Abstract
We provide an overview of rehabilitation in neurological diseases. A large amount of literature available on neurorehabilitation is based from the rehabilitative work on stroke and spinal cord injuries. After a brief description of rehabilitation, the potential application of neurorehabilitation in neurodegenerative diseases specifically multiple sclerosis (MS) is summarized. Since MS causes a wide variety of symptoms, the rehabilitation in MS patients may benefit from an interdisciplinary approach that encloses physiotherapy, cognitive rehabilitation, psychological therapy, occupational therapy, and other methods to improve fatigue. Neurorehabilitation helps patients to reach and maintain their optimal physical, psychological and intellectual, levels but it does not reverse long-term disabilities that arise from neurological disorders. This calls for the need of better neuroregenerative and neuroprotective treatment strategies in addition to neurorehabilitation. We discuss neuroprotective drugs aimed at preventing axonal, neuronal, myelin and oligodendrocyte damage and cell death that are approved and others that are currently in clinical trials, with an emphasis on human derived natural antibodies with remyleination potential. Our investigative group developed recombinant natural human IgM antibodies against oligodendrocytes and neurons with a potential for CNS repair and remyleination. One such recombinant antibody, rHIgM22 completed a phase 1 clinical trial with no toxicity and with an objective of promoting remyleination in multiple sclerosis. Inclusion of these drugs as a multifaceted approach may further enhance the efficacy of neurorehabilitation in neuroinflammatory and neurodegenerative disorders.
Highlights
We provide an overview of rehabilitation in neurological diseases
New strategies need to be identified for neuroinflammatory and neurodegenerative diseases and therapeutic approaches need to be focused on actively stimulating brain lesion repair and rehabilitation
This approach helps bridge the gap between basic pathology and symptomatic improvement of neurological diseases
Summary
“Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. The therapeutic effects of Nabs that target myelin and oligodendrocytes in demyelinating disease models encouraged our group to study monoclonal IgM antibodies with a capacity of binding to neuronal cells as probable treatment options in neurological insults (sHIgM12 and sHIgM22). These antibodies are different from those that promote remyleination with no effect on the extent of remyleination in vivo or on calcium influx in vitro, but these neuron binding antibodies play a role in the stimulation of neurite extension [45] and a recombinant of sHIgm was generated (rHIgM12) [46]. All these drugs are yet to show efficacy in phase 3 trials and it is difficult to know how they can be integrated in MS therapy and neurorehabilitation
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