Multiple Sclerosis (MS)

Virtual reality for multiple sclerosis rehabilitation.

De Keersmaecker E, Guida S, Denissen S, Dewolf L, Nagels G, Jansen B · The Cochrane database of systematic reviews · 2025 · n=264

Multiple sclerosis (MS) is the most common neurological disease in young adults. Virtual reality (VR) offers a promising rehabilitation tool by providing controllable, personalised environments for safe, adaptable and engaging training. Virtual reality can be tailored to patients' motor and cognitive skills, enhancing motivation through exciting scenarios and feedback. Primary objective To assess the effects of virtual reality interventions compared with an alternative or no intervention on lower limb and gait function, and balance and postural control in people with MS. Secondary objective To assess the effects of virtual reality interventions compared with an alternative or no intervention on upper limb function, cognitive function, fatigue, global motor function, activity limitation, participation restriction and quality of life, and adverse events in people with MS. We identified relevant articles through electronic searches of CENTRAL, MEDLINE, Embase, PEDro, CINAHL and Scopus.

Azathioprine for people with multiple sclerosis.

Ridley B, Nonino F, Baldin E, Casetta I, Iuliano G, Filippini G · The Cochrane database of systematic reviews · 2024 · n=1076

Multiple sclerosis (MS) is an immune-mediated, chronic, inflammatory demyelinating disease of the central nervous system, impacting around 2.8 million people worldwide. Characterised by recurrent relapses or progression, or both, it represents a substantial global health burden, affecting people, predominantly women, at a young age (the mean age of diagnosis is 32 years). Azathioprine is used to treat chronic inflammatory and autoimmune diseases, and it is used in clinical practice as an off-label intervention for MS, especially where access to on-label disease-modifying treatments (DMTs) for MS is limited. Given this, a review of azathioprine's benefits and harms would be timely and valuable to inform shared healthcare decisions. To evaluate the benefits and harms of azathioprine (AZA) for relapsing and progressive multiple sclerosis (MS), compared to other disease-modifying treatments (DMTs), placebo or no treatment. Specifically, we will assess the following comparisons. AZA compar

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials.

Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D · Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica · 2022 · n=16

Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD), stroke. The aim of our study was to review the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder. We searched two electronic databases (PubMed and EMBASE) for randomized controlled trials focusing on pharmacological and non-pharmacological medical treatments for overactive bladder symptoms associated with neurological diseases published up to 30 April 2022. A total of 157 articles were retrieved; 94 were selected by title and abstract screening; after removal of 17 duplicates, 77 records were evaluated by full-text examination. Sixty-two studies were finally selected. The articles selected for review focused on the following interventions: anticholinergics (n = 9), mirabegron (n = 5), comparison of different drugs (n = 3)

Modulation of gut microbiome in the treatment of neurodegenerative diseases: A systematic review.

Mincic AM, Antal M, Filip L, Miere D · Clinical nutrition (Edinburgh, Scotland) · 2024

Microbiota plays an essential role in maintaining body health, through positive influences on metabolic, defensive, and trophic processes and on intercellular communication. Imbalance in intestinal flora, with the proliferation of harmful bacterial species (dysbiosis) is consistently reported in chronic illnesses, including neurodegenerative diseases (ND). Correcting dysbiosis can have a beneficial impact on the symptoms and evolution of ND. This review examines the effects of microbiota modulation through administration of probiotics, prebiotics, symbiotics, or prebiotics' metabolites (postbiotics) in patients with ND like multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). PubMed, Web of Science, Medline databases and ClinicalTrials.gov registry searches were performed using pre-/pro-/postbiotics and ND-related terms. Further references were obtained by checking relevant articles. Although few compared to animal studi

Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations.

Beckett JM, Bird ML, Pittaway JK, Ahuja KD · Interactive journal of medical research · 2019

There is currently no scientific evidence supporting the use of specific diets in the management of multiple sclerosis (MS); the strongest dietary associations are observed with vitamin D and omega-3 fatty acid supplementation. Despite this, there are many websites that provide advice or suggestions about using various dietary approaches to control symptoms or disease progression. The objective of this study was to assess the dietary advice for the symptomatic management of MS available on the internet. This study was a systematic review of webpages that provided dietary advice for the management of MS. Webpages were selected from an internet search conducted in November 2016 using Google, Yahoo, and Bing search engines and the search term "MS diet." The first two pages of results from each search engine were included for the initial assessment. Duplicates were removed. Data extracted from websites included specific advice relating to diet and its rationale and the citation of suppor

The role of gluten in multiple sclerosis: A systematic review.

Thomsen HL, Jessen EB, Passali M, Frederiksen JL · Multiple sclerosis and related disorders · 2019

There is an increasing interest in diet as a modifying factor in multiple sclerosis (MS), and gluten has been suggested to affect MS. The aim of this systematic review is to qualitatively evaluate the evidence on the role of gluten in MS. A review protocol was submitted to PROSPERO. A systematic literature search was conducted in PubMed, Web of Science, Scopus, Embase, Cab Abstracts, and Google Scholar. Studies on patients with MS, clinically isolated syndrome, or celiac disease presenting with MS-related markers were included, if they investigated effects of diets containing specified amounts of gluten or associations between gluten sensitivities and MS. Forty-nine publications presenting 50 studies/cases met the inclusion criteria. Study designs, methods, and outcomes varied broadly across studies. Two intervention studies found a positive effect of a gluten-free diet on disease-related markers in patients with MS. One prospective cohort study also found a positive effect of a glu

Bile acid metabolites predict multiple sclerosis progression and supplementation is safe in progressive disease.

Ladakis DC, Harrison KL, Smith MD, Solem K, Gadani S, Jank L · Med (New York, N.Y.) · 2025 · n=47

Bile acid metabolism is altered in multiple sclerosis (MS) and tauroursodeoxycholic acid (TUDCA) supplementation ameliorated disease in mouse models of MS. Global metabolomics was performed in an observational cohort of people with MS, followed by pathway analysis to examine relationships between baseline metabolite levels and subsequent brain and retinal atrophy. A double-blind, placebo-controlled trial was completed in people with progressive MS (PMS), randomized to receive either TUDCA (2 g/day) or placebo for 16 weeks. Participants were followed with serial clinical and laboratory assessments. Primary outcomes were safety and tolerability of TUDCA, and exploratory outcomes included changes in clinical, laboratory, and gut microbiome parameters. In the observational cohort, higher primary bile acid levels at baseline predicted slower whole-brain atrophy, brain substructure atrophy, and specific retinal layer atrophy. In the clinical trial, 47 participants were included in our

Randomised controlled trial of intermittent calorie restriction in people with multiple sclerosis.

Ghezzi L, Tosti V, Shi L, Cantoni C, Mikesell R, Lancia S · Journal of neurology, neurosurgery, and psychiatry · 2025

Calorie restriction (CR) ameliorates preclinical models of multiple sclerosis (MS) via multiple mechanisms. These include decreased leptin, a proinflammatory adipokine, but mechanistic studies in humans are lacking. Tests of daily and intermittent CR (iCR) in people with MS (pwMS) showed improvements in fatigue and well-being measures. This trial studied the effects of 12-week iCR on metabolic, immunological, and clinical outcomes in pwMS. Relapsing-remitting MS participants were randomised to iCR or a control group. Study visits were conducted at baseline, 6 and 12 weeks. The primary outcome was reduction in serum leptin levels at 12 weeks. Feasibility and safety were assessed by diet adherence and adverse events (AEs). Secondary outcomes included changes in anthropometric and body composition measures, metabolic and immunologic profiling, and clinical measures. Mixed effects linear regression models were used to evaluate outcome differences between and within groups over time. Fort

Intermittent Fasting Confers Protection in CNS Autoimmunity by Altering the Gut Microbiota.

Cignarella F, Cantoni C, Ghezzi L, Salter A, Dorsett Y, Chen L · Cell metabolism · 2018

Multiple sclerosis (MS) is more common in western countries with diet being a potential contributing factor. Here we show that intermittent fasting (IF) ameliorated clinical course and pathology of the MS model, experimental autoimmune encephalomyelitis (EAE). IF led to increased gut bacteria richness, enrichment of the Lactobacillaceae, Bacteroidaceae, and Prevotellaceae families and enhanced antioxidative microbial metabolic pathways. IF altered T cells in the gut with a reduction of IL-17 producing T cells and an increase in regulatory T cells. Fecal microbiome transplantation from mice on IF ameliorated EAE in immunized recipient mice on a normal diet, suggesting that IF effects are at least partially mediated by the gut flora. In a pilot clinical trial in MS patients, intermittent energy restriction altered blood adipokines and the gut flora resembling protective changes observed in mice. In conclusion, IF has potent immunomodulatory effects that are at least p

Education, Lifestyle Risk Factors, and Treatment Choices and Multiple Sclerosis Progression.

Guo J, Olsson T, Hillert J, Alfredsson L, Hedström AK · JAMA network open · 2025 · n=3695

The implications of socioeconomic factors, including educational level, for multiple sclerosis (MS) progression remain unclear. Understanding whether educational level directly affects MS outcomes or is confounded by lifestyle risk factors and treatment choices could inform personalized care strategies. To investigate the association between educational level and outcomes related to MS, including worsening of disability, cognition, and health-related quality of life, after adjusting for potential confounding factors or mediation by lifestyle factors and treatment. This cohort study used data from 2 large, population-based case-control studies conducted in Sweden from April 2005 to December 2019 that used Swedish MS Registry data with detailed clinical and sociodemographic information. Patients with relapsing-onset MS aged 25 years or older at disease onset after 1995 were followed up from diagnosis until April 6, 2022, with a mean (SD) follow-up time of 10.4 (5.4) years. Data analysi

Randomized Controlled Trials of Rehabilitation in Multiple Sclerosis: Barriers and Unmet Needs.

Motl RW · Multiple sclerosis (Houndmills, Basingstoke, England) · 2024

Randomized controlled trials (RCTs) provide the foundation of evidence-based practice for the application of rehabilitation as complementary of medications for filling in the gaps and enhancing outcomes in people with multiple sclerosis (MS). This paper identifies seven field-wide areas of relevance for RCTs of rehabilitation that are barriers for (a) knowledge translation and implementation, (b) impact among those who most need rehabilitation, and (c) the field and its value in comprehensive MS care. The seven field-wide areas include improving the quality of RCTs; implementing discovery models for informing selection of interventions; focusing on primary end-points in samples screened for presence of symptoms/dysfunction; exploring response heterogeneity as an avenue for precision medicine; quantifying adherence and compliance for guiding future prescriptions; understanding mechanisms of outcomes through experimental medicine; and extending research into under-researched populations.

The Role of Ketogenic Diet in the Treatment of Neurological Diseases.

Dyńka D, Kowalcze K, Paziewska A · Nutrients · 2022

Over a hundred years of study on the favourable effect of ketogenic diets in the treatment of epilepsy have contributed to a long-lasting discussion on its potential influence on other neurological diseases. A significant increase in the number of scientific studies in that field has been currently observed. The aim of this paper is a widespread, thorough analysis of the available scientific evidence in respect of the role of the ketogenic diet in the therapy of neurological diseases such as: epilepsy, Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS) and migraine. A wide range of the mechanisms of action of the ketogenic diet has been demonstrated in neurological diseases, including, among other effects, its influence on the reduction in inflammatory conditions and the amount of reactive oxygen species (ROS), the restoration of the myelin sheath of the neurons, the formation and regeneration of mitochondria, neuronal metabolism, the provision of an alternativ

Early Neuroinflammatory Changes as a Prognostic Marker in Clinically Isolated Syndromes Patients.

n=37 · NCT01567553 · TERMINATED · TERMINATED

While significant progress has been made on medical imagery in recent years in the individualization of different lesions in the nervous system for demyelination, axonal loss, atrophy, little progress has been made in the specific recognition the inflammatory process. Yet this point is essential since the currently available treatments have a partial impact mainly on the inflammatory component and that many uncertainties remain about the links between inflammation and tissue destruction affecting myelin and axons. The recent discovery of a macrophage cell marker in the CNS, more specific (USPIO) of inflammation gives us the opportunity to answer important questions which one can sense that this could have a significant impact on therapeutic drug monitoring of these patients. This study will involve 50 patients recruited in five French centers (Marseille, Paris, Reims, Rennes, Toulouse) from the earliest manifestations of the disease with clinical and MRI scheduled for the first 3 years of their disease.

PET with [18F]Flumazenil As an Index of Neurodegeneration in MS: Sensitivity At an Early Disease Stage and Pathophysiological Meaning

n=45 · NCT03825601 · COMPLETED · COMPLETED

Beyond white matter pathology, grey matter damage is considered as a key player in disability onset and progression in Multiple Sclerosis (MS). The underlying substratum of grey matter damage is complex and pluriform, ranging from cortical demyelinating lesions, synapse and dendrite disappearance to neuronal cell death. Current Magnetic Resonance Imaging MRI techniques fail to fully assess and quantify grey matter pathology in this disease. The development of a quantitative marker of neurodegeneration for MS patients would allow: (i) to better understand the pathophysiological mechanisms underlying the distinct forms of MS; (ii) to stratify patients according to their prognosis; and (iii) to evaluate new therapies aimed at promoting neuroprotection. would allow to better understand the mechanisms underlying the distinct forms of MS, to stratify patients according to their prognosis, and to evaluate new therapies aimed at promoting neuroprotection.

A Randomized, Double-blind, Double-dummy, Parallel-group Study, Comparing the Efficacy and Safety of Remibrutinib Versus Teriflunomide in Participants With Relapsing Multiple Sclerosis, Followed by Extended Treatment With Open-label Remibrutinib

n=1007 · NCT05156281 · ACTIVE_NOT_RECRUITING · ACTIVE_NOT_RECRUITING

To compare the efficacy and safety of remibrutinib versus teriflunomide in patients with relapsing multiple sclerosis (RMS)

Cochrane Database of Systematic Reviews - Multiple Sclerosis

Cochrane

The Cochrane Library offers a collection of systematic reviews and meta-analyses related to multiple sclerosis, providing high-quality evidence on interventions and treatments.

TRIP Database - Multiple Sclerosis

TRIP Database

The TRIP database is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice, including numerous resources on multiple sclerosis.

Multiple Sclerosis Exercise

TRIP Database

TRIP Database provides a search engine for clinical evidence covering various medical topics, including multiple sclerosis and exercise. It aggregates evidence from multiple sources to facilitate evidence-based practice.