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Background Multiple sclerosis (MS) is a chronic disease of the central nervous system. Over 750,000 people are affected across Europe. The European Brain Council initiated in 2018 a project RETHINKING MS, calling for change in MS care. Methods The research framework included desk research data mapping and expert interviews. A series of clinical and patient-oriented benchmarks along the care process were developed. Data were analysed in collaboration with experts from across Europe to build an interdisciplinary consensus around practical and sustainable policy responses to MS in Europe. Results Results indicate that a timely diagnosis is important to enable a prompt initiation of specific drugs and symptomatic treatment which, in turn, can prevent potentially irreversible disability. Care must be individualised to each person and their specific symptoms and needs. Regular monitoring is key to personalise care and provide adequate support but there are often delays to diagnosis and limitations to treatment personalisation due to inadequate access to diagnostic facilities and MS specialists. Access to therapies can also be extremely challenging. The interdisciplinary approach is essential; disease management includes aspects of lifestyle modification, as many 'brain healthy' lifestyle factors may delay progression and relapses. Finally, social care can greatly improve quality of life for people with MS, social workers and occupational therapists can also support people with MS in their professional and daily lives. Conclusions Conclusions link timely diagnosis and coordinated care, long-term adaptable support to better quality of life. Primary prevention modification of lifestyle factors Key messages Policies for multiple sclerosis in Europe have to be changed. Primary and secondary prevention are possible.