Neurológia pre prax 1/2022

Management of secondary-progressive multiple sclerosis

Although one of the goals of treatment of relapsing-remitting multiple sclerosis is to prevent or delay secondary progression, a condition in which there is irreversible deterioration of neurological findings unrelated to relapses, there are effective treatment and care options for these patients. In secondary progressive multiple sclerosis with activity (clinical in the form of relapses and/or on magnetic resonance imaging), there is now the possibility of effectively delaying severe disability and reducing the frequency of relapses by treatment with siponimod. In all patients with secondary progressive multiple sclerosis, comprehensive multidisciplinary care and treatment of any comorbidities is essential. Due to their usually older age and the resulting more frequent comorbidities and usually more severe neurological impairment, these patients represent a vulnerable group with regard to infectious complications, among others. Therefore, these patients should be actively considered the benefits and risks of a particular vaccination on an individual basis. The aim of this article is to highlight the underlying pathophysiological mechanisms, current options for deployment and cessation of disease-modifying therapy and symptomatic care, with a focus on the possibility of preventing infectious complications in patients in the secondary progressive multiple sclerosis.

Keywords: multiple sclerosis, secondary progression, siponimode, vaccination