Progress of neuroimmunotherapies: Witnessing an impressive success in the treatment of neurologic autoimmunities.

This introductory chapter describes the evolution of immunotherapies in neurology as witnessed from the late 1970s to early 1980s, when the main therapy for all autoimmune neurologic diseases was only oral and IV steroids, to the present. The growing pains, complexities, challenges, and the very slow pace by which newer immunotherapeutic options were evolving are discussed pointing out that effective new therapies started to evolve many years later in the late 1990s to 2000 with plasmapheresis, IVIg, and β-interferon as the only disease modifying therapy (DMT) for multiple sclerosis. These early therapies were, however, the impetus for a subsequent faster pace of exploring new biologics with both failures and successes that steadily led to the present impressively galloping pace of trials and approvals of various monoclonal antibodies against B cells, cytokines, complement, FcRn, and currently Bruton's Tyrosine Kinase (BTK) inhibitors across the spectrum of all autoimmune neurologic diseases collectively pointing out that neuroimmunotherapy is now a "living process" with evolving therapeutic schemes that continuously change the therapeutic algorithm. The epitome of this successfully rapidly evolving pace is highlighted by the CAR-T cell therapies, currently explored in all refractory neuro-autoimmunities, when they were not even on the list when this volume began. The chapter describes this remarkable 40-year progress and evolution on immunotherapies in every autoimmune neurologic disease, addresses what has been learnt from the success and failures in the conducted therapeutic trials or targeted therapies, and highlights the promising future as currently projected in neuroimmunotherapeutics.