Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

In recent times, we have unequivocally witnessed a push towards digitising the healthcare system. Topics such as remote patient monitoring (RPM), digital health, and their use to monitor neurological disease progression have gained momentum and popularity. Notwithstanding the considerable advances that have been made in adopting such technologies and using them in the context of mental health or even a few neurodegenerative disease monitoring, they have not been widely used in the context of remote management and treatment of multiple sclerosis MS. In the same vein, given that (MS) is a very individualized disease to manage, there are numerous challenges yet opportunities associated with using digital health technologies for remote MS monitoring. This paper reviews the different research work and clinical attempts performed over the last decade (both home & hospital-based monitoring) en route to using digital health for MS monitoring and management. Similarly, this systematic review discusses the main challenges and barriers to translating that research from clinics into homes and highlights the opportunities in that context. Throughout this extensive review, we shine a light on various monitoring methods that hold the potential to be measured in a home environment, including electroencephalography (EEG) and evoked potentials (e.g., motor evoked potential (MEP), somatosensory evoked potentials (SSEP), and visual evoked potential (VEP)), electromyography (EMG), inertial measurement unit (IMU), and speech analysis. Combining such digital biomarkers could pave the way for developing a more personalised treatment for MS patients, thereby stopping its progression and avoiding silent MS disability. Adopting digital health for remote monitoring and management could also chart a route ahead for a new era of personalised medicine for MS patients and potentially other brain disorder patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported in part by a PhD grant from the Luxembourg National Research Fund (FNR) under the project reference 17223919/MMS/ Industrial Fellowship. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No data was collected as the paper is a systematic review.