Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Semin Neurol. 2013 Feb;33(1):5-12. doi: 10.1055/s-0033-1345709. Epub 2013 May 25.
Multiple sclerosis is a presumed autoimmune, inflammatory disease of the central nervous system. Since the early 1990s, medications have been devised, tested, and approved for relapsing forms of multiple sclerosis (MS). MS treatments work by altering the immune system to reduce inflammatory MS activity, thus curtailing clinical relapses (attacks), thereby reducing short-term disability related to the MS attacks. The promise of long-term improvement in MS-related disability remains the most desirable therapeutic goal; to what degree current MS therapies are effective in reducing this is controversial. Recent years have seen a surge in novel MS therapies delivered both parenterally and orally that offer new therapeutic alternatives to MS patients and their treating providers. It remains essential to make an unequivocal diagnosis of MS and identify its clinical course prior to initiating therapies. Switching and altering MS therapies can now be done by rational approaches based on therapeutic efficacy and tolerability; however, these remain nonevidence-based for the most part. The high cost of MS therapies remains a significant concern. A new therapeutic era is at hand offering new hope for patients affected by this chronic, frequently disabling disease.
多发性硬化症是一种中枢神经系统的自身免疫性、炎症性疾病。自 20 世纪 90 年代初以来，人们已经设计、测试和批准了用于治疗多发性硬化症（MS）复发形式的药物。MS 治疗方法通过改变免疫系统来减少炎症性 MS 活动，从而减少临床复发（发作），从而减少与 MS 发作相关的短期残疾。改善 MS 相关残疾的长期前景仍然是最理想的治疗目标；目前的 MS 疗法在多大程度上有效降低残疾程度仍存在争议。近年来，出现了许多新型的多发性硬化症治疗方法，包括肠内和口服治疗方法，为多发性硬化症患者及其治疗医生提供了新的治疗选择。在开始治疗之前，明确诊断多发性硬化症并确定其临床病程仍然至关重要。目前，基于治疗效果和耐受性，可以通过合理的方法来转换和改变 MS 治疗方法；然而，在大多数情况下，这些方法仍然没有证据支持。MS 治疗费用高昂仍然是一个重大问题。一个新的治疗时代即将到来，为受这种慢性、经常致残疾病影响的患者带来了新的希望。
