Neurol. praxi. 2008;9(4):218-222

LÉČBA RELAPS-REMITENTNÍ ROZTROUŠENÉ SKLERÓZY MOZKOMÍŠNÍ

MUDr. Eva Krasulová, doc. MUDr. Eva Havrdová, CSc.
Centrum pro demyelinizační onemocnění Neurologická klinika 1. LF UK a VFN Praha

Roztroušená skleróza představuje chronické autoimunitní demyelinizační onemocnění centrálního nervového systému a nejčastější příčinu invalidity mladých osob. Onemocnění začíná u 85 % pacientů relaps-remitentním stadiem, kdy se ataky neurologických příznaků střídají s remisí. V této fázi RS se patogeneticky uplatňuje především zánětlivá aktivita imunitního systému a léčebně lze zasáhnout širokou škálou postupů k prevenci trvalého neurologického postižení. V přirozeném průběhu choroby zánět postupně vede k ireverzibilnímu poškození nervových vláken, patogeneticky převažuje neurodegenerace nad zánětem a klinicky narůstá neurologický deficit. V této tzv. sekundárně-progresivní fázi jsou léčebné možnosti v současné době velmi omezené. Zásadním předpokladem k úspěšné terapii RS je tedy její včasné zahájení v počátečních stadiích choroby. Článek si klade za cíl shrnout aktuální doporučené léčebné postupy právě pro tuto skupinu pacientů s RS.

Keywords: Klíčová slova: roztroušená skleróza, relaps-remitentní forma, léčba.

Published: November 1, 2008  Show citation

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Krasulová E, Havrdová E. LÉČBA RELAPS-REMITENTNÍ ROZTROUŠENÉ SKLERÓZY MOZKOMÍŠNÍ. Neurol. praxi. 2008;9(4):218-222.
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References

  1. Cavazzuti M, Merelli E, et al. Lesion load quantification in serial MR of early relapsing multiple sclerosis patients in azathioprine treatment. A retrospective study. Eur Neurol. 1997; 38(4): 284-290. Go to original source... Go to PubMed...
  2. Edan G, Miller D, Clanet M, 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. Go to original source... Go to PubMed...
  3. Frohman EM, Havrdová E, et al. Azathioprine myelosuppression in multiple sclerosis: characterizing thiopurine methyltransferase polymorphisms. Mult Scler 2006; 12(1): 108-111. Go to original source... Go to PubMed...
  4. Havrdová E. Neuroimunologie. Praha: Maxdorf, 2001: 180-263.
  5. Jacobs LD, Cookfair DL, Rudick RA, 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. Go to original source... Go to PubMed...
  6. Johnson KP, Brooks BR, Cohen JA, 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. Go to original source... Go to PubMed...
  7. Karussis D, Biermann LD, Bohlega S, et al. A recommended treatment algorithm in relapsing multiple sclerosis: report of an international consensus meeting. Eur J Neurol. 2006; 13(1): 61-71. Go to original source... Go to PubMed...
  8. Kozák T, Havrdová E, Piťha J, et al. High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis. Bone Marrow Transplant. 2000; 25(5): 525-531. Go to original source... Go to PubMed...
  9. Le Page E, Leray E, Taurin G, et al. Mitoxantrone as induction treatment in aggressive relapsing remitting Multiple Sclerosis: treatment response factors in a 5-year follow-up observational study of 100 consecutive patients. J Neurol Neurosurg Psychiatry 2008; 79(1): 52-56. Epub 2007 Sep 10. Go to original source... Go to PubMed...
  10. Lublin FD, Baier M, Cutter G. Effect of relapses on development of residual deficit in multiple sclerosis. Neurology 2003 9; 61(11): 1528-1532. Go to original source... Go to PubMed...
  11. Paty DW, Ebers GC, Hartung HP, et al. Management of relapsing-remitting multiple sclerosis and treatment guidelines. Eur J Neurology 1999, Suppl. 1 S1-S35.
  12. Paty DW, Li DK. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. UBC MS/MRI Study Group and the IFNB Multiple Sclerosis Study Group. Neurology 1993; 43(4): 662-667. Go to original source... Go to PubMed...
  13. Polman CH, O'Connor PW, Havrdova E, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006 2; 354(9): 899-910. Go to original source... Go to PubMed...
  14. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet 1998 7; 352(9139): 1498-1504.
  15. Simon JH, Jacobs LD, Campion M, 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. Go to original source... Go to PubMed...
  16. Smith DR, Weinstock-Guttman B, Cohen JA, 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. Go to original source... Go to PubMed...
  17. 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. Go to original source... Go to PubMed...
  18. 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. Go to PubMed...
  19. The IFNB Multiple Sclerosis Study Group. Interferon beta-lb 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. Go to original source... Go to PubMed...
  20. Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998 29; 338(5): 278-285. Go to original source... Go to PubMed...




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