Multiple sclerosis

Česká verzia

Authors: E. Havrdová
Authors place of work: Neurologická klinika 1. LF UK a VFN, Praha
Published in the journal: Cesk Slov Neurol N 2008; 71/104(2): 121-132
Category: Minimonography

Summary

Multiple sclerosis (MS) is a multifocal inflammatory disease of the CNS in young adults the pathogenesis of which involves autoimmune and neurodegenerative mechanisms. Both factors and a combination of exogenous factors play a role in the etiology of the disease. Inflammatory and therefore partially controllable processes prevail at initial stages. The clinical picture at later stages depends on the degree of axonal loss, and even though it depends on inflammatory tissue destruction to a great extent, it is also partially inflammation-independent. New diagnostic criteria have accelerated the diagnostic process today. MS is not curable, but since 1993 there have been drugs available which influence the natural course of the disease, i.e. beta interferon and the more recent glatiramer acetate. The effect of the above drugs is most potent if treatment starts at the earliest possible stages of the disease. Data have been accumulating about the ability of the drugs to delay the advance of the disease if treatment starts at onset of the initial clinical symptoms (the clinically isolated syndrome – CIS). In case of insufficient therapeutic response to the first choice drugs or if the disease starts with a high inflammatory activity, the use of natalizumab, a recently introduced monoclonal antibody, is indicated. Treatment can be escalated also with the use of cytostatics or even by immunoablation with the support of autologous haematopoetic stem cells. Symptomatic treatment and rehabilitation form integral part of comprehensive care for MS patients which should be provided by a multidisciplinary team. Effective care relieves great part of MS patients of the burden of fatality associated with the disease for decades.

Key words:
multiple sclerosis – diagnostic criteria – beta interferon – glatiramer acetate – natalzumab

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