Early Disease-Modifying Treatments for Presymptomatic Multiple Sclerosis

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY
Burcu Zeydan, Christina J. Azevedo, Naila Makhani, Mikael Cohen, Melih Tutuncu, Eric Thouvenot, Aksel Siva, Darin T. Okuda, Orhun H. Kantarci, Christine Lebrun-Frenay
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引用次数: 0

Abstract

Radiologically isolated syndrome (RIS) is the earliest stage in the disease continuum of multiple sclerosis (MS). RIS is discovered incidentally in individuals who are asymptomatic but have typical lesions in the brain and/or spinal cord suggestive of demyelination. The 2009 and revised 2023 RIS criteria were developed for diagnosis. Presymptomatic individuals who fulfill the 2009 RIS criteria by having 3–4 of 4 dissemination in space McDonald 2005 MS criteria are still diagnosed with RIS using the revised 2023 RIS criteria. In presymptomatic individuals who do not fulfill the 2009 RIS criteria, the revised 2023 RIS criteria target to secure an accurate and timely diagnosis: In addition to (a) having one lesion in two of four locations (periventricular, juxtacortical/cortical, infratentorial, spinal cord), (b) two of three features (spinal cord lesion, cerebrospinal fluid (CSF)-restricted oligoclonal bands, and new T2 or gadolinium-enhancing lesion) should be fulfilled. Among laboratory biomarkers, CSF kappa-free light chain can also increase diagnostic accuracy. Once the diagnosis is confirmed, the established risk factors, including demographics, imaging, and laboratory biomarkers, should be evaluated for symptomatic MS transition and prognosis. Younger age, male sex, increased neurofilament-light chain, CSF abnormality, and the presence of infratentorial, spinal cord, or gadolinium-enhancing lesions on imaging are the main risk factors for transition to symptomatic MS. Two randomized clinical trials showed significant efficacy of disease-modifying treatments in delaying or preventing the development of the first clinical event in RIS. However, because some individuals remain as RIS, it is crucial to identify the individuals with a higher number of risk factors to optimize disease outcomes by early intervention while minimizing adverse events. Discussing each RIS case with an expert MS team is recommended because there is still a lack of clinical guidelines to improve care, counseling, and surveillance.

Abstract Image

针对无症状多发性硬化症的早期疾病调节疗法
放射学孤立综合征(RIS)是多发性硬化症(MS)疾病连续过程中的最早阶段。RIS是在无症状但大脑和/或脊髓有典型病变提示脱髓鞘的患者中偶然发现的。2009 年和修订后的 2023 年 RIS 诊断标准已经制定。符合 2009 年 RIS 标准的无症状患者,如果在麦当劳 2005 MS 标准的 4 个播散点中有 3-4 个播散点,则仍可根据修订后的 2023 年 RIS 标准诊断为 RIS。对于不符合2009年RIS标准的无症状患者,修订后的2023年RIS标准旨在确保准确及时的诊断:除了(a)在四个部位(脑室周围、皮质/皮质并区、脑室下、脊髓)中的两个部位有一个病变外,(b)还应符合三个特征(脊髓病变、脑脊液(CSF)限制性寡克隆带、新的T2或钆增强病变)中的两个特征。在实验室生物标志物中,脑脊液无卡帕轻链也能提高诊断的准确性。一旦确诊,应评估已有的危险因素,包括人口统计学、影像学和实验室生物标志物,以确定无症状多发性硬化的转归和预后。年龄较小、男性、神经丝光链增加、脑脊液异常以及影像学上存在幕下、脊髓或钆增强病变是向无症状多发性硬化症转变的主要危险因素。两项随机临床试验显示,改变病情的治疗在延迟或预防 RIS 首次临床事件的发生方面具有显著疗效。然而,由于部分患者仍为 RIS,因此必须识别出具有较多风险因素的患者,以便通过早期干预优化疾病预后,同时最大限度地减少不良事件的发生。建议与 MS 专家团队讨论每个 RIS 病例,因为目前仍缺乏临床指南来改善护理、咨询和监测。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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