Preventive strategies in neuroimmunology

Neuroimmunological diseases arise from a complex interplay of genetic susceptibility, environmental exposures, and immune-mediated mechanisms. In this context, modifiable lifestyle and environmental factors may contribute to disease risk and disease course, at least in a subset of patients. Accordingly, while disease-modifying immunotherapy remains the cornerstone of treatment, lifestyle-related factors are increasingly recognized as relevant targets for prevention and supportive disease management. This review summarizes current evidence on physical activity, nutrition, substance use, sleep, stress, rehabilitation, and digital health interventions across all levels of prevention-primary to quaternary. Physical activity exerts immunomodulatory and potential neuroprotective effects through pathways involving cytokines, growth factors, cerebral perfusion, and immune cell redistribution, and is associated with improvements in symptoms, function, and quality of life. Nutritional factors, including obesity and vitamin D deficiency, may be associated with MS risk and disease progression, whereas evidence for specific diets or supplements remains limited. Smoking represents a well-established modifiable risk factor for both MS disease development and progression, while findings regarding alcohol consumption are inconsistent. Sleep disturbances and chronic stress could influence immune regulation and symptom burden and may act as both risk and disease-modifying factors. Rehabilitation constitutes a cornerstone of tertiary prevention, and emerging digital technologies, including tele-exercise and virtual reality, may offer promising low-threshold strategies to support long-term self-management. Overall, lifestyle and behavioral interventions represent powerful, supportive and complementary tools in neuroimmunology, that may enhance overall health and disease management. High-quality interventional studies are required to define the optimal role of preventive strategies alongside immunotherapy.