Khan O A
Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.
J Pak Med Assoc. 1996 Jan;46(1):20-4.
Multiple sclerosis (MS) is an incurable neurological illness that frequently causes chronic disability. Neurologists broach the diagnosis with dread. "I'll end up in a wheel chair" is the anguished cry of the newly diagnosed and mostly young patients. The past decade has improved our understanding of the immunopathogenesis of MS enormously. This has led to a plethora of clinical trials and the resultant emergence of several new drugs in various stages of development. In 1993, Food and Drug Administration (FDA) approved Betaseron for the treatment of MS. Todate, this is the only drug approved by the FDA, specifically for the treatment of MS. However, it would not be too long before several other drugs are approved, leaving the neurologist bewildered having gone from a state of practically little to offer to a state of several options to choose from. This review discusses the status of current and future therapy in the treatment of MS. Multiple sclerosis (MS) is the most common demyelinating disease of the human central nervous system (CNS). Medline includes over 13000 articles on MS since 1966 that exclude book chapters and other references. MS typically affects the youth and women more than men, between the ages of twenty and forty. Clinically, the illness is characterized into a relapsing-remitting (RR) or chronic progressive (CP) stage although more precisely defined stages exist for research purposes. It tends to follow a highly unpredictable course leading to chronic and sometimes devastating disability. More recently, follow up data suggested that the disease may fall into a pattern after several years. Despite decades of hectic research and better understanding of immunological mechanisms involving human CNS disease, the cause of MS remains unknown. However, it is widely believed that MS is the result of an autoimmune disorder in a genetically susceptible individual, mediated by autoreactive T cells that migrate into the CNS and initiate the inflammatory demyelinating lesion. Regardless of the plausibility of this theory and without going into details, several aspects of immune mediated pathology of MS remain unexplained. This is an attempt to review the status of current therapy and future prospects in the treatment of MS.
多发性硬化症（MS）是一种无法治愈的神经系统疾病，常导致慢性残疾。神经科医生在诊断时往往心怀恐惧。“我最终会坐上轮椅”是新确诊的患者（大多为年轻患者）痛苦的呼喊。在过去十年里，我们对MS免疫发病机制的理解有了极大的提升。这引发了大量的临床试验，并催生了处于不同研发阶段的多种新药。1993年，美国食品药品监督管理局（FDA）批准了β-干扰素用于治疗MS。截至目前，这是FDA唯一批准专门用于治疗MS的药物。然而，用不了多久其他几种药物也会获批，这会让神经科医生从几乎无药可施的状态一下子陷入有多种选择的困惑之中。本综述讨论了MS治疗中当前及未来疗法的现状。多发性硬化症（MS）是人类中枢神经系统（CNS）最常见的脱髓鞘疾病。自1966年以来，医学在线数据库（Medline）收录了超过13000篇关于MS的文章，其中不包括书籍章节和其他参考文献。MS通常在20至40岁之间发病，女性比男性更易患病，且多为年轻人。临床上，该疾病分为复发缓解型（RR）或慢性进展型（CP）阶段，不过为了研究目的还有更精确的定义阶段。它往往遵循高度不可预测的病程，导致慢性且有时是严重的残疾。最近，随访数据表明该疾病在数年后可能会呈现出一种模式。尽管经过数十年的繁忙研究以及对涉及人类中枢神经系统疾病的免疫机制有了更好的理解，但MS的病因仍然不明。然而，人们普遍认为MS是由自身反应性T细胞介导的、发生在基因易感性个体中的自身免疫性疾病，这些T细胞迁移到中枢神经系统并引发炎症性脱髓鞘病变。无论该理论的可信度如何，且不深入探讨细节，MS免疫介导病理的几个方面仍无法解释。本文旨在综述MS治疗中当前疗法的现状及未来前景。
