Multiple sclerosis

Czech version

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

Overview

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

Sources

1. Havrdová E et al. Neuroimunologie. Praha: Maxdorf 2001: 180–263.

2. Lassmann H, Brück W, Lucchinetti CF. The immunopathology of multiple sclerosis: an overview. Brain Pathol 2007; 17(20): 210–218.

3. Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998; 338(5): 278–285.

4. Dutta R, Trapp BD. Pathogenesis of axonal and neuronal damage in multiple sclerosis. Neurology 2007; 68(22 Suppl 3): S22–31.

5. Kutzelnigg A, Lassmann H. Cortical lesions and brain atrophy in MS. J Neurol Sci 2005; 233(1–2): 55–59.

6. Serafini B, Rosicarelli B, Magliozzi R, Stigliano E, Aloisi F. Detection of ectopic B-cell follicles with germinal centers in the meninges of patients with secondary progressive multiple sclerosis. Brain Pathol 2004; 14(2): 164–174.

7. Piťha J, Havrdová E: Axonální patologie u roztroušené sklerózy. Cesk Slov Neurol N 2005; 68/101(3): 154–158.

8. Havrdová E. Roztroušená skleróza. Praha: Maxdorf 2006.

9. Sládková V, Muchová B, Ticháčková A, Mareš J, Urbánek K, Kaňovský P. Výskyt depresí u nemocných s roztroušenou sklerózou mozkomíšní. Cesk Slov Neurol N 2006; 69/102(4): 280–285.

10. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50(1): 121–127.

11. Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol 2005; 58(6): 840–846.

12. Paty DW, Hartung HP, Ebers GC et al. Management of relapsing-remitting multiple sclerosis: diagnosis and treatment guidelines. Eur J Neurol 1999; 6(Suppl 1): S1–S35.

13. Karussis D, Biermann LD, Bohlega S, Boiko A, Chofflon M, Fazekas F et al. A recommended treatment algorithm in relapsing multiple sclerosis: report of an international consensus meeting. Eur J Neurol 2006; 13(1): 61–71.

14. Richert ND, Ostuni JL, Bash CN, Leist TP, McFarland HF, Frank JA. Interferon beta-1b and intravenous methylprednisolone promote lesion recovery in multiple sclerosis. Mult Scler 2001; 7(1): 49–58.

15. The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993; 43(4): 655–661.

16. The IFNB Multiple Sclerosis Study Group and The University of British Columbia MS/MRI Analysis Group. Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology 1995; 45(7): 1277–1285.

17. Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol 1996; 39(3): 285–294.

18. Simon JH, Jacobs LD, Campion M, Wende K, Simonian N, Cookfair DL et al. Magnetic resonance studies of intramuscular interferon beta-1a for relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group. Ann Neurol 1998; 43(1): 79–87.

19. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998; 352(9139): 1498–1504.

20. Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology 1995; 45(7): 1268–1276.

21. Filippi M, Rovaris M, Rocca MA, Sormani MP, Wolinsky JS, Comi G. Glatiramer acetate reduces the proportion of new MS lesions evolving into "black holes". Neurology 2001; 57(4): 731–733.

22. Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006; 354(9): 899–910.

23. Kappos L, Bates D, Hartung HP, Havrdova E, Miller D, Polman CH et al. Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring. Lancet Neurol 2007; 6(5): 431–441.

24. Sorensen PS, Fazekas F, Lee M. Intravenous immunoglobulin G for the treatment of relapsing-remitting multiple sclerosis: a meta-analysis. Eur J Neurol 2002; 9(6): 557–563.

25. Fernández O, Fernández V, De Ramón E. Azathioprine and methotrexate in multiple sclerosis. J Neurol Sci 2004; 223(1): 29–34.

26. Frohman EM, Havrdova E, Levinson B, Slanar O. Azathioprine myelosuppression in multiple sclerosis: characterizing thiopurine methyltransferase polymorphisms. Mult Scler 2006; 12(1): 108–111.

27. Rieckmann P, Toyka KV, Bassetti C, Beer K, Beer S, Buettner U et al. Escalating immunotherapy of multiple sclerosis – new aspects and practical application. J Neurol 2004; 251(11): 1329–1339.

28. Hartung HP, Gonsette R, König N, Kwiecinski H, Guseo A, Morrissey SP et al. Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, double-blind, randomised, multicentre trial. Lancet 2002; 360(9350): 2018–25.

29. Edan G, Miller D, Clanet D, Confavreux C, Lyon-Caen O, Lubetzki C et al. Therapeutic effect of mitoxantrone combined with methylprednisolone in multiple sclerosis: a randomised multicentre study of active disease using MRI and clinical criteria. J Neurol Neurosurg Psychiatry 1997; 62(2): 112–118.

30. Tichá V, Havrdová E, Nováková I, Horáková D. Mitoxantron v léčbě aktivní RS. Cesk Slov Neurol N 2003; 66/99(1): 31–37.

31. Weiner HL, Cohen JA. Treatment of multiple sclerosis with cyclophosphamide: critical review of clinical and immunologic effects. Mult Scler 2002; 8(2): 142–154.

32. Smith DR, Weinstock-Guttman B, Cohen JA, Wei X, Gutmann C, Bakshi R et al. A randomized blinded trial of combination therapy with cyclophosphamide in patients-with active multiple sclerosis on interferon beta. Mult Scler 2005; 11(5): 573–582.

33. Saccardi R, Kozak T, Bocelli-Tyndall C, Fassas A, Kazis A, Havrdova E et al. Autologous stem cell transplantation for progressive multiple sclerosis: update of the European Group for Blood and Marrow Transplantation autoimmune diseases working party database. Mult Scler 2006; 12(6): 814–823.

34. Mezey E, Key S, Vogelsang G, Szalayova I, Lange GD, Crain B. Transplanted bone marrow generates new neurons in human brains. Proc Natl Acad Sci USA 2003; 100(3): 1364–1369.

35. Kinkel RP, Kollman C, O'Connor P, Murray TJ, Simon J, Arnold D et al. IM interferon beta-1a delays definite multiple sclerosis 5 years after a first demyelinating event. Neurology 2006; 66(5): 678–684.

36. Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernández O et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357(9268): 1576–1582.

37. Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet 2007; 370(9585): 389–97.

38. Achiron A, Kishner I, Sarova-Pinhas I, Raz H, Faibel M, Stern Y et al. Intravenous immunoglobulin treatment following the first demyelinating event suggestive of multiple sclerosis: a randomized, double-blind, placebo-controlled trial. Arch Neurol 2004; 61(10): 1515–1520.

39. Štětkářová I, Šroubek J, Vrba I, Peregrin J, Havrdová E. Jednorázové intratékální podání baklofenu a následné zavedení pumpového systému v léčbě těžké spasticity u osob s roztroušenou sklerózou. Cesk Slov Neurol N 2007; 70/103(2): 190–195.

40. Kesselring J, Beer S. Symptomatic therapy and neurorehabilitation in multiple sclerosis. Lancet Neurol 2005; 4(10): 643–652.

41. Christodoulou C, Melville P, Scherl WF, Macallister WS, Elkins LE, Krupp LB. Effects of donepezil on memory and cognition in multiple sclerosis. J Neurol Sci 2006; 245(1–2): 127–36.

42. Dušánková J, Havrdová E. Psychiatrická problematika u sclerosis multiplex. Neurol pro praxi 2006; 4: 192–194.

43. Kobelt G, Berg J, Lindgren P, Fredrikson S, Jönsson B. Costs and quality of life of patients with multiple sclerosis in Europe. J Neurol Neurosurg Psychiatry 2006; 77(8): 918–926.

44. Barkhof F, Filippi M, Miller DH et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 1997; 120: 2059–2069.

45. Tintoré M, Rovira A, Martínez MJ et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. Am J Radiology 2000; 21: 702–706.