Multiple sclerosis (MS) is a chronic inflammatory autoimmune demyelinating disease of the central nervous system that usually affects young adults, particularly women. The pathobiology of multiple sclerosis contains inflammatory and neurodegenerative mechanisms that affect both white and grey matter. These mechanisms cause the relapsing, and frequently progressive, course of multiple sclerosis, which is heterogeneous; confident prediction of long-term individual prognosis is not yet promising. Though, as revised MS diagnostic criteria that include neuroimaging data facilitate early diagnosis, most patients are encountered with making important long-term treatment decisions, most particularly the utilization and selection of disease modifying therapy. Presently, there are numerous approved MS disease modifying therapy with changing degrees of efficacy for decreasing relapse risk and preserving neurological function, but their long-term benefits stay imprecise. Furthermore, available disease modifying therapy vary with regard to the route and frequency of management, common adverse effects, tolerability and possibility of treatment adherence, risk of major toxicity, and pregnancy-related risks. Thorough understanding of the benefit risk profiles of these therapies is essential to establish logical and safe treatment procedures for patients with multiple sclerosis.