Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Lancet. 2024 Jan 13;403(10422):183-202. doi: 10.1016/S0140-6736(23)01473-3. Epub 2023 Nov 7.
Multiple sclerosis remains one of the most common causes of neurological disability in the young adult population (aged 18-40 years). Novel pathophysiological findings underline the importance of the interaction between genetics and environment. Improvements in diagnostic criteria, harmonised guidelines for MRI, and globalised treatment recommendations have led to more accurate diagnosis and an earlier start of effective immunomodulatory treatment than previously. Understanding and capturing the long prodromal multiple sclerosis period would further improve diagnostic abilities and thus treatment initiation, eventually improving long-term disease outcomes. The large portfolio of currently available medications paved the way for personalised therapeutic strategies that will balance safety and effectiveness. Incorporation of cognitive interventions, lifestyle recommendations, and management of non-neurological comorbidities could further improve quality of life and outcomes. Future challenges include the development of medications that successfully target the neurodegenerative aspect of the disease and creation of sensitive imaging and fluid biomarkers that can effectively predict and monitor disease changes.
多发性硬化症仍然是年轻成年人（18-40 岁）中最常见的神经功能障碍原因之一。新的病理生理学发现强调了遗传与环境相互作用的重要性。诊断标准的改进、MRI 协调指南以及全球化的治疗建议，使得诊断更加准确，免疫调节治疗的开始时间也比以前更早。了解和捕捉长期多发性硬化前驱期将进一步提高诊断能力，从而更早开始治疗，最终改善长期疾病结局。目前可用药物的大量组合为个性化治疗策略铺平了道路，这些策略将平衡安全性和有效性。纳入认知干预、生活方式建议以及非神经合并症的管理，可以进一步提高生活质量和结局。未来的挑战包括开发成功针对疾病神经退行性方面的药物，以及创建能够有效预测和监测疾病变化的敏感成像和液体生物标志物。
