Treatment of Multiple Sclerosis in Israel –
Dr Lidiia Prakhova

Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system. It requires accurate diagnosis, careful differential assessment, and timely initiation of therapy.
Dr. Lidiia Prakhova, a neurologist with more than 35 years of clinical experience, specializes in the diagnosis and treatment of multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), MOG-associated disease (MOGAD), and other autoimmune demyelinating conditions of the CNS.
Dr. Prakhova consults adult patients at Shamir Medical Center (Assaf Harofeh) in Israel. She provides diagnostic evaluation, treatment selection, and long-term clinical follow-up.
This page outlines key diagnostic principles, modern treatment strategies for MS in Israel, and Dr. Prakhova’s practical experience in managing patients with relapsing-remitting, primary progressive, and secondary progressive MS.

Dr. Lidiia Prakhova — an internationally recognized representative of the Russian Neurological School — has extensive experience treating patients with MS of different clinical types and levels of severity. In clinical practice, she applies:

• International diagnostic criteria (McDonald 2017, 2021)
• State-of-the-art MRI of the brain and spinal cord
• Immunological biomarkers
• Neurophysiological and ophthalmological studies (when indicated)

Particular attention is given to:

• Early recognition of first MS symptoms
• Differential diagnosis with NMOSD, MOGAD, leukodystrophies
• Assessment of disease activity, progression, and treatment response
• Selection of personalized therapy tailored to disease phenotype
• Long-term monitoring and follow-up

• 1. Management of Acute Relapses
• High-dose intravenous (oral) corticosteroid therapy (pulse therapy)
• Plasma exhange

2. Disease-Modifying Therapies (DMTs)First-line therapies:

• Betaferon (interferon beta-1b)
• Avonex, Rebif (interferon beta-1a)
• Copaxone (glatiramer acetate)
• Aubagio (teriflunomide)

First/second-line therapies:

• Tecfidera (dimethyl fumarate)
• Gilenya (fingolimod)
• Mayzent (siponimod)
• Zeposia (ozanimod)
• Mavenclad (cladribine)

Highly effective therapies:

• Tysabri (natalizumab)
• Lemtrada (alemtuzumab)
• Ocrevus (ocrelizumab)
• Kesimpta (ofatumumab)

3. Symptomatic TreatmentManagement of fatigue, spasticity, pain, gait disorders, bladder dysfunction, and cognitive symptoms.
4. RehabilitationComprehensive neurorehabilitation to maintain mobility, autonomy, and quality of life.

Current research in MS focuses on enhancing disease control, slowing progression, and restoring damaged CNS structures. Key investigational directions include:
1. Remyelinating TherapiesAgents promoting oligodendrocyte maturation and myelin repair (e.g., opicinumab, anti-LINGO-1, novel small molecules), potentially relevant for progressive forms.
2. Neuroprotective AgentsTherapies targeting mitochondrial stress, metabolic pathways, and axonal protection (e.g., high-dose biotin, izaten, olexulimab).
3. Cell-Based TherapiesMesenchymal stem cells (MSC) and CAR-T-inspired immunomodulatory approaches aimed at reducing pathological immune activity and supporting neural repair.
4. Highly Selective Immunological TargetsNext-generation monoclonal antibodies (anti-CD40L, updated anti-CD19 platforms) and second-generation BTK inhibitors offering precise modulation of B-cell and microglial activity.
5. Microbiome-Focused TherapiesProbiotics and fecal microbiota transplantation (FMT) protocols under investigation for potential immune-regulatory effects.
These approaches are not yet part of routine medical practice but represent the future of MS therapy, shifting focus from inflammation control to CNS repair and neuroprotection.

Appointment scheduling is available through the Shamir Medical Center registration desk:
📞 08-977-97-75
📞 08-977-91-45
📧 neuro@shamir.gov.il
📧 089779758@shamir.gov.il
📧 Dr. Lidiia Prakhova: lidiap@shamir.gov.il