Advances in Multiple Sclerosis 2017

Abstract

Multiple sclerosis (MS) is one of the most emerging fields in neurology. Recent pathophysiological insights have cleared the way for novel therapeutic strategies to combat disease aggravation. For instance, the B-cell depleting antibody ocrelizumab was recently approved for the treatment of relapsing-remitting (RRMS) and early primary progressive MS (PPMS). However, despite this progress, unmet medical necessities remain, especially for pediatric MS. Both new and more sophisticated therapeutic strategies and improved markers for predicting disease progression and/or treatment responses are still in demand.In the special issue "Advances in Multiple Sclerosis 2017", promising findings of this most prevalent neuroimmunological disease are depicted, covering different aspects of disease development and prediction, treatment options, and pathophysiological insights derived from both animal models and clinical studies.For instance, the search for (novel) biomarkers predicting disease progression and/or conversion from clinically isolated syndrome (CIS) to MS is still ongoing. Schwenkenbecher et al. recently described the critical role of intrathecal IgG synthesis and visual evoked potentials (VEPs) in this context [1]. If CIS patients presented unique oligoclonal bands in the cerebrospinal fluid (CSF), conversion to MS was more than twice as likely. While pathologic VEPs did not add further information to the conversion rate by patients with oligoclonal bands, they helped to predict the conversion rate in patients with optic neuritis and absent oligoclonal bands. To avoid or at least delay conversion from CIS to MS, an appropriate therapy must be chosen. Until today, there is very little known about how responsiveness to treatment can be predicted. One small current study aimed to identify the blood signature of CIS patients to provide clues for potential immunomodulatory therapies; increased levels of transitional B cells were found in CIS patients compared to healthy donors [2]. This small study emphasizes the possible important role of B cells not only for individuals suffering from CIS, but also from MS.Lehmann-Horn et al. recently reviewed the current knowledge of B cells in MS, including also their regulatory functions [3]. Nonetheless, further studies are needed to harness the evolving knowledge to improve the future efficacy and even safety of B cell-directed treatments. While the relevance of B cell-directed therapies in MS has to be seen in the next years, a clear strategy to increase the safety of highly effective therapy with natalizumab is still under development. There is growing concern regarding the risk of progressive multifocal leukoencephalopathy (PML), particularly after 24 doses and in patients that have previously received immunosuppressive drugs [4]. Nonetheless, clinical experiences are not homogenous, and there are no generally established guidelines so far. The same thing is true for the treatment of relapses following therapeutic plasma exchange as a second-line after a glucosteroid-unrespon...

Multiple sclerosis - A review of recent advances in diagnostics and treatments

“…Nie są jednak wymogiem diagnostycznym [14]. Jeśli pacjenci z CIS prezentowali unikalne prążki oligoklonalne w płynie mózgowo-rdzeniowym (CSF), konwersja do SM była ponad dwukrotnie bardziej prawdopodobna [17].…”

The Status of the Unaffected Eye Is a Predictor of Short-Term Recovery in a Croatian Cohort of Patients With Monocular Optic Neuritis

“…As well, it was reported that MS incidence is linked to longitude, suggesting that ON incidence could vary between eastern and western parts of the world [2]. MS and ON are not considered to be hereditary diseases but genetic variations have been associated with greater risk and infectious agents have been considered as triggers [8,9].…”