Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Feinstein, Anthony; Freeman, Jenny; Lo, Albert

doi:10.1016/s1474-4422(14)70231-5

Cited by 238 publications

(183 citation statements)

References 121 publications

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“…Besides, it might currently be the only treatment option leading to symptomatic improvement for patients with progressive MS types. 47 Furthermore, exercise therapy is safe: a recent review identified a slightly reduced relapse rate in the exercise training group compared with non-exercising controls and only few adverse events (1.2% and 2.0% in control and training groups, respectively). 36 Nowadays, first translational evidence 48 is being generated with observed clinical improvements after training on a balance board in 27 patients with MS being associated with identified neural changes in the microstructure of superior cerebellar peduncles.…”

Section: Non-medical Treatment Options: Active Rehabilitation Treatmentmentioning

confidence: 99%

The importance of a multi-disciplinary perspective and patient activation programmes in MS management

et al. 2016

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Background: Multiple sclerosis (MS) is a progressive disease associated with a large variety of symptoms and changing patients' needs during the disease course. In order to provide appropriate care in every disease stage and let patients live their lives to the full, a multi-disciplinary approach and patient activation is needed. Objective: To summarise the multi-disciplinary perspective of MS, with focus on the organisation of a multi-disciplinary care team and possibilities to support patient activation. Methods: This review reflects the content of the presentations, audience polling results and discussions on the multi-disciplinary perspective of MS during the second Pan-European MS Multi-stakeholder Colloquium. Results: In many countries, the neurologist with or without the support of an MS nurse is responsible for the long-term care of MS patients. When needed, they should refer to other (non-)medical specialists. However, the patient should be empowered as well to manage his/her disease and to implement a physically active lifestyle in order to improve treatment outcomes and quality of life. Conclusion: To create equal access to care for MS patients across Europe, evidence-based standards of care, symptom self-monitoring tools and educational programmes for patients and healthcare professionals including non-medical treatment strategies should be developed at the European level.

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Section: Non-medical Treatment Options: Active Rehabilitation Treatmentmentioning

confidence: 99%

The importance of a multi-disciplinary perspective and patient activation programmes in MS management

et al. 2016

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“…The outlook for patients with more progressive disease, however, is less optimistic. 92 Nevertheless, at most stages of MS there remains a great need for personalised regimens that aim to maximise resilience and Providing such intensive individual attention to all patients with MS is a challenge since access to treatments and services in MS across Europe is highly variable and often limited by the availability of healthcare resources. 93 Neurorehabilitation takes many forms depending on the various physical or mental manifestations of the disease in each patient and the problems they encounter.…”

Section: Resultsmentioning

confidence: 99%

Neurorehabilitation in Multiple Sclerosis – Resilience in Practice

Kesselring¹

2017

European Neurological Review

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In recent years, enormous strides have been made in increasing the range and efficacy of disease-modifying drugs available for the treatment of multiple sclerosis (MS) in its early and remitting stages, and more continue to emerge. Another equally important concept of successful treatment of MS is neurorehabilitation, which must be pursued alongside these medications. Key factors that contribute to the impact of neurorehabilitation include resilience and neuroplasticity. In the former, components such as nutrition, self-belief and physical activity provide a stronger response to the disease and improved responses to treatment. Neuroplasticity is the capacity of the brain to establish new neuronal networks after lesion damage has occurred and distant brain regions assume control of lost functions. In MS, it is vital that each patient is treated by a coordinated multidisciplinary team. This enables all aspects of the disease including problems with mobility, gait, bladder/bowel disturbances, fatigue and depression to be effectively treated. It is also important that the treating team adopts current best practice and provides internationally agreed standards of care. A further vital aspect of MS management is patient engagement, in which individuals are fully involved and are encouraged to strive and put effort into meeting treatment goals. In this approach, healthcare providers become motivators and patients need less intervention and consume fewer resources. Numerous interventions that promote neurorehabilitation are available, though evidence to support their use is limited by a lack of data from large randomised controlled trials. Combining interventions that promote neurorehabilitation with newer, more effective treatments creates a promising potential to substantially improve the outlook for patients at all stages of MS.

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“…According to this hypothesis, progression in MS would be present from the beginning of illness and progressive cytodegeneration would underlie all disease processes. Resolution of these conflicting ideas is unresolved, nonetheless both suggest that treatment of PMS, preferable at the early stages of disease, should be based on a combination of antiinflammatory, regenerative and neuroprotective strategies [11,17,18]. Nevertheless, although inflammatory and neurodegenerative events act in concert to induce MSspecific brain damage their relevance changes during the course of chronic disease evolution.…”

Section: Introductionmentioning

confidence: 99%

The link of inflammation and neurodegeneration in progressive multiple sclerosis

Pérez‐Cerdá

Sánchez‐Gómez

Matute

2016

Mult Scler Demyelinating Disord

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Progressive multiple sclerosis (MS) is characterized clinically by the accumulation of neurological disability without unequivocal recovery. Understanding the mechanisms that determine entering in this stage of the disease is a great challenge in order to identify potential therapeutic targets. Recent advances in defining more accurately the progressive phenotype of MS, have concluded that differences between primary and secondary progressive forms of disease are relatively quantitative rather than qualitative. In both cases, a large number of molecular and cellular events that might lead to neurodegeneration have been suggested. These include microglia activation, chronic oxidative injury, accumulation of mitochondrial damage in axons, age-related disturbances and dysfunctional axonal transport among others. Commonly, these pathological mechanisms have been considered as a result of inflammatory demyelination but a primary degenerative condition has also been argued. It is now clear that both events contribute to the progression of the disease, however their temporal sequence is still a matter of debate. A detailed knowledge of progressive MS pathogenesis will allow to develop effective treatments for both progression and symptom management that should be based on a combination of anti-inflammatory, regenerative and neuroprotective strategies. In this review, we summarize current data and recent hypothesis about pathological forces that drive progression of damage in MS, i.e. cumulative cortical demyelination and neurodegeneration as well as diffuse alterations (microglia activation, axonal injury and atrophy) throughout white and grey matter in the brain and spinal cord. Finally, we discuss the potential of the aforementioned proposed disease mechanisms with regard to developing suitable therapies to halt the progression in MS pathology.

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Treatment of progressive multiple sclerosis: what works, what does not, and what is needed

Cited by 238 publications

References 121 publications

The importance of a multi-disciplinary perspective and patient activation programmes in MS management

The importance of a multi-disciplinary perspective and patient activation programmes in MS management

Neurorehabilitation in Multiple Sclerosis – Resilience in Practice

The link of inflammation and neurodegeneration in progressive multiple sclerosis

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