Multiple Sclerosis

ECTRIMS 2016 Cris Constantinescu

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Published Online: Oct 25th 2016

Cris Constantinescu discusses the most exciting developments in the neurology field from the past year.



00:11 – So that’s a bit difficult. Certainly, from the MS point of view, I should probably say that, for a long time, the role of the immune system has been debated. And I think in the last few years, since the genome-wide association studies in MS have shown, without any doubt, that all the genes that have been associated with MS are genes of the immune system. So I think that’s probably the most convincing evidence the immune system plays a major role in MS. So I think I find that one of the most important discoveries.

00:55 – With regard to that, I think, also again, from the MS point of view, I was interested to see that about half of these genes are genes of the T cells; the other half, roughly, are genes of the B cells. And now we have drugs that are extremely promising for MS that target the B cells – deplete the B cells. And this seems to be extremely effective and not only in the relapsing remitting times of MS but also in progressive MS, at least in these few early trials. So I think that I find, as a great, exciting development in MS because, hopefully, we’ll have a treatment for progressive MS, and also we have a new target for treating MS which is the B cells.

01:47 – Also, we’ve just heard a talk about a risk-sharing scheme. In the United Kingdom, we had the risk-sharing scheme that allowed us to prescribe drugs, and we’re talking about first-line drugs that have been now used for 20 years in MS – interferon and Copaxone for MS. And we have just heard the ten-year results, so the final results of the study, which convincingly show, no matter how you look at the data – statistics are a bit complicated – but they show that they have an effect in preventing. They’re not a cure, they’re not sensational, but they reduce progression of disability in MS. So that’s, again, something very exciting.

02:43 – You were asking about neurology in general. What I find in the rest of neurology that is very exciting, I find in stroke that there are increasingly convincing studies that show the great benefits of early intervention in stroke. For example, there’s now about four studies that showed early clot retrieval – studies, interventions that improved significantly the prognosis of people with stroke. So I think these are only developments of the last four or five years, and I think that’s really promising for stroke.

03:28 – So in terms of Parkinson’s disease, I think the deep brain simulation has made a big difference. The introduction of deep brain simulation has and hopefully will make a major difference in the lives of people with Parkinson’s disease. The awareness of non-motor symptoms in Parkinson’s disease is increasing, and I think that’s, again, something that we’re only beginning to look at in more detail now.

03:57 – What else? Alzheimer’s disease; I think there is some progress. Well, also with regard to Parkinson’s, there have been genome-wide association studies that are showing pathways of neurodegeneration. I think those will be important for developing future targets. And the same with Alzheimer’s disease, but in particular, we know some genes now that are strongly associated with Alzheimer’s disease, but also some biomarkers; so biomarkers that you can follow from mild cognitive impairment to early, to late Alzheimer’s disease. And that may have prognostic significance, prognostic value, and also tell us a bit about the path of physiology, so hopefully enabling people to find therapeutic targets. So these are, I think, the major things that have been done in the last few years in neurology.

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