Stabilisation of secondary progressive multiple sclerosis and improved motor function

History

Multiple sclerosis was diagnosed at around the age of 40, after demyelinating lesions were found on MRI. At that time the disease presented among other things with headaches and impaired sensation below the level of the abdomen.

The patient went through various stages of disease-modifying therapy, including interferon and natalizumab, and received glucocorticosteroids during relapses. Specific therapy was later discontinued, while regular neuromotor rehabilitation continued.

Over the two years before she came to us, motor function deteriorated particularly noticeably. Walking came to require unilateral support and falls occurred from time to time. Her neurologist assessed the course of the disease as secondary progressive.

MRI confirmed widespread demyelinating involvement: multiple lesions were found in various parts of the brain and along the cervical spinal cord.

Before treatment

At the time she came to us the most significant problems were:

• marked weakness of the legs, more on the left
• a paraparetic gait
• the need for additional support when moving about
• considerably reduced physical endurance
• intermittent episodes of falling
• reduced sensation in the legs
• urinary difficulty of the retention type
• constipation
• headaches

The level of neurological deficit corresponded to EDSS 6.0–6.5, that is, the disease was already substantially limiting the patient's independent mobility.

The main aim of the programme was to achieve stabilisation of the secondary progressive process, preserve existing function and improve the patient's motor capacity as far as possible.

The programme

A personalised combined programme of cell, immunoregulatory and neuroregenerative therapy was drawn up for the patient.

At the preparatory stage peripheral blood was collected to obtain her own regulatory T cells.

The programme included:

• therapy with mesenchymal stromal cells
• use of autologous regulatory T cells
• systemic and neurally targeted cell components
• concentrated exosome therapy
• intranasal peptide support
• two sessions of neurotherapy
• continued follow-up and ongoing rehabilitation

The exact doses and the sequence of procedures formed part of an individual internal protocol.

Course after treatment

The patient began to notice the first positive changes about two weeks after the programme.

Strength in the legs

The most noticeable early result was increased strength in the legs.

It became considerably easier for her to lift her legs unaided. In particular, she could pull her legs up almost without help when getting into a car or moving into a lying position on the bed.

Walking and functional independence

Her ability to move about improved substantially.

Within two weeks the patient was able to climb to the first floor several times unaided, holding the handrail.

Walking then became more confident, and her capacity to tolerate physical exertion and to carry out everyday tasks with less help from others increased.

Rehabilitation

The increase in strength and motor control allowed the scope of active rehabilitation to widen.

In physiotherapy the patient began to perform exercises that had previously been beyond her, which extended her functional capacity further.

Endurance

General physical endurance rose: she was able to stay active for longer and tolerate greater physical demands.

Headaches

Positive change in her headaches was also noted – they became less severe and troubled her considerably less often.

Disease stabilisation

A particularly important result of the further follow-up was that the steady progression of the disease seen previously stopped.

After the therapy there was no further increase in motor deficit of the kind that had characterised the preceding years.

In addition, no new clinical relapses were recorded over the follow-up period.

The early positive change that appeared within two weeks was thus combined, over time, with stabilisation of the overall neurological picture.