Clinical and magnetic resonance imaging studies in multiple sclerosis have recently suggested that neurodegenerative events may take place in multiple sclerosis brains, which occur independently from inflammation. Here we summarize the results from recent pathological studies, which show, that inflammation is invariably present at all stages and in all forms of the disease. However, the patterns of inflammation differ between different disease stages. This may in part explain, why anti-inflammatory or immunosuppressive treatments fail in progressive multiple sclerosis.