Multiple sclerosis (MS) is a heterogeneous chronic autoimmune disease of the central nervous system that comes with a variety of variants in presentation, progression, and response to treatment. The advent of precision neurology presents a possibility of stratifying diagnosis, prognosis, and treatment options that fit biological personalities. This review examines the existing and developing methods of personalized care in MS in the context of genomic understanding, the discovery of new biomarkers, and pharmacogenomics Genetic variants that affect drug response, pathogenesis, and outcome have been identified using advances in next-generation sequencing and genome-wide association studies. Neuroimaging, cerebrospinal fluid, and blood-based biomarkers have the potential to diagnose earlier, predict disease activity, and monitor treatment with therapeutic efficacy. Pharmacogenomic experiments are playing an increasingly large role in determining patient-specific treatment choice, using these evaluations to optimize efficacy without adversely affecting the patient. The role of such tools in clinical practice has the potential to transform precision neurology as they will offer more specific data-driven treatment opportunities and improve patient outcomes. Questions that have not been answered are the validation of the novel biomarkers, ethical implications of using genomic data, and development of what are sound clinical decision-making algorithms. The aim of this review article is to provide a comprehensive overview of the genetic basis, biomarker-driven strategies, and precision neurology approaches in multiple sclerosis, highlighting current advances, clinical challenges, and future perspectives in personalized therapy.