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A critical challenge in treating, researching, and living with multiple sclerosis is that MRI and neurological exams identify disease changes only after they have occurred.
A critical challenge in treating, researching, and living with multiple sclerosis is that MRI and neurological exams identify disease changes only after they have occurred.
istock, ediebloom

The Future of Biomarkers in Multiple Sclerosis Care

MS expert Stephanie Buxhoeveden combines personal experience with scientific expertise to explore how biomarkers are transforming MS care

Stephanie Buxhoeveden, PhD, MSN, FNP-BC, MSCN
Stephanie Buxhoeveden, PhD, MSN, FNP-BC, MSCN
Stephanie Buxhoeveden, PhD, MSN, FNP-BC, MSCN

Stephanie Buxhoeveden, PhD, MSN, FNP-BC, MSCN, is a nurse practitioner, researcher, and dedicated advocate for people living with multiple sclerosis (MS).

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Published:Jun 26, 2025
|3 min read
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MRI and neurological exams have long been mainstays in the standard of care for multiple sclerosis (MS), a chronic autoimmune disorder affecting the brain and central nervous system. However, disease’s complexity and heterogeneity pose challenges for clinicians in using these standard-of-care assessments to make appropriate and meaningful treatment decisions.

The situation is improving, thanks to the advent of fluid-based biomarkers that could provide real-time insights into the patient’s disease—and empower clinical decision-making—well before any disease changes manifest in an MRI or a neurological exam. As a person living with MS, an MS certified nurse and nurse practitioner, and an MS researcher, I have a uniquely multifaceted perspective on this disease, and how the prognostic landscape is evolving, that fuels my passion for patient care and research. 

An MS diagnosis at 25: A life-changing shift

I was diagnosed about 12 years ago when I was 25. At the time, I was studying to become a nurse anesthetist and was also a competitive weightlifter. One day, my right foot fell asleep during a workout; over the next week, the numbness spread up both of my legs, but I brushed it off as a sports injury. A few days later, while changing into my surgical scrubs, I realized I had no feeling from the waist down and my vision became just a blur of bright fluorescent lights. As I often tell people: I walked into the hospital that day as a provider, but left as one of 2.3 million people worldwide living with MS. After my diagnosis, I shifted my professional focus to this disease.

The limitations of standard MS monitoring

A critical challenge in treating, researching, and living with MS is that MRI and neurological exams identify disease changes only after they have occurred. They can’t offer insights into the patient’s current disease activity, nor can they predict the risk of a relapse. Further, insurance often covers only low-resolution MRIs that may miss small lesions; a “clear” MRI may not convince a patient with worsening symptoms that everything is indeed OK. This vagueness may cause the patient to take a dramatic but possibly unnecessary step, such as changing their DMT, which they may have battled years to find, or considering a stem cell transplant. These are upsetting and scary prospects that completely disrupt the patient’s life—I know, because I’ve been there.

Why multi-biomarker panels matter

In the years since my diagnosis, interest in blood-based and other fluid biomarkers for MS has been growing among clinicians and patients. Research has shown Nfl, GFAP, and other individual biomarkers offer some value in assessing the disease. However, none is specific to MS, and so far, we’ve not found a single biomarker that accurately assesses acute disease activity and long-term prognosis in every patient.

This is where tests based on a multi-biomarker panel can make a huge difference. A few years ago, I was concerned my symptoms were getting worse; but was it because of stress, my age, or disease progression? I stood at the crossroads of staying the course with my current DMT or pivoting to new one. That’s when my neurologist suggested we try a new blood-based test that uses a panel of biomarkers of inflammation, degeneration, and neuronal health to produce a more holistic picture than tests based on single biomarkers. To my relief, the test score showed my relapse risk was low, confirming my previous MRI hadn’t missed any acute inflammation. 

Looking ahead: a more personalized future

The results of this test, together with my clinical exam, MS functional composite, and MRI, gave my neurologist and me a comprehensive picture of my real-time disease state, with invaluable longitudinal data on my long-term prognosis. It shifted our conversation from “Is my DMT working or not?” to, “How can we better manage your symptoms and quality of life?”—because there is much more to living with MS than just the choice of DMT. I continue to incorporate this test into my regular MS monitoring, and I’m extremely grateful for the possibility it offers: the chance to respond early and proactively, rather than being blindsided by another potentially catastrophic relapse.

The MS field stands at an inflection point. We have many efficacious therapies with different mechanisms of action but no way to predict which subset of patients will respond to a therapy. That uncertainty is exactly why I made the difficult decision to step away from patient care and focus my career on advancing biomarker research. I’m now dedicated to studying the kinds of game-changing innovations—like the work Octave is doing—that could help match each patient to the most effective DMT. My hope is that emerging and ongoing research into multi-biomarker panels will provide even greater value in the future by matching each patient to the most effective DMT, so that clinicians can make proactive decisions that preserve the best possible quality of life for their patients.