It was an exciting week for multiple sclerosis (MS) research in Toronto. From promising new treatment developments to advances in brain imaging, artificial intelligence, and patient-centered care, the 10^th Joint ACTRIMS–ECTRIMS Meeting (MSToronto2026), held October 21–23, brought together more than 7,000 participants from 102 countries to share discoveries and discuss the challenges still facing people living with MS.

The Buffalo Neuroimaging Analysis Center (BNAC) at the University at Buffalo was delighted to be part of this international gathering. Our faculty contributed invited talks on the translation of AI into clinical practice and the imaging of chronic neuroinflammation, while BNAC investigators and collaborators presented new findings on portable MRI for severe MS and cognitive outcomes in early relapsing disease. It was also a wonderful opportunity to reconnect with colleagues and exchange ideas that may shape the next generation of MS research.

New hope for treating MS beyond relapses

Some of the most closely watched findings came from Phase III studies of Bruton’s tyrosine kinase (BTK) inhibitors. These investigational oral therapies target immune-signaling pathways that may be relevant to both peripheral inflammation and ongoing inflammatory activity within the central nervous system. That distinction matters: despite major advances in preventing relapses, many people continue to accumulate disability, and therapies that address the biology of progression remain an urgent need.

Results presented in Toronto included evidence that fenebrutinib reduced MRI markers associated with chronic active lesions, together with relapse-rate reductions in relapsing MS trials. Separate Phase III studies found that remibrutinib reduced relapse activity compared with teriflunomide. These were important developments, but they should not be interpreted as proof that BTK inhibitors have solved progressive MS. Their longer-term clinical benefits, comparative effectiveness, and safety profiles require continued evaluation. Still, the enthusiasm was understandable: the treatment conversation is increasingly about preventing tissue injury and preserving neurological function, not only suppressing new relapses.

Making artificial intelligence clinically trustworthy

Michael G. Dwyer, PhD, Associate Professor of Neurology and Biomedical Informatics and Director of Neuroinformatics Development at BNAC, delivered the invited presentation “Overcoming Barriers for AI and Big Data.” MS appears particularly well suited to AI: MRI, retinal imaging, blood biomarkers, cognitive testing, and long-term clinical observations provide rich and repeated measurements. Yet MS is also a difficult disease to model because its biology, lesion types, and clinical trajectories are so heterogeneous, and the outcomes that matter most to patients, such as disability progression and cognitive function, are not always captured well by available datasets.

The presentation moved beyond algorithms to the practical barriers that determine whether AI can improve clinical care. MRI scanners and acquisition protocols differ among hospitals; training datasets may not represent the full diversity of people with MS; reference measurements are not always consistent; and models that perform well at one institution may fail elsewhere. Rigorous external validation, transparent reporting, privacy safeguards, and ongoing monitoring are therefore essential. The central question is not simply whether AI can detect more lesions, but whether it can help clinicians identify meaningful change, anticipate progression, and make more reliable decisions for individual patients.

Looking deeper into chronic neuroinflammation

Niels Bergsland, PhD, Assistant Professor of Neurology and Director of Integration at BNAC, delivered the invited lecture “The Choroid Plexus: A Gateway to Neuroinflammation in MS” within the North American Imaging in Multiple Sclerosis Cooperative (NAIMS) educational program. The choroid plexus is a small, highly vascular structure within the brain that produces cerebrospinal fluid and helps regulate communication between the immune system and the central nervous system. Because it is involved in normal immune surveillance, it has attracted growing attention as a possible window into inflammatory processes that conventional lesion imaging may not fully reveal.

Dr. Bergsland reviewed evidence that choroid plexus enlargement can be detected early in MS and may be linked to chronic active lesions, injury near the brain’s fluid-filled spaces, cognitive changes, and disability worsening. Importantly, research is now moving beyond measurements of size alone toward more detailed MRI tissue-characterization methods and molecular imaging. These approaches may offer a closer view of the biology underlying persistent inflammation. However, the critical scientific question remains open: do changes in the choroid plexus contribute to damage, reflect inflammation elsewhere, or both? Understanding that distinction will be essential before these measurements can guide routine clinical decisions.

Bringing MRI to people who are too often left out of research

One of the most meaningful BNAC contributions came from the Comprehensive Assessment of Severely Affected Multiple Sclerosis (CASA-MS) program. People with advanced MS are frequently underrepresented in imaging research because transportation, wheelchair dependence, and the practical demands of conventional MRI can make participation exceptionally difficult. Together with collaborators at The Boston Home in Massachusetts, the CASA-MS team is exploring whether portable ultra-low-field (0.064-tesla) MRI can bring imaging to these individuals rather than requiring them to travel to a scanner.

The one-year follow-up poster evaluated whether portable MRI can measure longitudinal brain volume changes and capture differences related to disease severity. In the progressive MS cohort, average whole-brain volume change was approximately −2.0% among 13 participants with more severe disability, compared with approximately −1.0% among eight participants with less severe disability. The difference was not statistically significant, and measurements showed substantial variability. Comparisons with conventional 3-tesla MRI also showed only modest agreement in a small validation cohort. These early results are promising for feasibility, not yet a validated test for tracking an individual patient’s atrophy.

Even with those limitations, the potential impact is substantial. Research on neurodegeneration should not systematically exclude the very people who are most severely affected. Improving access to repeated brain imaging could help close a longstanding gap in our understanding of late-stage MS and, over time, inform better approaches to care. The CASA-MS program is supported by the Annette Funicello Research Fund for Neurological Diseases, the Jacquemin Family Foundation, and generous private donors.

Protecting cognitive health as a treatment goal

BNAC was also represented in a multicenter analysis from the Phase IIIb ENLIGHTEN study, conducted with Bristol Myers Squibb and investigators across the United States and Canada. The study examined cognitive processing speed in people with early relapsing MS treated with ozanimod. This is an outcome of immediate relevance to everyday life: difficulties processing information can affect work, communication, independence, and quality of life, even when physical symptoms are relatively limited.

Using the Symbol Digit Modalities Test (SDMT), investigators evaluated whether participants experienced meaningful improvement, stability, or worsening over three years. Among the 104 participants assessed at year three, 94.2% had scores that were stable or improved according to the study’s eight-point change threshold. These are encouraging observations, although the open-label, single-arm design cannot establish that ozanimod caused the cognitive outcomes, and early study closure reduced the number of participants available for long-term assessment. The larger message is that successful MS care must consider cognition alongside relapses, MRI activity, and physical disability.

A shared commitment to better lives with MS

Beyond the presentations, MSToronto2026 was a reminder of why international scientific meetings matter. New treatment strategies, more informative biomarkers, and technologies that can broaden access to research all emerged from conversations across disciplines and institutions. The most encouraging theme was the field’s increasing focus on the outcomes that matter to people living with MS: preserving independence, maintaining cognitive health, and understanding progression before irreversible disability occurs.

We returned to Buffalo energized by the science, grateful for our collaborators, and optimistic about what comes next. For BNAC, the goal remains to connect rigorous discovery with practical improvements in care, whether through trustworthy AI, a clearer understanding of chronic inflammation, more inclusive MRI, or better monitoring of cognition. That is where the promise of MS research becomes meaningful.