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Multiple Sclerosis: Advances in Therapeutic Approaches
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Multiple Sclerosis: Advances in Therapeutic Approaches

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (30 September 2025) | Viewed by 2618

Special Issue Editor

Prof. Dr. Renata Balnytė

E-Mail Website
Guest Editor
Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
Interests: neurodegeneration; Alzheimer's disease; multiple sclerosis; neuroinflammation; demyelinating diseases; neurophysiology; neurological diseases

Special Issue Information

Dear Colleagues,

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system that causes significant disability and healthcare burden. The treatment of MS has evolved over the past three decades with the development of new, high-efficacy disease-modifying therapies targeting various mechanisms, including immune modulation, immune cell suppression or depletion, and enhanced immune cell sequestration. The main goal of current disease-modifying therapy (DMT) is to quiet the disease by reducing inflammation, myelin injury, and relapses. Emerging therapies include CNS-penetrant Bruton's tyrosine kinase inhibitors and autologous hematopoietic stem cell transplantation, as well as therapies aimed at remyelination or neuroprotection for patients with a very active disease course or non-active with slow progression. Therapy development for progressive MS has been more challenging with limited efficacy of current approved agents for inactive disease courses and older patients with MS with comorbidity.

The aim of this Special Issue is to provide a broad overview of the recent advances in therapeutic approaches for MS.

Prof. Dr. Renata Balnytė
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multiple sclerosis
  • disease modifying treatment
  • immunomodulating teratment
  • new therapeutic approaches
  • neuroinflammation
  • neurodegeneration

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Published Papers (3 papers)

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Research

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12 pages, 235 KB  
Article
Prevalence and Associations of Poor Sleep in Patients with Relapsing-Remitting Multiple Sclerosis on Disease-Modifying Therapy
by Dimitar Taskov, Sonya Ivanova, Nikolay Topalov, Alexandra Barkalova-Atanasova, Nikolay Yordanov, Mitko Yurukov, Karina Atanasova-Ivanova, Paulina Ilieva-Nedeva, Antonia Nikolova, Sonia Chipeva and Ivan Milanov
J. Clin. Med. 2025, 14(21), 7837; https://doi.org/10.3390/jcm14217837 (registering DOI) - 4 Nov 2025
Abstract
Background: Sleep disturbances in the multiple sclerosis (MS) population are increasingly recognized, but the factors driving this association remain understudied. This study aimed to determine the prevalence and associations of poor sleep quality in the relapsing–remitting MS (RRMS) population receiving disease-modifying therapy (DMT). [...] Read more.
Background: Sleep disturbances in the multiple sclerosis (MS) population are increasingly recognized, but the factors driving this association remain understudied. This study aimed to determine the prevalence and associations of poor sleep quality in the relapsing–remitting MS (RRMS) population receiving disease-modifying therapy (DMT). Methods: We conducted a cross-sectional study that enrolled 399 individuals diagnosed with RRMS on DMT. Data on patient demographics, clinical presentation, and treatment were systematically evaluated. Sleep-related outcomes were assessed using validated questionnaires—the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), STOP-Bang questionnaire, and Hamilton Anxiety Rating Scale (HAM-A). Independent associations of poor sleep were examined using log-binomial regression to estimate risk ratios (RR). Results: Poor sleep was reported in 42% of the participants in our cohort. In multivariable analysis, only insomnia severity (RR = 1.07; 95% CI 1.05–1.09, p < 0.001) and anxiety (RR = 1.02; 95% CI 1.01–1.04, p = 0.001) remained independently associated with poor sleep. Conclusions: Sleep disturbances are common among patients with RRMS. Insomnia severity and anxiety, rather than demographic or disease-related characteristics, showed independent associations with impaired sleep. Routine screening and targeted interventions addressing insomnia and anxiety may improve sleep quality and, consequently, overall quality of life in this population. Full article
(This article belongs to the Special Issue Multiple Sclerosis: Advances in Therapeutic Approaches)
25 pages, 1600 KB  
Article
Evaluation of a Theoretical and Experiential Training Programme for Allied Healthcare Providers to Prescribe Exercise Among Persons with Multiple Sclerosis: A Co-Designed Effectiveness-Implementation Study
by Yvonne C. Learmonth, Georgios Mavropalias and Kym Wansbrough
J. Clin. Med. 2025, 14(18), 6625; https://doi.org/10.3390/jcm14186625 - 19 Sep 2025
Cited by 1 | Viewed by 643
Abstract
Background: Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting [...] Read more.
Background: Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting and prescribing this effective treatment. We implemented an online evidence-based educational programme and evaluated the effect, acceptability, appropriateness, and feasibility of the programme in improving HCP confidence, knowledge, and attitudes towards remote exercise prescription to persons with MS. Methods: Physiotherapists and exercise physiologists were recruited and received the educational programme (online theory and 16-week experience of prescribing to persons with MS). Participants’ confidence, knowledge and attitudes towards exercise prescription, as well as their professional quality of life, were our primary outcomes—baseline (T1), immediately post-online theoretical learning (T2), post-application with clients (T3; approximately 16 weeks after T2), and at 12-month follow-up (T4). We gathered participants’ acceptability, appropriateness, and feasibility evaluation at T2, T3 and T4. We analysed the effect on primary outcomes using generalised linear mixed models, with secondary and evaluative outcomes analysed as counts and qualitative themes. Results: Of 40 participants who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ≥ 1.27, SEs ≤ 0.31, |zs| ≥ 5.28, ps < 0.001), with large effect sizes (percentage change: 256.8–479.4%). Some theoretical domains framework-based domains have improved, such as beliefs about skills to prescribe evidence-based principles. Participants expressed high satisfaction with the programme and showed increased delivery of implementation behaviour change strategies. Conclusions: An online evidence-based education programme for MS care improved HCPs’ self-confidence, perceived skills and delivery of evidence-based exercise behaviour-based prescription. Full article
(This article belongs to the Special Issue Multiple Sclerosis: Advances in Therapeutic Approaches)
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15 pages, 1428 KB  
Systematic Review
Oral Manifestations of Multiple Sclerosis: A Systematic Review
by Paula García-Rios, Francisco Javier Rodríguez-Lozano and Miguel Ramón Pecci-Lloret
J. Clin. Med. 2025, 14(9), 2944; https://doi.org/10.3390/jcm14092944 - 24 Apr 2025
Viewed by 1635
Abstract
Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by diverse clinical manifestations, including the potential involvement of the oral cavity. Oral symptoms in MS patients may arise both as direct consequences of the disease and as [...] Read more.
Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by diverse clinical manifestations, including the potential involvement of the oral cavity. Oral symptoms in MS patients may arise both as direct consequences of the disease and as side effects of pharmacological treatments. These manifestations, such as xerostomia, periodontal disease, and dental sensitivity, can significantly affect quality of life and may be underrecognized in clinical practice. Aim: To systematically assess the presence and relevance of oral manifestations in patients with MS, and to identify correlations between these symptoms and clinical parameters such as MS phenotype, disease duration, and disability level. Materials and Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was conducted in PubMed and Scopus on 17 March 2025, using terms related to “multiple sclerosis” and “oral manifestations”. Inclusion criteria were limited to observational studies published in the last ten years, focusing on oral symptoms in MS patients. Furthermore, the quality of the studies was assessed following the Newcastle–Ottawa Scale (NOS) for cohort and case–control studies, and the JBI Critical Appraisal checklist for analytical cross-sectional studies. Results: Ten studies met the inclusion criteria. The most frequently reported oral manifestations were hyposalivation, gingival inflammation, increased DMFT and plaque indices, dental sensitivity, and oral pain. Several studies found statistically significant associations between oral dryness and MS phenotype (p < 0.05), and between periodontal health and degree of disability (p < 0.05). However, heterogeneity in methodology and lack of longitudinal studies were noted as limitations. Conclusions: This review highlights a clear relationship between MS and several oral health disturbances, particularly xerostomia and periodontal disease. The findings underscore the need for multidisciplinary care approaches and further studies with standardized protocols to better understand oral-systemic interactions in MS. Full article
(This article belongs to the Special Issue Multiple Sclerosis: Advances in Therapeutic Approaches)
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