Willis Mary Alissa, Fox Robert J
Continuum (Minneap Minn). 2016 Jun;22(3):785-98. doi: 10.1212/CON.0000000000000323.
Many therapeutic advances for relapsing-remitting multiple sclerosis (MS) have occurred in the past 25 years. Although similar advances in disease-modifying therapies have not been realized in progressive MS, many symptomatic therapeutic strategies can benefit patients with progressive MS. Few guidelines exist for management of patients with progressive MS.
The classification of progressive MS was revised in 2013 to include a description of inflammatory disease activity determined by clinical relapses or imaging findings. Developing knowledge about the pathogenesis of progressive MS and the role of comorbidities in modifying the disease course has implications for the clinical management of patients with progressive MS as well as for clinical trial design. Current and upcoming clinical trials will assess a wide range of interventions, including immunomodulatory agents, putative neuroprotective molecules, stem cell therapy, nutrition, and rehabilitation techniques.
None of the therapies currently approved for use in relapsing-remitting MS have been shown to slow the gradual progression of disability that occurs in the absence of recent relapses or changes in MRI. A multidisciplinary approach is needed to address the many symptoms that impact quality of life for patients with progressive MS.
在过去25年中，复发缓解型多发性硬化症（MS）取得了许多治疗进展。尽管进展型MS在疾病修饰治疗方面尚未取得类似进展，但许多对症治疗策略可使进展型MS患者受益。目前针对进展型MS患者的管理指南较少。
2013年对进展型MS的分类进行了修订，纳入了根据临床复发或影像学表现确定的炎症性疾病活动的描述。对进展型MS发病机制以及合并症在改变疾病进程中作用的认识不断深入，这对进展型MS患者的临床管理以及临床试验设计都具有重要意义。当前和即将开展的临床试验将评估广泛的干预措施，包括免疫调节药物、假定的神经保护分子、干细胞治疗、营养和康复技术。
目前批准用于复发缓解型MS的治疗方法均未显示出能减缓在近期无复发或MRI无变化情况下出现的残疾逐渐进展。需要采用多学科方法来解决影响进展型MS患者生活质量的诸多症状。
