France

Translational Research Unit National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico Rome Italy

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