Background: There is limited data regarding the association of Neutrophil-lymphocyte ratio (NLR) inflammatory marker with multiple sclerosis (MS) disability and activity. Objective: The aim of the present study was to evaluate validity of NLR as an inflammatory marker for MS disability and activity. Methods: A case-control study including 140 MS patients and 140 age, sex and body mass index matched healthy controls was performed. All participants were subjected to detailed history taking, complete general and neurological examination, laboratory and radiological investigations. Assessment of disease disability was performed using Expanded Disability Status Scale. Results: The NLR levels was significantly higher in MS patients compared to the controls and in patients with relapse compared to remission. Logistic regression analyses showed that NLR was significantly associated with disease disability (odds ratio (OR): 2.568; confidence interval (CI): 1.377 – 4.788; P: 0.003) and activity (OR: 3.603; CI: 2.086 – 6.226; P: 0.02). The cutoff value for the NLR to predict MS disability and activity was 3.12. Conclusion: NLR was significantly increased in MS patients compared to controls. The significant association of NLR with MS disability and activity suggest that it could be utilized as a simple, rapid and inexpensive inflammatory marker.