Clinically isolated syndromes - Predicting and delaying multiple sclerosis
Clinically isolated syndromes - Predicting and delaying multiple sclerosis
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DOI：
10.1212/01.wnl.0000277704.56189.85
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发表时间：
2007-06-01
期刊：
影响因子：
9.9
通讯作者：
Thrower, Ben W.
中科院分区：
文献类型：
--
作者：
Thrower, Ben W.
多发性硬化症（MS）代表脱髓鞘的频谱，取决于疾病的持续时间和临床分类。大多数患者表现为疾病的复发缓解型。复发-缓解型多发性硬化（RRMS）最早的临床表现是临床孤立综合征（CIS）。由于临床发作和轴突病理程度的差异，预测哪些CIS患者是MS的高风险患者变得复杂。然而，最近的干扰素- β (ifn - β)试验表明，早期治疗可以延迟第二次脱髓鞘事件的发生，并且早期治疗也可以减缓RRMS向继发性进展性MS （SPMS）的进展。临床表现结合脑MRI和脑脊液分析可用于CIS患者评估其临床明确多发性硬化（CDMS）的风险。麦当劳标准的应用也允许早期MS诊断，通过使用新的MRI病变及时确定播散。对选定的CIS患者进行早期免疫调节治疗可能最终预防这种终身疾病中未来的轴突病理和残疾进展。
Multiple sclerosis ( MS) represents a spectrum of demyelination that depends on disease duration and clinical categorization. Most patients present with the relapsing-remitting form of the disease. The earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). Predicting which CIS patients are at high risk for MS is complicated by the disparity between clinical attacks and the extent of axon pathology. However, recent interferon-beta (IFN-beta) trials have demonstrated a delay in time to the second demyelinating event with early treatment, and early treatment could also slow the progression from RRMS to secondary-progressive MS (SPMS). Clinical findings in combination with brain MRI and CSF analysis can be used in CIS patients to evaluate their risk for clinically definite MS (CDMS). Application of the McDonald criteria also allows an earlier MS diagnosis by using new MRI lesions to define dissemination in time. Early immunomodulatory therapy for selected CIS patients may eventually prevent future axon pathology and progression of disability in this lifelong disease.