Learning new skills could promote myelin repair in MS patients

Rehabilitation strategies aimed at learning new skills may promote myelin repair in people with multiple sclerosis (MS), said scientists, who called for more research to test these strategies and determine the best way to deploy them.

The international team provided an overview of what’s currently known about how rehab might facilitate myelin repair, highlighted unanswered questions, and offered suggestions for future research.

Their paper, “The Potential of Rehabilitation to Amplify Experience-Induced Myelin Plasticity and Remyelination in Multiple Sclerosis: A Narrative Review,” was published in Current Neurology and Neuroscience Reports. 

The myelin sheath is a fatty covering that surrounds nerve fibers and helps nerves to send electrical signals, much like rubber insulation around a metal wire. In MS, inflammation in the brain and spinal cord damages the myelin sheath and disrupts nerve signaling, ultimately driving MS symptoms.

A variety of MS treatments can slow disease progression, but they all work by dampening inflammation. No therapy has been definitively proven to promote remyelination (myelin repair) in MS patients. In theory, repairing myelin may not only slow disease progression, but also reverse disease processes, easing symptoms and lessening disability.

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Scientists once believed that healthy brains stop making new myelin in young adulthood. But over the past couple of decades, new research has proven that the brain continues to make new myelin well into adulthood as part of neuroplasticity, the brain’s ability to rewire itself when a person learns something new.

For example, a 2009 study demonstrated that healthy adults who learned to juggle showed an increase in myelin in brain regions that help control hand-eye coordination.

These discoveries have raised an intriguing question: Might it be possible to promote remyelination in people with MS by using rehabilitation programs that help patients learn or relearn new skills, taking advantage of the brain’s natural capacity for rewiring? Such rehab might offer a complementary approach to other interventions, including medications, to promote myelin repair.

There isn’t currently enough data to say with certainty whether learning-focused rehab is a viable strategy to promote myelin repair in people with MS. To date, only 11 studies have directly looked into this question, with conflicting results.

Complicating matters, all these studies have been very small, and each has used different methods for rehab and measuring myelin repair, making it almost impossible to draw meaningful comparisons across studies.

Moreover, many factors may affect myelin repair in people with MS. For example, the brain’s ability to make new myelin tends to decline with age, so rehab strategies may be less effective in older MS patients than in younger people. Other factors, such as biological sex differences, co-occurring health conditions, lifestyle choices, and MS type, may also influence remyelination abilities.

Despite these complexities, the researchers argued that early data are sufficiently promising to warrant further exploration of learning-focused rehab as a potential remyelination strategy.

“Although current findings are promising, they remain fragmented, underpowered, and [variable] in methodology,” they wrote. “Still, a consistent theme emerges: experience-dependent myelin plasticity is both feasible and potentially clinically meaningful, offering a new frontier for neurorehabilitation in MS.”

The team called for further studies with larger sample sizes, longer follow-up times, and more standardized methodologies. They also stressed that it will be key for future research to proactively account for factors such as age.

“Collectively, these research priorities will clarify how experience-dependent myelin plasticity can be harnessed to promote [myelin repair], delay decline, and improve quality of life for people with MS,” the scientists wrote.