Researchers have not fully determined why remyelination fails to occur in MS. Regeneration focuses on remyelination — producing new myelin sheaths in the central nervous system (CNS). Myelin sheaths are created by oligodendrocytes, which are specialized cells in the CNS. The brain creates oligodendrocytes from oligodendrocyte precursor cells (OPCs) throughout life, but the efficiency of natural remyelination declines with age. Preserving and repairing myelin is likely to be one of the best ways to prevent neurodegeneration.

There are a variety of rehabilitation strategies to prevent new MS symptoms from occurring, to restore lost function, and to maintain good health. Evidence supporting rehabilitative strategies is growing, but translating the results from these small, varied studies to the larger MS community is difficult. This process is further complicated by the fact that MS symptoms affect each person differently.

Accurately measuring disease progression and disability is important for understanding regeneration, testing therapeutic approaches, guiding treatment decisions and informing personalized care. Advances in medical imaging measures — such as MRIs and PETs and myelin water imaging — have offered a quantitative and objective way to evaluate MS disease progression, but have limited ability to track myelin changes, early disease progression and disability over time.

Studies show the potential impact of exercise on neuroprotection and regeneration in animal models and humans. Exercise is safe, can improve strength, cardiorespiratory fitness, mobility, energy levels and cognition and overall is an effective symptomatic treatment in MS.

There is data to support the idea that neuro-regeneration and restoration of function are possible in MS. Research in regeneration focuses on removing impediments to natural myelin repair, fostering the development of OPCs and transplanting cells with the potential to promote repair. Emerging technologies using remote-monitoring, wearable devices may offer insights into early detection and disease progression.

Collaborative studies are needed to target remyelination more precisely and develop better imaging tools that specifically measure changes in myelination. Promoting neuroprotection, strengthening the connection between nerve cells and preventing neurodegeneration are promising approaches for reducing disability and restoring function in those living with MS.