Could multiple sclerosis one day be detected before symptoms appear? And if so, should we be actively screening people who are at higher risk?

In this episode of the ECTRIMS–MS Journal collaboration series, host Prof. Anneke van der Walt, Controversies Editor at the Multiple Sclerosis Journal, is joined by Prof. Helen Tremlett (University of British Columbia) and Prof. Ruth Ann Marrie (Dalhousie University) to debate one of the most important emerging questions in MS research.

Helen argues that targeted screening should begin now—but only within carefully designed research studies—to better understand how MS develops before clinical symptoms appear. Ruth Ann argues that while prevention is the ultimate goal, the science, ethics and healthcare systems are not yet ready for widespread screening.

Together they discuss:

· Whether MS is entering a new era of prevention research

· What lessons can be learned from Parkinson's disease and radiologically isolated syndrome (RIS)

· The ethical and psychological impact of identifying people at risk before symptoms develop

· How screening programmes could improve—or worsen—health inequalities

· What research is still needed before screening could ever become part of routine clinical practice

Although they argue opposing positions, both experts agree on one important point: preventing MS is an achievable ambition—but only if research proceeds carefully, ethically and equitably.

This MS Journal Controversies article series has been made open access for the next month for ease of reading.

Note: This episode is part of the MS Journal Controversies in MS series, where experts debate opposing viewpoints on important unresolved questions in MS research. The positions argued do not necessarily represent the authors' personal opinions, but rather present the strongest evidence supporting each side of the debate.