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Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Multiple sclerosis (MS) care in Germany has entered a phase in which therapeutic progress is increasingly constrained by delivery capacity. Earlier diagnosis, broader access to high-efficacy disease-modifying therapies (DMTs), and more refined monitoring strategies have improved the potential for favourable long-term outcomes. At the same time, these advances have increased the need for specialised expertise, infusion and monitoring infrastructure, rapid imaging access, structured safety procedures, and cross-sector coordination. Real-world evidence from Germany indicates a shift towards early high-efficacy treatment but also shows regional variation in treatment initiation, therapy intensity, and the proportion of people with MS who remain DMT-untreated. This expert-informed narrative review combines a non-systematic literature review with selected regional implementation examples from German MS care. This review synthesises key delivery challenges in German MS care and maps regional models whose underlying organisational principles may be transferable across healthcare settings, while their specific implementation depends on the local regulatory and reimbursement context. The central argument is that high-quality MS care should be understood not only as a therapeutic decision but as a system property: evidence-based treatment must be embedded in reliable pathways for diagnosis, monitoring, escalation, de-escalation, rehabilitation, and long-term support. Regional models such as ambulatory specialist care structures, hub-and-spoke networks, Germany\u00b4s inpatient MS complex treatment programme, delegated task models, telemedical consultation pathways, and digital monitoring infrastructures provide practical building blocks. Implementation at scale will require measurable quality indicators, financing of coordination work, formalised skill-mix models, digital interoperability, and explicit strategies for ageing and multimorbid MS populations. For neurological practice, the challenge is therefore not whether modern MS care is possible, but how to make it reproducible, safe, and equitable across regions.<\/jats:p>","DOI":"10.1186\/s42466-026-00531-2","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:00:44Z","timestamp":1788796844000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delivering high-quality multiple sclerosis care in Germany: challenges and regional models"],"prefix":"10.1186","volume":"8","author":[{"given":"Marc","family":"Pawlitzki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Huntemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Masanneck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah M.","family":"Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Postert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Lassek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G","family":"Meuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Gehring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Havla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Albrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjalf","family":"Ziemssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Grothe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"531_CR1","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0140-6736(23)01473-3","volume":"403","author":"D Jakimovski","year":"2024","unstructured":"Jakimovski, D., Bittner, S., Zivadinov, R., et al. 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His research is funded by ArgenX, Biogen, Demecan, Hexal, Horizon, Merck Serono, Novartis, Roche, Viatris, Takeda and Teva, all outside the scope of this work. His research is funded by the German Multiple Sclerosis Foundation (DMSG), the B. Braun Foundation and the German Alzheimer Society.Niklas Huntemann received honoraria for lecturing, consulting, travel expenses for attending meetings, and research support from Alexion, ArgenX, Janssen-Cilag, Merck, Novartis, UCB, and Viatris.Lars Masanneck reports honoraria for lecturing, consulting and travel expenses for attending meetings from Biogen, Merck, argenX, Roche, Neuraxpharm, Alexion and Novartis, all outside the scope of this work. His research is funded by the German Multiple Sclerosis Foundation (DMSG), the B.Braun Foundation and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) \u2013 493659010.Noah M Werner reports no conflict of interest.Julian Zimmermann received honoraria for lectures and advisory board participation from Merck, Novartis, Neuraxpharm, Roche, and Sanofi, and travel support from argenx, and UCB outside the submitted work.Thomas Postert reports no conflicts of interest related to this manuscriptChristoph Lassek received travel grants, speaker\u2019s honoraria, financial research support and consultancy fees from Roche, Teva, Merck Serono, Sanofi, Neuraxpharm, Novartis, Bayer, Biogen IdecSven G Meuth reports Honoraria\/travel support from Academy2, Argenx, AstraZeneca, Bayer, Biontech, Celgene, Datamed, Desitin, Diaplan, DIU, Dpmed, Gen Medicine & Healthcare, IGES, Impulze GmbH, KW Medipoint, MedDay, Medmile, MICE, Mylan, Neuraxpharm, Neurapharm, Oxford PharmaGenesis, QuintilesIMS, Sanofi, Springer, STADA, Chugai, UCB, Viatris, Wings for Life int, and Xcenda. Research support from BMBF, BfR, DFG, EKFS, G-BA, Hertie Fdn, IZKF, DGN, Ministry of Culture & Science NRW, Daimler & Benz Fdn, dmsg, Peek & Cloppenburg Fdn, Hempel Fdn, German Alzheimer Society, Bayer, BMS, Demecan, Diamed, Genzyme, Hexal, Janssen, MerckSerono, Novartis, NovoNordisk, ONO Pharma, Roche, and Teva.Klaus Gehring received travel grants, speaker\u2019s honoraria, financial research support and consultancy fees from Roche, Teva, Merck Serono, Sanofi, Neuraxpharm, Novartis, Bayer, Biogen, Schwabe, diaplan, Johnson&Johnson, Eisai, Lilly, GBAJoachim Havla reported grants for OCT research from the Sumaira Foundation, Horizon\/Amgen, Roche and Merck, personal consulting fees and honoraria from Alexion, Amgen, Merck, Novartis, Neuraxpharm, Johnson&Johnson, Rewind Therapeutics and Roche and nonfinancial support of the Sumaira Foundation and Guthy-Jackson Charitable Foundation, all outside the submitted work.Philipp Albrecht PA is associate Editor of Springer\/Nature Neuroretina, Frontiers in Neurology, Frontiers in Immunology, BMC Neuroscience and Journal of Clinical Medicine. He received the following grant support: German research association (DFG) (AL 1769\/4-1), EFRE-NRW. He received research grants from industry: Abbvie, Biogen, Bristoll Myers Squibb \/ Celgene, Merck, Merz, Novartis, Roche. He has received speaker honoraria, travel support and served on advisory boards for Abbvie, Biogen, Bristoll Myers Squibb \/ Celgene, Eisai, Ipsen, Lilly, Merck, Merz, Novartis, Roche, Sanofi, Teva, Viatris.Tjalf Ziemssen reports personal fees from Biogen, BMS, Merck, Neuraxpharm, Novartis, Novo Nordisk, Roche, Sanofi, Sandoz, Teva, and Viatris; and research support from Genzyme, Neuraxpharm, Novartis, Roche, Sanofi, and Teva.Matthias Grothe has received honoraria for boards and speaking activities from Bayer, Biogen, Bristol-Myers Squibb, Johnson & Johnson, Merck, Novartis, Roche, Sanofi and Teva; and has received research support from the Bundesministerium f\u00fcr Bildung und Forschung, Deutsche Forschungsgemeinschaft, Merck, Novartis and Sanofi.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"75"}}