OBJECTIVES: To assess clinical characteristics of MS patients not on any DMTs in key countries in European Union (EU) and the U.S. METHODS: A multi-country multi-center medical chart-review study of MS patients was conducted in 4Q2012 among Healthcare providers (HCPs; >85% neurologists) in hospitals and private practices to collect de-identified data. HCPs from UK, Germany, France, Italy and Spain (5EU) and the US were screened for duration of practice (>=3yrs) and patient volume (>=15 MS patients/month) and recruited from a large panel to be geographically representative in each country. Medical charts of next 10 consecutive MS patients were completed by each physician.  HCPs abstracted patient diagnosis, treatment patterns and patient symptomatology/disease status. MS patients not on any DMTs were analyzed. RESULTS: 967 eligible MS patients were included in the analysis (5EU:749; US:218). Mean age (yrs) – 5EU:39.0yrs, US:42.2yrs; Female – 5EU:69%; US:67%. Key reasons for not receiving DMTs were (5EU/US): mild/early-MS (35%/36%), patient refusal (26%/44%), progressive/severe/advanced-MS (20%/17%), lack of efficacy of current treatment options (10%/14%), side-effects/tolerance/co-morbidities (6%/12%), waiting for DMTs to become available (5%/12%) and funding/authorization/guidelines (4%/7%). Among patients who refused DMTs, more than half were not convinced of therapy benefits. Distribution of MS type was (5EU/US): Clinically Isolated Syndrome (CIS)-26%/25%, Relapse Remitting MS (RRMS)-44%/49% and Secondary Progressive MS (SPMS)-30%/26%. Patients with moderate/severe disease and those with active/highly active disease (both, per physician judgment) were (5EU/US): CIS:10%/11%, RRMS:25%/40%, SPMS:95%/86%, and CIS:31%/44%, RRMS:39%/37%, SPMS:36%/32% respectively. Mean Expanded Disability Status Scale score were (5EU/US): CIS:0.8/0.7, RRMS:1.8/2.2, SPMS:6.5/5.6); % patients currently suffering a relapse were (5EU/US): CIS:20%/29%, RRMS:21%/15%, SPMS:6%/16%; % patients with >=1 relapses in last 12months were (5EU/US): CIS:69%/69%, RRMS:52%/58%, SPMS:18%/32%. CONCLUSIONS: Among MS patients not on any DMTs, disease burden seems substantial. Further research is warranted to scrutinize the observed patient management practices to alleviate patient burden.