The therapeutic landscape for multiple sclerosis has evolved markedly in recent years, with an expanding arsenal of disease- modifying therapies offering clinicians more tools to manage the disease. This progress presents both opportunities and complexities, as treatment decisions increasingly require individualized strategies balancing efficacy, safety, and long-term outcomes. While current therapies effectively reduce inflammation and delay disease progression, they fall short in halting neurodegeneration, highlighting a critical unmet need. Treatment paradigms range from escalation strategies prioritizing safety to early high-efficacy approaches aimed at aggressive disease control. Data increasingly support early initiation of high-efficacy DMTs in patients with poor prognostic indicators, but concerns over long-term safety and tolerability remain. Shared decision-making, informed by patient preferences and evolving evidence, is central to modern MS care. The future is promising, with new therapies in advanced stages of research, which seek to exceed the limits of current therapy, to act in a targeted manner, limiting both inflammation and neurodegeneration, for better control of disease activity, with an improved safety profile.
Cannabinoids' usefulness in the treatment of neurological disorders (epilepsy, and various neurodegenerative diseases, such as Multiple Sclerosis and Alzheimer's Disease) has been demonstrated in a growing number of studies. Of the 11 known general types of natural cannabinoids, the focus has been mainly directed at cannabidiol (CBD) due to its specificity in stimulating cannabinoid receptors and the low rate of side effects, as well as on Δ (9)-tetrahydrocannabinol (Δ9-THC). The natural and synthetic analogs of CBD have been described as a potential treatment in neurological diseases, as they showed their therapeutic benefits in reducing the seizures from epilepsy and their neuroprotectivity in neurodegenerative diseases. First and foremost, CBD's neuroprotective properties are due to its capacity to act as an endogenous cannabinoid receptor agonist. Second, CBD enhances neuroprotection by interacting with many signal transduction pathways mediated indirectly through cannabinoid receptors. CBD also reduces the hyperphosphorylation of glycogen synthetase kinase 3 (GSK-3) induced by the buildup of Amyloid β in the physiopathology of Alzheimer's disease.
Besides the motor and sensory dysfunction that characterizes multiple sclerosis, during the disease evolution and with the accumulation of new demyelinating lesions in specific areas of the central nervous system, autonomic dysfunction be-comes more prevalent among patients suffering from multiple sclerosis. Although not usually addressed, the complex spectrum of autonomic dysfunction manifestations has the potential of a negative impact on the daily activities of multiple sclerosis patients, needing specific investigations and therapeutic measures destined to alleviate symptoms and increase the quality of life. Since urinary dysfunction is evident from the early stages of multiple sclerosis on urodynamic studies even in patients without urinary complaints, it is indicated to thoroughly screen for urinary tract dysfunction as well as other autonomic dysfunctions in all the multiple sclerosis patients.
Multiple sclerosis (MS) is an autoimmune disease in which the myelin sheath is damaged by the body itself. Because of the symptoms and progressive forms, in most cases, patients experience recurrent depressive disorder or anxious depression disorders. Depression treatment for MS patients stands in two categories, one is psychotherapy and the other is pharmacological. This article presents the research results on customized pharmacological treatment schemes applied to a group of relapsing-remitting multiple sclerosis (RRMS) patients with moderate, or severe, depression. All of them are included in the national treatment program for multiple sclerosis and their health state is continuously monitored. The therapeutic scheme based on four different antidepressants had encouraging results, meaning that any of the antidepressants used is efficient and with the patient's good tolerance. There were no side effects that could determine interruption of the treatment. Further research development would focus on improved therapeutic plans for patients with depression disorders in relapsing-remitting multiple sclerosis.
