The pros and cons of early treatment of relapsing forms of multiple sclerosis

2004 ◽  
Vol 251 (S4) ◽  
Author(s):  
Xavier Montalban
Keyword(s):  
Multiple Sclerosis ◽  
Early Treatment ◽  
Pros And Cons

scholarly journals Manajemen Tatalaksana Neuritis Optik Demielinasi

2020 ◽  
Vol 8 (2) ◽  
pp. 73-79
Author(s):  
Okta Della Susmitha ◽  
Muhammad Yusran
Keyword(s):  
Multiple Sclerosis ◽  
High Risk ◽  
Literature Review ◽  
Optic Neuritis ◽  
Early Treatment ◽  
Treatment Trial ◽  
Interferon Β ◽  
Prevention Study ◽  
Optic Neuritis Treatment Trial

Pendahulan: Neuritis Optik (ON) didefinisikan sebagai inflamasi pada saraf optik, yang sebagian besar idiopatik. Namun dapat dikaitkan dengan penyebab lain seperti lesi demielinasi, gangguan autoimun, infeksi dan inflamasi. Dari semua ini, multiple sclerosis (MS) adalah penyebab paling umum dari demielinasi ON. Tujuan: Untuk mengetahui diagnosis dan tatalaksana neuritis optik demielinasi. Metode: Artikel ini dibuat dengan metode literature review, melibatkan 29 pustaka baik buku dan jurnal nasional atau internasional. Hasil: ON terjadi karena proses inflamasi yang mengarah pada aktivasi sel-T yang dapat melewati sawar darah otak dan menyebabkan reaksi hipersensitivitas terhadap struktur saraf. Mekanisme pastinya belum diketahui. Diagnosis klinis ON terdiri dari tiga gejala klasik yaitu kehilangan penglihatan, nyeri periokular dan dischromatopsia. Hal ini membutuhkan pemeriksaan oftalmik, neurologis dan sistemik yang cermat untuk membedakan antara ON spesifik dan tidak. Diagnosis banding diperlukan untuk membuat rencana tatalaksana yang tepat. Pembahasan: Menurut Optic Neuritis Treatment Trial (ONTT), pengobatan pertama adalah metilprednisolon intravena dengan pemulihan yang lebih cepat dan lebih sedikit kemungkinan kasus relaps dan konversi ke MS. Namun prednisolon oral saja dikontraindikasikan karena peningkatan risiko relaps. Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study (CHAMPS) dan Early Treatment of MS study (ETOMS) dan telah melaporkan bahwa pengobatan dengan interferon β-1a, dengan hasil pengurangan risiko karakteristik MS dari MRI. Sensitivitas kontras, penglihatan warna dan bidang visual adalah parameter yang sebagian besar tetap terganggu bahkan setelah pemulihan ketajaman visual yang baik. Simpulan: Tatalaksana pada neuritis optik demielinasi dominan diberikan steroid dan interferon β-1a.   Kata kunci: demielinasi, multipel skeloris, neuritis optik, tatalaksana  

scholarly journals PND11 HEALTH ECONOMIC IMPACT OF EARLY TREATMENT OF MULTIPLE SCLEROSIS WITH DISEASE MODIFYING THERAPY

2010 ◽  
Vol 13 (3) ◽  
pp. A139
Author(s):  
S Curkendall ◽  
C Wang ◽  
BH Johnson ◽  
Z Cao ◽  
R Preblick ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Economic ◽  
Economic Impact ◽  
Early Treatment ◽  
Disease Modifying Therapy ◽  
Disease Modifying

scholarly journals Effect of fingolimod on MRI outcomes in patients with paediatric-onset multiple sclerosis: results from the phase 3 PARADIGMS study

2020 ◽  
Vol 91 (5) ◽  
pp. 483-492 ◽  
Author(s):  
Douglas L Arnold ◽  
Brenda Banwell ◽  
Amit Bar-Or ◽  
Angelo Ghezzi ◽  
Benjamin M Greenberg ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Early Treatment ◽  
Brain Atrophy ◽  
Treatment Discontinuation ◽  
Interferon Β ◽  
Phase 3 ◽  
Once Daily ◽  
T2 Lesions ◽  
Superior Efficacy

ObjectivePARADIGMS demonstrated superior efficacy and comparable safety of fingolimod versus interferon β-1a (IFN β-1a) in paediatric-onset multiple sclerosis (PoMS). This study aimed to report all predefined MRI outcomes from this study.MethodsPatients with multiple sclerosis (MS) (aged 10–<18 years) were randomised to once-daily oral fingolimod (n=107) or once-weekly intramuscular IFN β-1a (n=108) in this flexible duration study. MRI was performed at baseline and every 6 months for up to 2 years or end of the study (EOS) in case of early treatment discontinuation/completion. Key MRI endpoints included the annualised rate of formation of new/newly enlarging T2 lesions, gadolinium-enhancing (Gd+) T1 lesions, new T1 hypointense lesions and combined unique active (CUA) lesions (6 months onward), changes in T2 and Gd+ T1 lesion volumes and annualised rate of brain atrophy (ARBA).ResultsOf the randomised patients, 107 each were treated with fingolimod and IFN β-1a for up to 2 years. Fingolimod reduced the annualised rate of formation of new/newly enlarging T2 lesions (52.6%, p<0.001), number of Gd+ T1 lesions per scan (66.0%, p<0.001), annualised rate of new T1 hypointense lesions (62.8%, p<0.001) and CUA lesions per scan (60.7%, p<0.001) versus IFN β-1a at EOS. The percent increases from baseline in T2 (18.4% vs 32.4%, p<0.001) and Gd+ T1 (–72.3% vs 4.9%, p=0.001) lesion volumes and ARBA (–0.48% vs −0.80%, p=0.014) were lower with fingolimod versus IFN β-1a, the latter partially due to accelerated atrophy in the IFN β-1a group.ConclusionFingolimod significantly reduced MRI activity and ARBA for up to 2 years versus IFN β-1a in PoMS.

A guide to facilitate the early treatment of patients with idiopathic demyelinating disease (multiple sclerosis and neuromyelitis optica)

2013 ◽  
Vol 19 (10) ◽  
pp. 1371-1380 ◽  
Author(s):  
WM Carroll ◽  
T Saida ◽  
HJ Kim ◽  
J Kira ◽  
AG Kermode ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neuromyelitis Optica ◽  
Early Treatment ◽  
Clinical Evidence ◽  
Demyelinating Disease ◽  
Treatment Decision ◽  
Careful Monitoring ◽  
First Line ◽  
Require Time ◽  
Appropriate Treatment

Definite diagnosis of inflammatory demyelinating disease (multiple sclerosis (MS) and neuromyelitis optica (NMO)) may require time, but early treatment offers the opportunity to maximize patient outcomes. The purpose of this report is to provide guidance to facilitate early treatment decisions for patients with inflammatory demyelinating disease, before definitive diagnosis. Neurology experts reviewed the existing literature and clinical evidence. A treatment decision pathway was developed, defining patients for whom first-line MS disease-modifying therapies (a) are unlikely to be effective, (b) may be effective but require careful monitoring and (c) are likely to provide benefit. This algorithm seeks to ensure that patients, particularly those in Asia, receive appropriate treatment early in inflammatory demyelinating disease.

scholarly journals Learning a CNN on multiple sclerosis lesion segmentation with self-supervision

2020 ◽  
Vol 2020 (17) ◽  
pp. 3-1-3-7
Author(s):  
Alexandre Fenneteau ◽  
Pascal Bourdon ◽  
David Helbert ◽  
Christine Fernandez-Maloigne ◽  
Christophe Habas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Multiple Sclerosis Lesion ◽  
Image Size ◽  
Mr Images ◽  
Traffic Sign ◽  
Demyelinating Lesions ◽  
The Central Nervous System ◽  
Pros And Cons ◽  
Segmentation Task ◽  
High Level

Multiple Sclerosis (MS) is a chronic, often disabling, autoimmune disease affecting the central nervous system and characterized by demyelination and neuropathic alterations. Magnetic Resonance (MR) images plays a pivotal role in the diagnosis and the screening of MS. MR images identify and localize demyelinating lesions (or plaques) and possible associated atrophic lesions whose MR aspect is in relation with the evolution of the disease. We propose a novel MS lesions segmentation method for MR images, based on Convolutional Neural Networks (CNNs) and partial self-supervision and studied the pros and cons of using self-supervision for the current segmentation task. Investigating the transferability by freezing the firsts convolutional layers, we discovered that improvements are obtained when the CNN is retrained from the first layers. We believe such results suggest that MRI segmentation is a singular task needing high level analysis from the very first stages of the vision process, as opposed to vision tasks aimed at day-to-day life such as face recognition or traffic sign classification. The evaluation of segmentation quality has been performed on full image size binary maps assembled from predictions on image patches from an unseen database.

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