Balance In Multiple Sclerosis Research Articles

Measuring standing balance in multiple sclerosis: Further progress towards an automatic and reliable method in clinical practice

BackgroundBalance deficits in multiple sclerosis (MS) are often monitored by means of observer-rated tests. These may provide reliable data, but may also be time-consuming, subject to inter-rater variability, and potentially insensitive to mild fluctuations throughout the clinical course. On the other hand, laboratory assessments are often not available. The Nintendo Wii Balance Board (WBB) may represent a low-cost solution. The purpose of the current study was to examine the methodological quality of WBB data in MS (internal consistency, test-retest reliability), convergent validity with observer-rated tests (Berg Balance Scale, BBS; Timed-Up and Go Test, TUG), and discriminative validity concerning clinical status (Expanded Disability Status Scale, EDSS). MethodsStanding balance was assessed with the WBB for 4min in 63 MS patients at two assessment points, four months apart. Additionally, patients were examined with the BBS, TUG and the EDSS. ResultsA period of 4min on the WBB provided data characterized by excellent internal consistency and test-retest reliability. Significant correlations between WBB data and results of the BBS and TUG were obtained after merely 2min on the board. An EDSS median-split revealed that higher EDSS values (>3) were associated with significantly increased postural sway on the WBB. ConclusionsWBB measures reflecting postural sway are methodologically robust in MS, involving excellent internal consistency and test-retest reliability. They are also characterized by convergent validity with other considerably lengthier observer-rated balance measures (BBS) and sensitive to broader clinical characteristics (EDSS). The WBB may hence represent an effective, easy-to-use monitoring tool for MS patients in clinical practice.

Rehabilitation in multiple sclerosis: the role of tele-rehabilitation/gaming.

Neurodegenerative Disease ManagementVol. 6, No. 6s Symposium PaperRehabilitation in multiple sclerosis: the role of tele-rehabilitation/gamingMathias MäurerMathias Mäurer*Author for correspondence: E-mail Address: m.maeurer@juliusspital.de Department of Neurology, Caritas Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 Bad Mergentheim, GermanySearch for more papers by this authorPublished Online:22 Nov 2016https://doi.org/10.2217/nmt-2016-0049AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View article"Rehabilitation in multiple sclerosis: the role of tele-rehabilitation/gaming." , 6(6s), pp. 17–18Keywords: multiple sclerosistele-rehabilitationgamingReferences1 Neville LM, O'Hara B, Milat A. Computer-tailored physical activity behavior change interventions targeting adults: a systematic review. Int. J. Behav. Nutr. Phys. Act. 6, 30 (2009).Crossref, Medline, Google Scholar2 Haase R, Schultheiss T, Kempcke R, Thomas K, Ziemssen T. Use and acceptance of electronic communication by patients with multiple sclerosis: a multicenter questionnaire study. J. Med Internet. Res. 14, e135 (2012).Crossref, Medline, Google Scholar3 Marrie RA, Salter AR, Tyry T, Fox RJ, Cutter GR. Preferred sources of health information in persons with multiple sclerosis: degree of trust and information sought. J. Med. Internet Res. 15, e67 (2013).Crossref, Medline, Google Scholar4 Sweet SN, Perrier MJ, Podzyhun C, Latimer-Cheung AE. Identifying physical activity information needs and preferred methods of delivery of people with multiple sclerosis. Disabil. Rehabil. 35, 2056–2063 (2013).Crossref, Medline, Google Scholar5 Motl RW, Dlugonski D, Wójcicki TR, McAuley E, Mohr DC. Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult. Scler. 17, 116–128 (2011).Crossref, Medline, Google Scholar6 Tallner A, Pfeifer K, Mäurer M. Web-based interventions in multiple sclerosis: the potential of tele-rehabilitation. Ther. Adv. Neurol. Disord. 9, 327–335 (2016).Crossref, Medline, Google Scholar7 Frevel D, Mäurer M. Internet-based home training is capable to improve balance in multiple sclerosis: a randomized controlled trial. Eur. J. Phys. Rehabil. Med. 51, 23–30 (2015).Medline, CAS, Google Scholar8 Lyons EJ, Hatkevich C. Prevalence of behavior changing strategies in fitness video games: theory-based content analysis. J. Med Internet. Res. 15, e81 (2013).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Vol. 6, No. 6s Follow us on social media for the latest updates Metrics Downloaded 57 times History Published online 22 November 2016 Published in print December 2016 Information© Future Medicine LtdKeywordsmultiple sclerosistele-rehabilitationgamingFinancial & competing interests disclosureM Mäurer has received honoraria for lecturing, travel expenses for attending meetings and financial support for research from: Almirall, Bayer Health Care, Böhringer Ingelheim, Biogen, Genzmye/SanofiAventis, MerckSerono, Novartis, Roche, Talecris and Teva. M Mäurer serves on a steering committee for Biogen and Novartis and is a consultant for Biogen, Genzyme and Roche. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Writing assistance was utilized in the production of this manuscript. Writing assistance was provided by Content Ed Net (Madrid, Spain), with funding from Almirall SA (Barcelona, Spain).PDF download

Poster Abstracts from the Sixth International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the Sixth International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the Fifth International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the Fifth International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the Fourth International Symposium on Gait and Balance in Multiple Sclerosis: The Role of CognitionCleveland Clinic • Cleveland, Ohio, USA • October 10 & 11, 2014.

Poster Abstracts from the Fourth International Symposium on Gait and Balance in Multiple Sclerosis: The Role of CognitionCleveland Clinic • Cleveland, Ohio, USA • October 10 & 11, 2014.

MiR26a modulates Th17/T reg balance in the EAE model of multiple sclerosis by targeting IL6.

A number of different microRNAs (miRNAs) have been implicated in various autoimmune diseases, including multiple sclerosis (MS). T helper (Th)17 and regulatory T cells (Tregs) have likewise been implicated as key players in MS, and a functional imbalance of these cell types is increasingly recognized as a key etiological factor in the disease. Although specific panels of transcription factors and cytokines are known to regulate the Th17/Treg balance, the role of noncoding RNAs remains poorly understood. The inflammatory cytokine, interleukin (IL)6, appears to play a critical role in both the development of the Th17 response and the inhibition of Treg functions. In this research, an IL6-associated miRNA, miR26a, was identified, and its normally downregulated expression was shown to be highly correlated with disease severity in patients suffering from MS as well as in C57BL/6 mice with experimental autoimmune encephalomyelitis (EAE; a well-established animal model of human MS). Using the EAE model system, in vivo silencing of miR26a was found to result in increased expression of Th17-related cytokines and increased severity of EAE, while overexpression of miR26a was found to result in reduced expression of Th17-related cytokines and a milder form of EAE. By contrast, Treg cell-specific transcription factor, Foxp3, was found to be positively correlated with miR26a expression. Finally, miR26a was found to downregulate Th17 and to upregulate Treg cell function through its targeting of IL6. Taken together, our data indicate an important role for miR26a in maintaining the Th17 and Treg cell balance in MS that involves repression of IL6 expression.

Balance in multiple sclerosis. Evaluation and rehabilitation

Balance in multiple sclerosis. Evaluation and rehabilitation

The Effects of Salsa Dance on Gait and Balance in Multiple Sclerosis (P3.053)

The Effects of Salsa Dance on Gait and Balance in Multiple Sclerosis (P3.053)

Poster Abstracts from the Third International Symposium on Gait and Balance in Multiple Sclerosis

Saint Louis University • St. Louis, Missouri, USA • October 18 & 19, 2013Editor's note: This is a listing of the poster abstract titles, authors, and author affiliations. The full abstracts are available on IJMSC's online edition at http://IJMSC.org.(1) COMPARISON OF AN INTERMITTENT VS. CONTINUOUS WALKING PROGRAM IN PERSONS WITH MULTIPLE SCLEROSIS USING THE 6 MINUTE WALK TEST: A RANDOMIZED CROSSOVER PILOT STUDYH Karpatkin, S DiCarrado, B Dungan, E Huallpa, J PotrzebaHunter College, City University of New York, New York, NY(2) CONSTRUCT VALIDITY OF THE FUNCTIONAL GAIT ASSESSMENT IN PERSONS WITH MULTIPLE SCLEROSISAnette Forsberg,1,2 Ylva Nilsagård2,31Family Medicine Research Centre, Örebro County Council, Örebro, Sweden;2School of Health and Medical Sciences, Örebro University, Örebro, Sweden;3Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden(3) IMMEDIATE IMPACT OF A HIP FLEXION ASSIST DEVICE ON SPATIOTEMPORAL PARAMETERS OF GAIT IN INDIVIDUALS WITH MSFrancois BethouxMellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH(4) STRUCTURAL CONNECTIVITY OF PROPRIOCEPTIVE NEURAL PATHWAYS IN MSBrett W. Fling, Fay B. HorakDepartment of Neurology, Oregon Health and Science University, Portland, OR(5) USE OF INERTIAL SENSORS TO DETECT EFFECTS OF DALFAMPRIDINE ON BALANCE IN PEOPLE WITH MULTIPLE SCLEROSISGG Dutta, M Mancini, RI Spain, FB Horak, MH CameronDepartment of Neurology, Oregon Health and Science University, Portland, OR(6) EFFECT OF A SERVICE DOG ON AMBULATION IN MS INDIVIDUALS WITH GAIT DYSFUNCTIONCecilie Fjeldstad, Gabriel PardoOklahoma Medical Research Foundation, MS Center of Excellence, Oklahoma City, OK(7) DETECTING CHANGES IN GAIT CHARACTERISTICS DURING A SIX-MINUTE WALK USING WIRELESS TECHNOLOGY IN MS SUBJECTSMatthew Engelhard,1 Stephen D. Patek,1 Shanshan Chen,2 John Lach,2 Rebecca Yeamans,3 Myla D. Goldman31Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA;2Charles L. Brown Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA;3Department of Neurology, University of Virginia, Charlottesville, VA(8) SYNERGISTIC EFFECT OF IMPAIRED VIBRATION AND LOWER LIMB KINETICS CONTRIBUTING TO GAIT AND BALANCE LIMITATIONS IN MULTIPLE SCLEROSISEC Held Bradford,1 RT Naismith,2 JM Wagner31Department of Neurology, Saint Louis University, St. Louis, MO;2Department of Neurology, Washington University in St. Louis, St. Louis, MO;3Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO(9) PHYSIOLOGICAL FALL RISK AND DUAL TASK COST OF WALKINGDA Wajda, RW Motl, JJ SosnoffDepartment of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL(10) ACCELEROMETRY TO MEASURE POSTURAL SWAY IN PERSONS WITH MULTIPLE SCLEROSIS AGREES WITH GOLD STANDARD MEASURESJessie M. Huisinga,1 Martina Mancini,2 Rebecca Spain,2,3 Fay B. Horak21University of Kansas Medical Center, Kansas City, KS;2Oregon Health and Science University, Portland, OR;3Neurology Service and MS Center of Excellence-West, Portland VA Medical Center, Portland, OR(11) CONCURRENT VALIDITY OF THE PATIENT-SPECIFIC FUNCTIONAL SCALE AND THE TIMED 25 FOOT WALK TEST IN PEOPLE WITH MULTIPLE SCLEROSISMark M. Mañago,1,2 Jeffrey R. Hebert21University of Colorado Hospital, Aurora, CO;2Physical Therapy Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO(12) COHERENCE ANALYSIS REVEALS ALTERED POSTURAL CONTROL DURING STANDING IN PERSONS WITH MULTIPLE SCLEROSISFB Horak,1 JM Huisinga,2 M Mancini11Oregon Health and Science University, Portland, OR;2University of Kansas Medical Center, Kansas City, KS(13) BALANCE-EXERCISE PROGRAMME REDUCED FALLS IN PEOPLE WITH MSY Nilsagård,1,2 L von Koch,3 A Forsberg2,41Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden;2School of Health and Medical Sciences, Örebro University, Örebro, Sweden;3Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;4Family Medicine Research Centre, Örebro County Council, Örebro, Sweden(14) EFFECT OF DALFAMPRIDINE ON GAIT AND BALANCE IN PATIENTS WITH MULTIPLE SCLEROSIS: THE STEADY STUDYGabriel Pardo,1 Cecilie Fjeldstad,1 Gustavo Suárez,2 Michael Klingler,2 Herbert R. Henney III,2 Adrian L. Rabinowicz21Oklahoma Medical Research Foundation, MS Center of Excellence, Oklahoma City, OK;2Acorda Therapeutics, Inc, Ardsley, NY(15) PHYSIOLOGICAL FACTORS OF GAIT VARIABILITY IN PERSONS WITH MULTIPLE SCLEROSISJ Sung, Y Moon, DA Wajda, S Balantrapu, RW Motl, JJ SosnoffDepartment of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL(16) CENTER OF PRESSURE TRAJECTORY OF FOOT FALLS IN MULTIPLE SCLEROSISY Moon, DA Wajda, J Sung, RW Motl, JJ SosnoffDepartment of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.Implications for RehabilitationApproaches to improve Gait and Balance dysfunction in Multiple Sclerosis.Balance exercises that include training of sensory strategies.Self-management and self-management support.Pharmacologic intervention, such as Dalfampradine.Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

Objective and subjective measures reflect different aspects of balance in multiple sclerosis

The objective of this study was to evaluate relationships between subjective and objective measures of balance in multiple sclerosis (MS). In 54 subjects with MS, balance was measured objectively with the Sensory Organization Test (SOT) using dynamic posturography and subjectively with the Activities-specific Balance Confidence (ABC) Scale and the Falls Efficacy Scale-International (FES-I). MS-related disability was assessed with the Expanded Disability Status Scale (EDSS). Relationships between the magnitude (root mean square, range, and area) as well as velocity of center of pressure sway (calculated from the center of pressure signal from the SOT), composite SOT, ABC Scale, FES-I, and EDSS scores were assessed. The magnitude and velocity of center of pressure sway was statistically significantly correlated with the ABC Scale (rho = -0.2 to -0.5), FES-I (rho = 0.3 to 0.5), and EDSS (rho = 0.3 to 0.4). The composite SOT was also statistically significantly correlated with the ABC Scale, FES-I, and EDSS. Objective balance measures, as reflected by posturography, were significantly related to subjective reports of imbalance and clinical measures of disability in MS. The relationships are moderate to weak, indicating that a comprehensive description of balance problems in people with MS likely requires both objective and subjective balance measures.

Poster Abstracts from the Second International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the Second International Symposium on Gait and Balance in Multiple Sclerosis

Editorial

As we close out another busy year in caring for patients with multiple sclerosis (MS), the current issue of IJMSC offers another set of articles covering a broad range of topics relevant to MS clinicians and researchers.One important article deals with the initial diagnosis of MS, which is a critical step in defining subsequent treatment approaches, whether these are pharmacologic, rehabilitative, or a mixture of the two. Dr. Lalan and colleagues of the University of Mississippi Medical Center in Jackson contribute to our understanding of how to differentiate neuromyelitis optica (NMO) from MS using magnetic resonance imaging. Given that NMO is treated differently than more standard forms of MS, and that NMO patients may even worsen if given standard disease-modifying agents used in MS, this differentiation between the two entities is critical. The authors offer guidelines that are helpful to all MS clinicians, but especially to those who may not have seen this rarer form of demyelinating disease on a regular basis.Once the diagnosis of MS is established, the next step for an MS clinician is generally to consider whether a disease-modifying agent is appropriate and, if so, which one. An important subsequent step is to make sure that the patient is compliant with this agent. Dr. Dhib-Jalbut of the UMDNJ–Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues describe the effect of a focused training and education program using specialized nurses on compliance with interferon beta-1b in patients with early-onset MS. The program seemed to be effective in increasing patients' adherence to disease-modifying therapy.We have two contributions on specific areas of symptom management in this issue, one being a discussion of the use of a comprehensive pain management program in MS, and the other being a listing of poster presentations at a recent symposium on gait and balance in MS. While some clinicians continue to believe that MS does not cause pain, MS patients clearly experience pain from the disease as well as from multiple other causes, and most MS clinicians feel ill-equipped to effectively help patients with their pain. Dr. Sullivan and colleagues at the Cleveland Clinic in Cleveland, Ohio, describe the experience of MS patients who have chronic pain and have been enrolled in a comprehensive chronic pain rehabilitation program at the Cleveland Clinic. The authors demonstrate that MS patients can have significant improvements in pain, depression, and functioning, with results similar to those experienced by non-MS patients. Dr. Zackowski of the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues have organized a symposium on gait and balance in MS for a couple of years now, and we have the pleasure of including a list of the poster abstract titles from the most recent conference in the print issue, with the full abstracts published in our online edition at IJMSC.org. We are glad to help achieve a wider audience for their excellent work on this important topic.We are particularly pleased to have a contribution from a colleague in Jordan, Dr. Hamed of the University of Jordan in Amman, which discusses the real-life experience of MS patients and how environmental factors hinder their attempts to integrate into the wider community. Dr. Hamed also discusses the potential role for occupational therapists as well as others in planning intervention programs for patients with MS. Although the study involved Jordanian MS patients, the findings are equally applicable to other countries.Closing out this issue are two helpful contributions regarding caregivers of people with MS. Ms. Gupta of Kantar Health in Princeton, New Jersey, along with colleagues at EMD Serono and Pfizer, compares the reported burden of caregiving for MS patients and Alzheimer's disease patients, finding that MS caregivers have a much heavier load in some areas. This interesting study has important implications for policymaking as well as raising our awareness of caregiving issues. Ms. Preissner and colleagues of the University of Illinois at Chicago discuss the difficulty of doing research involving MS caregivers and how to get around these issues in order to advance such research and then develop educational programs to assist the caregivers, who are so crucial to the lives of our MS patients.We also want to remind you that the deadline for submitting abstracts for the Fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis, to be held in the spring of 2013, is December 31, 2012. Enjoy the rest of 2012, and we at IJMSC wish you all a very happy New Year!

1st International Symposium on Gait and Balance in MS: Gait and Balance Measures in the Evaluation of People with MS

Gait and balance measures have particular potential as outcome measures in Multiple Sclerosis (MS) because, of the many hallmarks of MS disability, gait and balance dysfunction are present throughout the course of the disease, impact many aspects of a person's life, and progress over time. To highlight the importance and relevance of gait and balance measures in MS, explore novel measurements of gait and balance in MS, and discuss how gait, balance, and fall measures can best be used and developed in clinical and research settings, the 1st International Symposium on Gait and Balance in Multiple Sclerosis was held in Portland, Oregon, USA on October 1, 2011. This meeting brought together nearly 100 neurologists, physiatrists, physical therapists, occupational therapists, nurses, engineers, and others to discuss the current status and recent advances in the measurement of gait and balance in MS. Presentations focused on clinician-administered, self-administered, and instrumented measures of gait, balance, and falls in MS.

Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials

To determine the effects of physiotherapy interventions on balance in people with multiple sclerosis. A systematic literature search was conducted in Medline, Cinahl, Embase, PEDro, both electronically and by manual search up to March 2011. Randomized controlled trials of physiotherapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health (ICF) category of "Changing and maintaining body position", were included. The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention. After screening 233 full-text papers, 11 studies were included in a qualitative analysis and 7 in a meta-analysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis. These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.

Poster Abstracts from the First International Symposium on Gait and Balance in Multiple Sclerosis

Poster Abstracts from the First International Symposium on Gait and Balance in Multiple Sclerosis

Editorial

Editorial

Assessment of Postural Balance in Multiple Sclerosis

Compromised postural balance is a common manifestation of multiple sclerosis (MS). Effective quantitative methods of assessing postural imbalance are needed to help clinicians evaluate progression of this impairment. The primary objective of this study was to compare postural balance in MS patients and healthy controls using a standard screening tool, the Berg Balance Scale (BBS), as well as a more technically sophisticated device, the NeuroCom SMART Balance Master (NeuroCom International, Inc, Clackamas, OR). The study participants consisted of 14 individuals diagnosed with MS and 10 healthy controls. Each participant was assessed with the BBS and also underwent six different balance tests using the NeuroCom, most comprising several subcomponent measures. Assessment with the BBS showed significantly more postural instability in the MS group than in the control group (P < .05). Testing with the NeuroCom showed significantly more postural instability in the MS group than in the control group on two of the six tests (four specific balance measures) (P < .05). Moderate-to-high correlations (0.50–0.80) were found between the postural assessments using the standard BBS and the NeuroCom balance tests for the MS group. These results indicate that the BBS is an effective screening instrument for balance problems in people with MS.

Immunotherapy of multiple sclerosis.

Based on the assumption that multiple sclerosis is an autoimmune disease, a number of clinical trials designed to suppress the immune system or to restore immune balance in multiple sclerosis have been attempted. Depending on the disease category, the clinical goals of immunotherapy differ. Therapeutic goals include improving recovery from acute attacks, preventing or decreasing the number of relapses, and halting the disease in its progressive stage. The ultimate goal of multiple sclerosis therapy is the early treatment of patients in an attempt to halt the onset of progression. Specific strategies of immunotherapy include generation of a suppressor influence, removal of helper/inducer cells, manipulation of activated T cells, manipulation of class II major histocompatibility complex-bearing cells, alteration of lymphocyte traffic, extracorporeal removal of serum factors or cells, and manipulation of antigen-specific cells. Present treatment modalities are beginning to show some efficacy of nonspecific immunosuppression, but these treatments are limited by their toxicities. As the immunotherapy of multiple sclerosis moves to the next stage in the coming years, patients at an earlier stage of their disease will have to be treated, nontoxic forms of therapy developed, clinical trials lengthened, and a laboratory monitor of the disease developed. Given the positive effects of immunotherapy seen thus far in the disease, it is possible that appropriate immunotherapeutic intervention may provide effective treatment for the disease in the future.