Most cited article - PubMed ID 10713630
High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis
In Europe, theoretical approaches to physical therapy and rehabilitation in multiple sclerosis often appear significantly different. While there is general agreement that rehabilitation plays an important role in maintaining and improving function in persons with multiple sclerosis, no consensus exists on what may be the most effective approach to achieve the best possible functionality within an individual's limitations.The objective of this paper is to initiate an analysis of currently applied physical interventions for people with multiple sclerosis throughout Europe during inpatient or outpatient rehabilitation programs. A study of the content of rehabilitation may show presently performed treatment methods revealing the basic considerations that nowadays guide clinicians implicitly or explicitly in the treatment of persons with multiple sclerosis. Following this first step, comparative studies can be set up.
- MeSH
- History, 20th Century MeSH
- History, 21st Century MeSH
- Humans MeSH
- Evidence-Based Medicine * MeSH
- Rehabilitation methods MeSH
- Multiple Sclerosis rehabilitation MeSH
- Physical Therapy Modalities * history MeSH
- Check Tag
- History, 20th Century MeSH
- History, 21st Century MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Historical Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
Conventional drugs, including disease-modifying drugs, various cytostatic regimens and steroids, are unable to control disease activity in a small group of patients with "malignant" multiple sclerosis (MS). This group of patients could be offered aggressive therapies, such as high-dose immunosuppression followed by haematopoietic stem cell transplant (HSCT). Bone marrow or peripheral blood HSCT has been proposed for the treatment of autoimmune diseases because of its immunosuppressive and immunomodulatory effects, and recapitulation of lymphocyte ontogeny may stabilise or improve the course of MS in some patients. There have been a few small studies conducted using high-dose immunoablation and HSCT. A recent clinical trial of 85 patients treated by HSCT revealed that more than 60% of patients may benefit from this procedure. Due to the perceived risks associated with HSCT, only patients with malignant MS who no longer benefit from more conventional therapies were enrolled. HSCT is thus a justified and feasible treatment in certain patient groups, although transplant-related mortality must be reduced.
