Memantine for Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Trials

Turalde, Christian Wilson R.; Espiritu, Adrian I.; Anlacan, Veeda Michelle M.

doi:10.3389/fneur.2020.574748

Cited by 9 publications

(3 citation statements)

References 47 publications

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“…However, in AD, although improvement in patients was seen in terms of cognition and behaviour, the efficacy outcomes reported were modest ( Matsunaga et al, 2015 ; Kishi et al, 2017 ), with unclear effects on brain volume ( Yang et al, 2013 ). Similarly in MS, trials using memantine have been performed, but no significant effects were seen on either cognitive impairment or disability ( Peyro Saint Paul et al, 2016 ; Turalde et al, 2020 ). Therefore, the search for novel neuroprotective therapeutic targets and strategies continues.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiological Ionotropic Glutamate Signalling in Neuroinflammatory Disease as a Therapeutic Target

2021

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Glutamate signalling is an essential aspect of neuronal communication involving many different glutamate receptors, and underlies the processes of memory, learning and synaptic plasticity. Despite neuroinflammatory diseases covering a range of maladies with very different biological causes and pathophysiologies, a central role for dysfunctional glutamate signalling is becoming apparent. This is not just restricted to the well-described role of glutamate in mediating neurodegeneration, but also includes a myriad of other influences that glutamate can exert on the vasculature, as well as immune cell and glial regulation, reflecting the ability of neurons to communicate with these compartments in order to couple their activity with neuronal requirements. Here, we discuss the role of pathophysiological glutamate signalling in neuroinflammatory disease, using both multiple sclerosis and Alzheimer’s disease as examples, and how current steps are being made to harness our growing understanding of these processes in the development of neuroprotective strategies. This review focuses in particular on N-methyl-D-aspartate (NMDA) and 2-amino-3-(3-hydroxy-5-methylisooxazol-4-yl) propionate (AMPA) type ionotropic glutamate receptors, although metabotropic, G-protein-coupled glutamate receptors may also contribute to neuroinflammatory processes. Given the indispensable roles of glutamate-gated ion channels in synaptic communication, means of pharmacologically distinguishing between physiological and pathophysiological actions of glutamate will be discussed that allow deleterious signalling to be inhibited whilst minimising the disturbance of essential neuronal function.

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Section: Discussionmentioning

confidence: 99%

Pathophysiological Ionotropic Glutamate Signalling in Neuroinflammatory Disease as a Therapeutic Target

2021

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“…To date, clinical trials have failed to demonstrate any significant effect of memantine on patients with MS whatever the parameter investigated: fatigue, cognitive performance, or spasticity [ 247 – 251 ] (Table 6 ). Worse still, adverse events have been reported in several studies.…”

Section: Neuroprotective Effect Of Drugs Under Developmentmentioning

confidence: 99%

A Narrative Review on Axonal Neuroprotection in Multiple Sclerosis

et al. 2022

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Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) resulting in demyelination and neurodegeneration. The therapeutic strategy is now largely based on reducing inflammation with immunosuppressive drugs. Unfortunately, when disease progression is observed, no drug offers neuroprotection apart from its anti-inflammatory effect. In this review, we explore current knowledge on the assessment of neurodegeneration in MS and look at putative targets that might prove useful in protecting the axon from degeneration. Among them, Bruton’s tyrosine kinase inhibitors, anti-apoptotic and antioxidant agents, sex hormones, statins, channel blockers, growth factors, and molecules preventing glutamate excitotoxicity have already been studied. Some of them have reached phase III clinical trials and carry a great message of hope for our patients with MS.

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“…Medications typically used for AD and DLB include cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) and the N-methyl-D-aspartate receptor antagonist memantine. Unfortunately, these agents do not appear to be effective for treating cognitive impairment in MS [ 82 , 83 ], and some studies have suggested that memantine may even worsen MS-related symptoms [ 84 , 85 , 86 ]. Whether these treatment options would be safe and effective in patients with dementia due to MS or with concomitant dementia syndromes remains to be seen.…”

Section: Dementia and Ms: Can Older Pwms Develop Dementia Or Other Ne...mentioning

confidence: 99%

Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature

et al. 2022

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Several important questions regarding cognitive aging and dementia in older people with multiple sclerosis (PwMS) are the focus of this narrative review: Do older PwMS have worse cognitive decline compared to older people without MS? Can older PwMS develop dementia or other neurodegenerative diseases such as Alzheimer’s disease (AD) that may be accelerated due to MS? Are there any potential biomarkers that can help to determine the etiology of cognitive decline in older PwMS? What are the neural and cellular bases of cognitive aging and neurodegeneration in MS? Current evidence suggests that cognitive impairment in MS is distinguishable from that due to other neurodegenerative diseases, although older PwMS may present with accelerated cognitive decline. While dementia is prevalent in PwMS, there is currently no consensus on defining it. Cerebrospinal fluid and imaging biomarkers have the potential to identify disease processes linked to MS and other comorbidities—such as AD and vascular disease—in older PwMS, although more research is required. In conclusion, one should be aware that multiple underlying pathologies can coexist in older PwMS and cause cognitive decline. Future basic and clinical research will need to consider these complex factors to better understand the underlying pathophysiology, and to improve diagnostic accuracy.

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Memantine for Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Trials

Cited by 9 publications

References 47 publications

Pathophysiological Ionotropic Glutamate Signalling in Neuroinflammatory Disease as a Therapeutic Target

Pathophysiological Ionotropic Glutamate Signalling in Neuroinflammatory Disease as a Therapeutic Target

A Narrative Review on Axonal Neuroprotection in Multiple Sclerosis

Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature

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