Multiple Sclerosis as a By-Product of the Failure to Sustain Protective Autoimmunity: A Paradigm Shift

In recent years, there has been a paradigm shift in the treatment of multiple sclerosis (MS) owing to the approval of a number of new drugs with very distinct mechanisms of action. All approved disease-modifying drugs primarily work directly on the immune system. However, the identification of an ‘optimal choice’ for individual patients with regard to treatment efficacy, treatment adherence and side-effect profile has become increasingly complex including conceptual as well as practical considerations. Similarly, there are peculiarities and specific requirements with regard to treatment monitoring, especially in relation to immunosuppression, the development of secondary immune-related complications, as well as the existence of drug-specific on- and off-target effects. Both classical immunosuppression and selective immune interventions generate a spectrum of potential therapy-related complications. This article provides a comprehensive overview of available immunotherapeutics for MS and their risks, detailing individual mechanisms of action and side-effect profiles. Furthermore, practical recommendations for patients treated with modern MS immunotherapeutics are provided.

Download Full-text

Deleterious versus protective autoimmunity in multiple sclerosis

Cellular Immunology ◽

10.1016/j.cellimm.2015.04.006 ◽

2015 ◽

Vol 296 (2) ◽

pp. 122-132 ◽

Cited By ~ 20

Author(s):

Milos Kostic ◽

Ivana Stojanovic ◽

Goran Marjanovic ◽

Nikola Zivkovic ◽

Ana Cvetanovic

Keyword(s):

Multiple Sclerosis ◽

Protective Autoimmunity

Download Full-text

Lifestyle physical activity in persons with multiple sclerosis: the new kid on the MS block

Multiple Sclerosis Journal ◽

10.1177/1352458514525873 ◽

2014 ◽

Vol 20 (8) ◽

pp. 1025-1029 ◽

Cited By ~ 62

Author(s):

Robert W Motl

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Exercise Training ◽

Paradigm Shift ◽

Behavioral Interventions ◽

Vigorous Physical Activity ◽

Public Health Approach ◽

Supervised Exercise ◽

Lifestyle Physical Activity ◽

Potential Impact

Supervised exercise training has substantial benefits for persons with multiple sclerosis (MS), yet 80% of those with MS do not meet recommended levels of moderate-to-vigorous physical activity (MVPA). This same problem persisted for decades in the general population of adults and prompted a paradigm shift away from “exercise training for fitness” toward “physical activity for health.” The paradigm shift reflects a public health approach of promoting lifestyle physical activity through behavioral interventions that teach people the skills, techniques, and strategies based on established theories for modifying and self-regulating health behaviors. This paper describes: (a) the definitions of and difference between structured exercise training and lifestyle physical activity; (b) the importance and potential impact of the paradigm shift; (c) consequences of lifestyle physical activity in MS; and (d) behavioral interventions for changing lifestyle physical activity in MS. The paper introduces the “new kid on the MS block” with the hope that lifestyle physical activity might become an accepted partner alongside exercise training for inclusion in comprehensive MS care.

Download Full-text

Exercise as Medicine in Multiple Sclerosis—Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives

Current Neurology and Neuroscience Reports ◽

10.1007/s11910-019-1002-3 ◽

2019 ◽

Vol 19 (11) ◽

Cited By ~ 22

Author(s):

Ulrik Dalgas ◽

Martin Langeskov-Christensen ◽

Egon Stenager ◽

Morten Riemenschneider ◽

Lars G. Hvid

Keyword(s):

Multiple Sclerosis ◽

Paradigm Shift ◽

Disease Modifying

Download Full-text

The pathology of multiple sclerosis: a paradigm shift

Current Opinion in Neurology ◽

10.1097/01.wco.0000227032.47458.cb ◽

2006 ◽

Vol 19 (3) ◽

pp. 242-247 ◽

Cited By ~ 61

Author(s):

Michael H Barnett ◽

Ian Sutton

Keyword(s):

Multiple Sclerosis ◽

Paradigm Shift

Download Full-text

Multiple Sclerosis: A Paradigm Shift

Physical Medicine and Rehabilitation Clinics of North America ◽

10.1016/j.pmr.2005.01.016 ◽

2005 ◽

Vol 16 (2) ◽

pp. xvii-xx

Author(s):

Theodore R. Brown ◽

George H. Kraft

Keyword(s):

Multiple Sclerosis ◽

Paradigm Shift

Download Full-text

Using IMPrESS to guide policy change in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517737388 ◽

2017 ◽

Vol 24 (9) ◽

pp. 1251-1255 ◽

Cited By ~ 4

Author(s):

Michela Tinelli ◽

Panos Kanavos ◽

Olina Efthymiadou ◽

Erica Visintin ◽

Federico Grimaccia ◽

...

Keyword(s):

Multiple Sclerosis ◽

Paradigm Shift ◽

Well Being ◽

Socioeconomic Impact ◽

International Evidence ◽

Socioeconomic Burden ◽

Disease Modifying ◽

Health And Well Being

The International MultiPlE Sclerosis Study (IMPrESS) studied the significant impact of multiple sclerosis (MS) on the health and well-being of both people with the disease and their caregivers, along with its broader socioeconomic impact. Results confirmed that there is an urgent need to achieve better outcomes for people with MS. This paper uses results from the IMPrESS to present new international evidence on the socioeconomic burden of MS and discuss the merits of a likely paradigm shift in the management of MS towards the use of better (and more accurate) diagnostic follow-up to monitor disease progression and the earlier use of disease-modifying treatments (DMTs) to achieve better clinical, quality-of-life and socioeconomic results for individuals.

Download Full-text