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Article History

Received: 10 September 2025

Revised: 15 December 2025

Accepted: 18 January 2026

First Online: 30 January 2026

Declarations

:

: CZ received compensation for speaking activities, and/or consulting services, from Alexion, Amgen, Astrazeneca, Biogen, Bristol Myers Squibb, Janssen, Merck, Novartis, Roche, Sandoz, Sanofi; AGio received consulting fees and travel grant from Novartis; FL has nothing to disclose; AGil has nothing to disclose; MS has nothing to disclose; EM has nothing to disclose; KM has nothing to disclose; VV has nothing to disclose; FE received consulting fees from Merck Serono and Genzyme; MAR received consulting fees from Biogen, Bristol Myers Squibb, Roche, and speaker honoraria from Alexion, Biogen, Bristol Myers Squibb, Celgene, Horizon Therapeutics Italy, Merck Serono SpA, Mitsubishi-Tanabe Pharma, Neuraxpharm, Novartis, Roche, Sandoz, and Sanofi, she receives research support from the MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla, she is Associate Editor for Multiple Sclerosis and Related Disorders ; and Associate Co-Editor for Europe and Africa for Multiple Sclerosis Journal . MF is Editor-in-Chief of the Journal of Neurology , Associate Editor of Human Brain Mapping , Neurological Sciences, and Radiology , received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi, speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA, participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda, scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme, he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

: Approval was received from the ethical standards committee on human experimentation of IRCCS San Raffaele Hospital (Protocol N° REGISTRO SM001 e REGISTRO SM002). Written informed consent was obtained from all patients before study participation in accordance with the Declaration of Helsinki.