To optimize the management of patients with familial multiple sclerosis (MS) by identifying the clinical and epidemiological features of the disease course. Material and methods. The object of the study was 2253 patients with clinically reliable MS according to McDonald criteria (2010, 2017) living in the Rostov region. Statistical analysis of the results was processed using the application package Excel, Statistics 13.0 MacOSX (Apple Inc., USA). Data analysis was carried out using the 𝜒2 criterion. The significance of differences was assessed using the Student’s t-test; the differences were considered statistically significant at p < 0,05. Results. 108 family cases were identified in the analyzed population of the Rostov region (2 or more MS patients in a family). The overall risk of recurrence among the population of the Rostov region was 4,8%, the family risk of recurrence was 2,7%. The M:F ratio is 1:3,5, the age of debut in the first generation exceeded the age of debut in subsequent generations on average by 5,9 (0,1) years. The duration of the first remission in the family MS group (2,4 (1,0) years), and the average rate of progression was 0.5 (0,1) points per year. Conclusions. In most families, the «ancestor» of MS was a woman, this fact indicates a possible role of mitochondria in the pathogenesis of the disease. Genealogical analysis of the evidence in favor of non-mendelian types of inheritance. A burdened family history is an unfavorable prognostic factor for the course of MS, which should be taken into account when determining the patient’s management tactics.