Freedman Mark S
Multiple Sclerosis Research Unit, The Ottawa Hospital General Campus, University of Ottawa, Ottawa, Canada.
Neurol Sci. 2008 Sep;29 Suppl 2:S250-2. doi: 10.1007/s10072-008-0953-y.
Not all patients presenting with their first attack of multiple sclerosis (MS) or early thereafter are necessarily in the same phase of disease; some truly present early with minimal disease, whereas others present late, having accumulated already considerable damage to the central nervous system (CNS). This beckons a different approach to therapy depending on "where" a patient may be in the course of disease. If early, then any of the current first line immunomodulating agents may be appropriate, whereas later disease calls for a more aggressive approach entailing either induction with a more powerful but riskier treatment or an escalation approach, moving through first line agents and stepping up to more aggressive treatments. This paper discusses the rationale for either regimen.
并非所有首次出现多发性硬化症（MS）发作或在此后不久发病的患者都必然处于疾病的同一阶段；一些患者确实在疾病早期表现为轻微症状，而另一些患者则在晚期发病，此时中枢神经系统（CNS）已积累了相当程度的损伤。这就需要根据患者在疾病进程中所处的“位置”采取不同的治疗方法。如果是早期，那么目前任何一种一线免疫调节药物可能都是合适的，而对于晚期疾病，则需要采取更积极的治疗方法，要么采用更强大但风险更高的治疗进行诱导，要么采用逐步升级的方法，从一线药物开始，逐步升级到更积极的治疗。本文讨论了这两种治疗方案的依据。
