Primary Progressive Multiple Sclerosis: New Therapeutic Approaches.

BACKGROUND AND PURPOSE

Primary progressive multiple sclerosis (PPMS) is a clinically different form of MS that causes gradual and irreversible neurological impairment from symptom onset without relapses or remissions. With a mean onset age of 37-43 years, PPMS affects 10%-15% of MS patients and presents distinct diagnostic and treatment issues. Mobility issues, persistent pain, sensory disturbances, cognitive deficits, and bowel and bladder problems intensify over time. Neuroimaging shows substantial brain and spinal cord atrophy with fewer brain lesions but more spinal cord lesions.

FINDINGS

Drugs like ocrelizumab reduce progression, whereas high-dose biotin, simvastatin, and coenzyme Q10 are being investigated. PPMS treatment is difficult, with continuing research on fingolimod, idebenone, anti-LINGO-1, neuromodulation, and plasmapheresis. Ocrelizumab has shown encouraging outcomes. Preclinical gene therapy studies on immune regulation, neuroprotection, and remyelination in MS animals show promise. Hematopoietic and non-hematopoietic stem cell therapies have also been studied for their capacity to reduce neuroinflammation, repair tissue, and boost neurotrophic support.

CONCLUSIONS

Clinical research utilizing human fetal neural precursor cells (hfNPCs) reveals neuroprotective advantages and opportunities for PPMS treatment. Early clinical trials have shown promising results, but more study is needed to prove the safety and usefulness of these new PPMS treatments.