Neuroprotection is an area of research in multiple sclerosis.
The permanent symptoms of MS develop when nerve cells are destroyed. This is thought to occur when nerve fibres are exposed to chemicals produced by the inflammation of tissue that MS causes. The theory of neuroprotection is that, if the nerve cells can be protected from these chemicals, destruction of nerve cells - and thus further permanent problems - can be lessened or prevented.
Neuroprotective drugs will not be able to reverse progression or restore lost function. However, if suitable drugs can be developed, it is hoped that this will mean that the progression of multiple sclerosis can be significantly slowed down - something that is not possible with existing medication.
Different aspects of neuroprotection are being examined, concentrating of different elements that lead to loss of nerve cells.
Glutamate receptor blockers are aimed at controlling one of the chemicals involved in transmitting messages from nerve cell to nerve cell. Excessive glutamate can lead to the loss of nerve fibres and early research is looking at the effects of trying to control this.
- Riluzole is a glutamate inhibitor that is used in the treatment of amyotrophic lateral sclerosis (ALS), a form of motor neurone disease. A small study involving 16 people with primary progressive multiple sclerosis did not show any definite effect. There was a trend for a reduction in MRI changes but not in clinical measures of disability.
Inflammation leads to the increase in levels of nitric oxide and sodium, both of which can damage nerve cells. Research is underway to examine the effect of blocking these chemicals.
- Lamotrigine is a sodium channel blocker sometimes used to treat pain in MS that has been studied as a potential neuroprotective drug, though the results did not differ from placebo.
- Phenytoin is a sodium channel blocker used to treat epilepsy. A study in people with optic neuritis found that people who had been treated with phenytoin showed less damage to nerve cells in the retina than people taking a placebo.
Other drugs that have been used in other conditions have being investigated for their neuroprotective effect in MS:
- Amiloride has shown signs of limiting damage to nerves in a small study of people with primary progressive MS though more research is needed.
- Ibudilast has been studied in people with relapsing remitting MS to see if the drug would have a neuroprotective effect.
- Eliprodil has been investigated as a treatment for Parkinson's disease. There have been very early laboratory trials in MS.
- Cannabis was studied in a trail called CUPID that showed it was no better at reducing progression than placebo.
Amiloride, ibudilast and riluzole are being studied by the the MS-SMART trial for a neuroprotective effect in people with secondary progressive MS.
Research in this area is at a relatively early stage and these studies are exploring the potential of neuroprotection as a strategy rather than the possibility of making particular drug available to people with MS in the short-term. That said, if this work does lead to drugs that can slow down the progression of multiple sclerosis, this will be a major step forward in an aspect of MS for which there are currently no treatments.
- Journal of Neurological Sciences 2008;265(1-2):21-25. Summary Neuroprotection and repair.
- Current Pharmaceutical Design 2012;18(29):4471-4474. Summary Neurodegeneration and neuroprotection in multiple sclerosis.
- Trends in Neuroscience 2010;33(3):140-152. Summary Neuroprotection, regeneration and immunomodulation: broadening the therapeutic repertoire in multiple sclerosis.
- Current Opinion in Neurology 2006;19(3):255-259. Summary Neuroprotection in multiple sclerosis: therapeutic strategies and clinical trial design.
- Journal of Neurological Science 2005;233(1-2):113-115. Summary Glutamate inhibition in MS: the neuroprotective properties of riluzole.
- Lancet Neurology 2010;9(7):681-688. Summary Lamotrigine for neuroprotection in secondary progressive multiple sclerosis: a randomised, double-blind, placebo-controlled, parallel-group trial.
Last updated: 17 April 2015
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