The European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS) has been convening an annual congress for more than 30 years with the aim of facilitating communication, creating synergies, and promoting and enhancing research and learning among professionals for the ultimate benefit of people affected by multiple sclerosis (MS).1 Since ECTRIMS has been active, the landscape in the management of MS has changed beyond recognition, from the emergence of disease-modifying treatments (DMT) in 1996 to the increasing availability of new treatment options for patients with relapsing MS and primary progressive MS, and potential treatment options on the horizon for secondary progressive MS.2 Most recently, the 34th ECTRIMS conference (ECTRIMS 2018) was held in Berlin, Germany, from 10th–12th October, and welcomed >9,400 researchers, neurologists, and MS professionals from 105 countries.3,4 Common themes explored included the value of real-world data in making treatment decisions, the use of biomarkers for neurodegeneration, and the ongoing challenges of treating progressive forms of MS.4 One key highlight was a ‘Free Communication’ presentation discussing the implications of the recent 2017 McDonald diagnostic criteria for MS.5,6 The consensus was that the new guidelines provide higher sensitivity and lower specificity for the diagnosis of MS, meaning that the proportion of patients diagnosed with MS has increased by nearly 25%, at the expense of the clinically isolated syndrome (CIS) diagnosis that would have been previously made. This has ethical, legal, and potential socio-economic implications for people previously diagnosed with CIS who may now fit the criteria for MS. It should also be noted that some experts believe that the revisions to the new guidelines may force treatment to be given too early, discounting the impact of neurodegeneration and adverse events associated with exposure to DMT, which must be considered. As it is not possible to review all areas covered during ECTRIMS 2018, three topics of particular interest have been selected for discussion in this article: 1) the management of MS in women of child-bearing age; 2) the measurement and management of disability progression; and 3) the management of long-term disease.