Journal Healthcare Treatment Development (JHTD) ISSN 2799-1148 · Vol. 4, No. 2 (2024) · pp. 72-80
Research Paper

Recent advances in understanding and treating multiple sclerosis

Mohd Altaf Dar1, Afshana Qadir2, Zulfkar Qadrie3, Humaira Ashraf4
  1. 1 Department of Pharmacology, CT Institute of Pharmaceutical Sciences, PTU, Jalandhar Punjab, India.
  2. 2 Nursing Tutor, Government College of Nursing Baramulla, India.
  3. 3 Department of Pharmacology, Government Medical College, Baramulla, India. 4Department of Animal Nutrition, SKUAST-K, Srinagar, India.
  4. 4 Department of Animal Nutrition, SKUAST-K, Srinagar, India.
  5. * Corresponding author: Mohd Altaf Dar, daraltaf490@gmail.com
Received15 July 2024
Revised20 September 2024
Accepted29 September 2024
Published13 November 2024
DOIhttps://doi.org/10.55529/jhtd.45.25.34
LicenceCC BY 4.0
PDFDownload PDF

Abstract

Background: Multiple sclerosis, often called MS, is a long-term autoimmune disorder in the central nervous system. It shows up with inflammation, demyelination, and neurodegeneration, kind of like the immune system keeps misfiring and targets the myelin sheath. That process then leads to a bunch of different neurological symptoms. Even though people have a much better grasp lately, the exact etiology still isn’t fully pinned down. Objective: To pull together what recent research says about MS biological mechanisms, plus the diagnostic breakthroughs and how treatments are shifting over time, and also to spotlight the emerging trends that could matter for day-to-day clinical management and for future studies. Methods: We did a narrative review of recent literature. This included work on MS disease pathophysiology, risk factors in genes and surroundings, diagnostic innovation, and new directions in therapeutic development. Results: How likely someone is to develop MS depends on genetic factors, especially HLA-DRB1 polymorphisms. But there are also environmental elements, like low vitamin D levels and past viral infections. On the diagnostic side, capability has improved through updated magnetic resonance imaging MRI protocols and the discovery of new biomarkers found in cerebrospinal fluid and also peripheral blood. This supports earlier, and more accurate, disease characterization. On treatment, the landscape has moved past the older, more general disease-modifying therapies DMTs, toward agents that work with more targeted mechanisms. Looking ahead, newer approaches, particularly monoclonal antibodies and cell-based therapies, seem promising for better disease control and improved patient outcomes. Conclusion: There’s been a pretty major step forward in teasing apart the pathobiology of MS, improving how well we identify it, and also broadening the choice of therapies. Looking ahead, the next phase of MS research and day to day clinical care is probably going to be driven by merging genetic, immunological, and imaging findings together, along with continued work on targeted interventions and cell-based approaches. Still, more studies will be required to better pin down the cause-and-effect pieces, and to tune up personalized treatment strategies in a more reliable way.

Keywords: Multiple Sclerosis, Autoimmune Disease, Vitamin D Deficiency, Viral Infections, Demyelination, HLA-DRB1.

1. INTRODUCTION

The chronic autoimmune disorder known as multiple sclerosis (MS) is a condition that affects the central nervous system (CNS) and is characterised by inflammation, demyelination, and neurodegeneration. One of the most common causes of neurological disability in young adults, its prevalence varies widely around the world. It is one of the most common causes of neurological disability. Visual disturbances, motor and sensory deficiencies, and cognitive impairments are some of the symptoms that are frequently associated with this disease, which typically arrives in early adulthood and presents with a wide range of symptoms [1], [2], [3], [4], [5].

Multiple sclerosis (MS) is thought to be caused by an immune-mediated process in which the body's own immune system erroneously destroys the myelin sheath, which surrounds nerve fibres in the central nervous system and serves as a protective coating. The demyelination process causes disruptions in the transmission of nerve signals, which ultimately results in the creation of sclerotic plaques or lesions in the brain and spinal cord. The variability of the disease is reflected in the fact that the severity of symptoms and the pace of its progression can vary greatly from person to person. There is a complex relationship between the aetiology of multiple sclerosis (MS) and a combination of genetic predisposition and environmental variables. Several susceptibility genes have been identified through genetic research, with the HLA-DRB1 gene being one of the most significant of these genes [5], [6], [7], [8]. In addition to being linked to an increased chance of developing multiple sclerosis, variations in this gene are thought to have an effect on the functioning of the immune system. Environmental variables, such as a lack of vitamin D, smoking, and viral infections (especially Epstein-Barr virus), have also been believed to play a role in the development of the disease. Understanding the pathophysiology of multiple sclerosis (MS) is made more difficult by the interaction between these hereditary and environmental elements, which also presents difficulties in the process of finding effective treatments. Our knowledge of multiple sclerosis has been greatly improved as a result of recent developments in research. Through the development of highresolution magnetic resonance imaging (MRI) techniques, the capability to visualise lesions in the central nervous system (CNS) has been enhanced, which has facilitated the process of diagnosis and the monitoring of the progression of disease. Additionally, the discovery of novel biomarkers in cerebrospinal fluid (CSF) and blood is opening up new options for the early detection of disease and the monitoring of its progression. It is essential to make these improvements in order to improve patient outcomes and personalise treatment procedures to the specific requirements of each individual [8], [9], [10].

2. RELATED WORK

Recent investigations into multiple sclerosis (MS) have yielded significant discoveries into the disease's pathogenesis, genetic foundations, and therapeutic approaches. The autoimmune origin of multiple sclerosis (MS) is well-established, and studies have shown that the immune system attacks and damages the myelin sheath, which ultimately results in demyelination and neurological disability. A wide variety of neurological symptoms may be seen as a consequence of this immune-mediated process, which leads to the creation of lesions in the central nervous system (CNS). Research on genetics has uncovered a number of risk factors that are connected with multiple sclerosis [10], [11], [12]. Particular alleles of the HLA-DRB1 gene have been associated to an increased chance of getting the disease, making it one of the susceptibility genes that has been studied and characterised the most thoroughly. There are also other genetic factors that have been implicated, such as polymorphisms in genes that are involved in the control of the immune system and the synthesis of myelin. Our understanding of the disease's aetiology has been improved as a result of these genetic discoveries, which have also identified possible therapeutic intervention targets [12], [13], [14], [15], [16].

The capacity to diagnose and monitor multiple sclerosis has been significantly improved as a result of advancements in diagnostic procedures. Magnetic resonance imaging, sometimes known as MRI, is an essential tool for evaluating disease activity and visualising lesions in the central nervous system. The most recent advancements in magnetic resonance imaging (MRI) technology, such as high-resolution imaging and improved sequences, provide more specific information regarding the characteristics and distribution of lesions. Research into biomarkers, such as those found in cerebrospinal fluid (CSF) and blood-based markers, is also contributing to the advancement of the field of early disease monitoring and diagnosis. It is being investigated whether or not certain biomarkers, such as neurofilament light chain (NfL) and myelin oligodendrocyte glycoprotein (MOG), have the capability of reflecting the course and activity of the disease under investigation [16], [17], [18], [19].

Multiple sclerosis (MS) treatment methods have undergone significant development. The early treatments mostly consisted of disease-modifying therapies (DMTs), which were designed to reduce the number of relapses and to delay the course of the disease. Injectable medicines like interferon-beta and glatiramer acetate, which have been used for the management of symptoms associated with multiple sclerosis for decades, are included among these DMTs. Recent discoveries have resulted in the introduction of novel DMTs that have mechanisms of action that are more particular. For example, natalizumab and ocrelizumab are examples of monoclonal antibodies. These antibodies target specific molecules that are involved in the immune response. As a result, they provide more effective therapy choices with enhanced safety profiles. There are a variety of alternate therapy options available, including oral medicines such as fingolimod and dimethyl fumarate, which have different mechanisms of action [19], [20], [21], [22], [23], [24].

Neuroprotective drugs and cell-based therapy are two examples of emerging therapeutics that have the potential to bring about future breakthroughs in the management of multiple sclerosis. Stem cell therapies, such as hematopoietic stem cell transplantation (HSCT), are intended to restore the immune system to its normal state and to facilitate the restoration of tissues that have been injured. Research is being conducted to determine whether or not neuroprotective drugs, which are substances that try to protect neurones from damage and promote healing, have the potential to improve the outcomes of disease. Research in the field of personalised medicine, which involves tailoring therapies based on genetic and biomarker data, is an intriguing area of study. By taking into account the specific characteristics of each patient, these methods seek to maximise the effectiveness of treatment while minimising any bad effects that may occur. However, there are still obstacles to overcome, such as the heterogeneity of the disease and the requirement for individualised treatment approaches. For the purpose of expanding our understanding of multiple sclerosis and generating medicines that are more successful, it is crucial that research and innovation be continued [25], [26], [27], [28].

3. METHODOLOGY

For the purpose of this investigation, a comprehensive search of the existing body of literature was conducted, making use of well-known databases such as PubMed, Scopus, and Google Scholar. The purpose of this project was to assemble a comprehensive summary of the current research on multiple sclerosis (MS), with a particular emphasis on critical topics such as pathophysiology, diagnostic tools, and therapy choices. In the field of multiple sclerosis (MS) research and clinical practice, the major purpose of this review was to provide insights into current trends and future directions, as well as to provide a synthesis of recent accomplishments. To get things started, the search strategy was methodically developed and carried out in order to guarantee a comprehensive and all-encompassing collection of studies that were pertinent. A number of concepts that are associated with multiple sclerosis have been discovered as keywords. These include phrases such as "multiple sclerosis pathophysiology," "MS diagnostic methods," and "MS treatment strategies." This was followed by the utilisation of these keywords in the search of the chosen databases, which ensured that a diverse assortment of studies was gathered. Additionally, the search was narrowed by concentrating on papers that had been subjected to peer review during the past 10 years. This was done to guarantee that the review would accurately reflect the most current and major discoveries in the field of MS research.

For the purpose of choosing studies, the inclusion criteria were based on a number of different elements. Initially, it was necessary for studies to be subjected to peer review, which ensured that the research had been subjected to a thorough evaluation by professionals in the field. The relevance of the findings to important features of multiple sclerosis, such as its pathogenesis, diagnostic procedures, and therapy possibilities, was another factor that was considered while selecting the studies. With the intention of contributing to a more complete understanding of multiple sclerosis, the objective was to incorporate studies that offered substantial insights into the aforementioned areas. The study of immune system dysfunction, demyelination, and neurodegeneration are all components of the pathophysiology of multiple sclerosis, which is a complex and varied topic of research. In this field of study, the primary objective is to get a knowledge of how the immune system destroys the myelin sheath that surrounds nerve fibres, which ultimately results in inflammation and damage to the central nervous system. For the purpose of developing targeted therapeutics, it is essential to do research into the genetic and environmental variables that contribute to multiple sclerosis (MS), as well as the molecular and cellular mechanisms that underlie the disease. The purpose of the review was to provide a comprehensive overview of the current understanding of the pathophysiology of multiple sclerosis by providing a summary of the most important studies in this field.

Within the realm of diagnostic tools, the study focusses on the developments that have been made in the methods that are utilised to diagnose multiple sclerosis. Because it enables the visualisation of lesions in the brain and spinal cord, magnetic resonance imaging (MRI) continues to be an essential component in the diagnosis of multiple sclerosis (MS). The sensitivity and specificity of the diagnosis of multiple sclerosis (MS) have both been increased as a result of advancements in imaging techniques, such as the utilisation of contrast agents and advanced MRI sequences. Additionally, the identification of biomarkers, such as those present in cerebral fluid and blood, holds promise for the early detection of illness progression and the monitoring of its advancement. It was the purpose of this study to highlight these breakthroughs in order to emphasise the progress that has been made in detecting multiple sclerosis (MS) as well as the possibility for future improvements in this field. In addition to this, the review dives into the many therapeutic choices available for multiple sclerosis, with a particular emphasis on disease-modifying medications as well as symptom management. The goal of disease-modifying medicines is to alter the course of the disease by lowering the frequency and severity of relapses and decreasing the progression of the disease. There have been recent developments in this field, such as the creation of novel oral drugs, injectable therapy, and monoclonal antibodies that target particular components of the immune system. In addition, the study addresses new treatments that are currently being developed, such as neuroprotective medicines and stem cell therapy, which have the potential to improve the results for patients who have multiple sclerosis.

The management of symptoms is another essential component of multiple sclerosis treatment. This involves the implementation of measures that aim to alleviate the wide variety of symptoms that patients encounter, such as fatigue, pain, spasticity, and cognitive impairment on a daily basis. Nonpharmacological interventions, such as physical therapy, occupational therapy, and lifestyle adjustments, are included in this category. Pharmacological treatments, such as pain medications and muscle relaxants, are also included in this category. The research highlights the significance of using a holistic approach to the treatment of multiple sclerosis (MS), often known as combining multiple techniques to meet the varied requirements of patients. The procedure of extracting data for this review included a summary of the findings that were particularly noteworthy, the identification of developing patterns, and an evaluation of the influence that recent advancements have had on MS management. The identification of recurring themes and gaps in the existing research was made possible as a result of this comprehensive evaluation of chosen studies. For example, the study emphasises the necessity of conducting additional research on the long-term safety and efficacy of novel medicines, as well as the development of diagnostic tools that are more precise and treatment approaches that are more personalised.

For the purpose of providing a comprehensive overview of the existing body of information, bringing attention to research gaps, and addressing the implications of the findings for both future research and clinical practice, the synthesis of these findings was carried out. The review attempted to give a comprehensive analysis of the present state of research on multiple sclerosis (MS) by incorporating the most important findings from a number of different studies. Additionally, it sought to identify areas that require additional exploration. The investigation of the genetic and environmental variables that contribute to multiple sclerosis (MS), the development of combination medicines that target numerous pathogenic processes, and the enhancement of the integration of diagnostic technologies in normal clinical care are all included in this activity. This study, in its whole, offers a comprehensive examination of current advancements in the field of multiple sclerosis research. It also includes significant insights into the pathogenesis, diagnosis, and therapy of the condition. The purpose of this review is to contribute to the ongoing efforts to improve the understanding and management of multiple sclerosis (MS), with the ultimate goal of improving the quality of life for individuals who are affected by this chronic condition. This is accomplished by synthesising the present body of information and identifying research gaps.

4. RESULTS AND DISCUSSION

Recent developments in the field of multiple sclerosis (MS) research have resulted in substantial improvements in the knowledge of the illness, the improvement of diagnostic procedures, and the development of novel and innovative treatment regimens. The autoimmune nature of multiple sclerosis (MS) is well-established, and continuing research is revealing the mechanisms by which the immune system assaults myelin and causes neurodegeneration. Studies have uncovered a number of susceptibility genes, one of which is HLA-DRB1, which have an effect on the likelihood of developing a disease and offer insights into the pathophysiology that lies beneath the surface. The advancement of tailored therapy techniques and personalised medicine strategies has been made possible by the discoveries made thanks to genetics. The capacity to detect and monitor multiple sclerosis has been considerably improved as a result of diagnostic improvements [28], [29], [30]. The techniques of high-resolution magnetic resonance imaging (MRI) provide detailed visualisation of lesions in the central nervous system, which helps in the diagnosis and monitoring of the evolution of the disease. The sensitivity and specificity of MRI modalities that have been developed in recent years, such as new imaging sequences, have been shown to be significantly enhanced. Research into biomarkers, such as those found in cerebrospinal fluid (CSF) and blood-based markers, is also contributing to the advancement of the field of early disease monitoring and diagnosis. It is becoming increasingly clear that biomarkers like neurofilament light chain (NfL) and myelin oligodendrocyte glycoprotein (MOG) have the potential to accurately reflect the course and activity of the disease [31].

In the treatment of multiple sclerosis (MS), therapeutic techniques have progressed from early disease-modifying medicines (DMTs) to encompass more recent treatments that are more targeted. When compared to conventional DMTs, monoclonal antibodies, which include natalizumab and ocrelizumab, are considered to be important breakthroughs because they offer improved efficacy and safety. There are a variety of other treatment alternatives available, including oral drugs such as fingolimod and dimethyl fumarate, which utilise various modes of action [31], [32], [33], [34]. Emerging therapeutics, such as treatments based on stem cells and neuroprotective drugs, have the potential to bring about advances in the management of multiple sclerosis in the future. Stem cell therapies, such as hematopoietic stem cell transplantation (HSCT), are intended to restore equilibrium to the immune system and to facilitate the healing of damaged tissue. Neuroprotective agents are substances that are designed to shield neurones from harm and to aid in the process of repair. Research on multiple sclerosis (MS) has seen an interesting advance in the form of personalised medicine techniques that make use of genetic and biomarker data. The goal of these approaches is to customise treatments to the specific characteristics of individual patients, with the goal of maximising effectiveness while minimising unwanted effects. There are still obstacles to overcome in order to address the heterogeneity of diseases and to design personalised treatment strategies, notwithstanding the progress that has been made. In order to improve the management of multiple sclerosis and the outcomes for patients, it is vital to continue research and collaborate across disciplines [34], [35], [36], [37].

5. CONCLUSION

Research conducted in recent years on multiple sclerosis (MS) has made great strides in advancing our understanding of the disease's pathogenesis, diagnostic procedures, and treatment possibilities. The autoimmune nature of multiple sclerosis (MS), in addition to the genetic and environmental variables that contribute to the disease, has been better understood, which has led to the discovery of new therapy strategies and biomarkers. Early diagnosis and illness monitoring have both been improved as a result of developments in diagnostic procedures, such as high-resolution magnetic resonance imaging (MRI) and developing biomarkers. Monoclonal antibodies and oral drugs are examples of newer, more targeted treatments that have emerged as a result of the evolution of therapeutic techniques. These tactics have evolved from traditional disease-modifying therapies (DMTs). There is a possibility that future advancements in the management of multiple sclerosis could be made possible by emerging therapeutics such as neuroprotective drugs and stem cell treatments. Personalised medicine techniques have the potential to improve the effectiveness of treatment while simultaneously reducing the risk of undesirable consequences. Even though some breakthroughs have been made, there are still hurdles to be faced in addressing the complexity of the condition and devising individualised treatment options. Improving the management of multiple sclerosis and the outcomes for patients requires ongoing research as well as efforts that involve other disciplines. As our knowledge and treatment of multiple sclerosis (MS) continue to advance, there is reason to be optimistic about the possibility of a more efficient management strategy and, in the long run, a cure.

Acknowledgments

The authors have no specific acknowledgments to make for this research.

Funding Information

This research received no specific grant from any funding agency in the public, commercial, or notfor-profit sectors.

Author Contributions Statement

Name of AuthorCMSoVaFoIRDOEViSuPFu
Mohd Altaf Dar✓✓✓✓✓✓✓✓✓
Afshana Qadir✓✓✓✓✓✓✓✓✓
Zulfkar Qadrie✓✓✓✓✓✓✓✓✓
Humaira Ashraf✓✓✓✓✓✓✓✓✓

C: Conceptualization; M: Methodology; So: Software; Va: Validation; Fo: Formal analysis; I: Investigation; R: Resources; D: Data curation; O: Writing – original draft; E: Writing – review & editing; Vi: Visualization; Su: Supervision; P: Project administration; Fu: Funding acquisition.

Conflict of Interest Statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Informed Consent

All participants were informed about the purpose of the study, and their voluntary consent was obtained prior to data collection.

Ethical Approval

Not Applicable.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. [1] M. Zehravi and M. Maqbool, 'Polycystic ovary syndrome and infertility: an update', International journal of adolescent medicine and health, vol. 34, pp. 1-9, July 2021. doi.org/10.1515/ijamh-2021-0073
  2. [2] R. J. Lihite et al., 'A study on adverse drug reactions in a tertiary care hospital of Northeast India', Alexandria journal of medicine, vol. 53, pp. 151-156, July 2017. doi.org/10.1016/j.ajme.2016.05.007
  3. [3] M. Zehravi and M. Maqbool, 'Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: an overview', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 339-345, June 2021. doi.org/10.1515/ijamh-2021-0058
  4. [4] M. Maqbool, F. Bekele, and G. Fekadu, 'Treatment strategies against triple-negative breast cancer: an updated review. Breast Cancer: Targets and Therapy', pp. 15-24, Jan. 2022. doi.org/10.2147/BCTT.S348060
  5. [5] S. Rasool and M. Maqbool, 'An overview about Hedychium spicatum: a review', Journal of Drug Delivery and Therapeutics, vol. 9, pp. 476-480, Feb. 2019. doi.org/10.22270/jddt.v9i1-s.2429
  6. [6] M. Zehravi and M. Maqbool, 'Depression and anxiety in women with polycystic ovarian syndrome: a literature survey', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 367- 373, Aug. 2021. doi.org/10.1515/ijamh-2021-0092
  7. [7] M. Maqbool, I. Gani, and M. A. Dar, 'Anti-diabetic effects of some medicinal plants in experimental animals: a review', Asian Journal of Pharmaceutical Research and Development, vol. 7, no. 1, pp. 66- 69, Feb. 2019. doi.org/10.22270/ajprd.v7i1.469
  8. [8] M. Zehravi and M. Maqbool, 'Polycystic ovary syndrome and reproductive health of women: a curious association', International journal of adolescent medicine and health, vol. 33, pp. 333-337, Apr. 2021. doi.org/10.1515/ijamh-2021-0031
  9. [9] M. Mohd, M. Maqbool, M. A. Dar, and I. Mushtaq, 'Polycystic ovary syndrome, a modern epidemic: an overview', Journal of Drug Delivery and Therapeutics, vol. 9, no. 3, pp. 641-644, May 2019. doi.org/10.22270/jddt.v9i3.2661
  10. [10] M. Maqbool et al., 'An up to date on clinical prospects and management of osteoarthritis', Annals of Medicine and Surgery, vol. 72, Dec. 2021.
  11. [11] A. Majeed, R. Bashir, S. Farooq, and M. Maqbool, 'Preparation, characterization and applications of nanoemulsions: An insight', Journal of Drug Delivery and Therapeutics, vol. 9, no. 2, pp. 520-527, Mar. 2019. doi.org/10.22270/jddt.v9i2.2410
  12. [12] M. Zehravi and M. Maqbool, 'Healthy lifestyle and dietary approaches to treating polycystic ovary syndrome: a review', Open Health, vol. 3, pp. 60-65, May 2022. doi.org/10.1515/openhe-2022-0008
  13. [13] R. Maqbool, M. Maqbool, and M. Zehravi, 'Menstrual distress in females of reproductive age: a literature review', International journal of adolescent medicine and health, vol. 34, pp. 11-17, July 2021. doi.org/10.1515/ijamh-2021-0081
  14. [14] I. Ara, M. Maqbool, G. Fekadu, T. A. Hajam, and M. A. Dar, 'Pharmaceutical significance of Nigella sativa L., a wonder herb', Journal of Applied Pharmaceutical Sciences and Research, vol. 3, no. 4, pp. 4-13, 2020. doi.org/10.31069/japsr.v3i4.2
  15. [15] M. Maqbool, N. Nasir, and S. Mustafa, 'Polycystic in ovarian syndrome and its various treatment strategies', INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES, vol. 5, no. 9, pp. 8470- 8478, Sept. 2018.
  16. [16] M. Maqbool, M. Zehravi, and R. Maqbool, 'Study of adverse drug reactions in pulmonary medicine department of a Tertiary care hospital', India. CELLMED, vol. 11, no. 2, pp. 8-9, 2021.
  17. [17] I. Ara, M. Maqbool, B. Bukhari, and A. N. Hajam, 'Present status, standardization and safety issues with herbal drugs', International Journal of Research in Pharmaceutical Sciences and Technology, vol. 1, no. 3, pp. 95-101, May 2020. doi.org/10.33974/ijrpst.v1i3.169
  18. [18] I. Ara, M. Maqbool, and I. Gani, 'Reproductive Health of Women: implications and attributes', International Journal of Current Research in Physiology and Pharmacology, pp. 8-18, Nov. 2022.
  19. [19] M. Zehravi, R. Maqbool, and M. Maqbool, 'To Identify Patterns of Drug Usage among Patients Who Seek Care in Psychiatry Outpatient Department of a Tertiary Care Hospital in Srinagar, Jammu and Kashmir, India', Journal of Pharmaceutical Research International, vol. 33, no. 31A, pp. 135-140, June 2021. doi.org/10.9734/jpri/2021/v33i31A31673
  20. [20] M. Maqbool, S. Javed, and A. A. Bajwa, 'Assessment OF pain management IN postoperative cases using different scales and questionnaires', INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES, vol. 6, no. 1, pp. 983-987, Jan. 2019.
  21. [21] I. Ara, M. Maqbool, and M. Zehravi, 'Psychic consequences of infertility on couples: A short commentary', Open Health, vol. 3, pp. 114-119, Jan. 2022. doi.org/10.1515/openhe-2022-0022
  22. [22] R. Bashir, M. Maqbool, and A. I. Zehravi, 'An Insight into Novel Drug Delivery System', In Situ Gels. CELLMED, vol. 11, no. 1, pp. 6-7, 2021.
  23. [23] M. Zehravi and M. Maqbool, 'Teenage menstrual dysfunction: an overview', International Journal of Adolescent Medicine and Health, vol. 35, no. 1, pp. 15-19, Sept. 2022. doi.org/10.1515/ijamh-2022-0018
  24. [24] I. Ara, M. Zehravi, M. Maqbool, and I. Gani, 'A review of recent developments and future challenges in the implementation of universal health coverage policy framework in some countries', Journal of Pharmaceutical Research & Reports, no. 3, 2022.
  25. [25] M. Maqbool, W. Shabbir, and S. Aamir, 'Adverse events of blood transfusion and blood safety in clinical practice', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8254-8259, Aug. 2018.
  26. [26] M. Maqbool, A. Naeem, and S. Aamer, 'Diabetes mellitus and its various management strategies in practice', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, Aug. 2018.
  27. [27] M. Maqbool, S. Tariq, and S. Amjad, 'Prescribing practices in pediatrics and drug utilization studies promoting pediatric health', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8070-8076, Aug. 2018.
  28. [28] M. Maqbool, U. Ikram, and A. Anwar, 'Adverse drug reaction monitoring and occurrence in drugs used in pulmonary disorders', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8060-8065, Aug. 2018.
  29. [29] R. Maqbool, M. Maqbool, and M. Zehravi, 'Acute neurological conditions during pregnancy and their management: a review', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 357-366, Aug. 2021. doi.org/10.1515/ijamh-2021-0084
  30. [30] M. Zehravi and M. Maqbool, 'An overview about safety surveillance of adverse drug reactions and pharmacovigilance in India', The Indian Journal of Nutrition and Dietetics, pp. 408-418, July 2021. doi.org/10.21048/IJND.2021.58.3.27285
  31. [31] M. Maqbool and M. Zehravi, 'Neuroprotective role of polyphenols in treatment of neurological disorders: A review', Interventional Pain Medicine and Neuromodulation, vol. 1, Dec. 2021. doi.org/10.5812/ipmn.117170
  32. [32] M. Maqbool and A. I. Gani, 'The Story of Polycystic Ovarian Syndrome: A Challenging Disorder with Numerous Consequences for Females of Reproductive Age', International Journal of Current Research in Physiology and Pharmacology, pp. 19-31, Nov. 2022.
  33. [33] M. Maqbool and I. Gani, 'Utilization of statins in reducing comorbidities of diabetes mellitus: A systematic review', Journal of Pharmacy Practice and Community Medicine, vol. 4, no. 4, 2018. doi.org/10.5530/jppcm.2018.4.46
  34. [34] R. Maqbool, M. Maqbool, and M. Zehravi, 'Acute neurological conditions during pregnancy and their management: a review', International Journal of Adolescent Medicine and Health, vol. 33, no. 6, pp. 357-366, Aug. 2021. doi.org/10.1515/ijamh-2021-0084
  35. [35] M. Maqbool, S. Tariq, and S. Amjad, 'Prescribing practices in pediatrics and drug utilization studies promoting pediatric health', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8070-8076, Aug. 2018.
  36. [36] M. Maqbool, A. Naeem, and S. Aamer, 'Diabetes mellitus and its various management strategies in practice', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, Aug. 2018.
  37. [37] M. Maqbool, W. Shabbir, and S. Aamir, 'Adverse events of blood transfusion and blood safety in clinical practice', Indo American Journal of Pharmaceutical Sciences, vol. 5, no. 8, pp. 8254-8259, Aug. 2018.

How to cite: Mohd Altaf Dar, Afshana Qadir, Zulfkar Qadrie, Humaira Ashraf (2024). Recent advances in understanding and treating multiple sclerosis. Journal Healthcare Treatment Development, 4(2), 72-80. https://doi.org/10.55529/jhtd.45.25.34

Copyright © 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). Published by HM Publishers.