2016 年 33 巻 3 号 p. 475-477
Two main pathogenetic mechanisms of multiple sclerosis (MS) include ‘inflammation’ and ‘neurodegeneration’. Most of current disease–modifying drugs (DMT) (e.g. interferon–beta [IFNβ], fingolimod, natalizumab and glatiramer acetate) target for inflammatory processes in MS. The pivotal randomized clinical trials (RCT) for clinically isolated syndrome (CIS) with some silent magnetic resonance imaging lesions identified that rate of patients who developed clinically definite MS (CDMS) was reduced by using DMT. A randomized cohort study 21 years after the start of the pivotal IFNβ1b trial provided that early treatment with IFNβ1b is associated with prolonged survival in initially treatment–naïve patients with relapsing–remitting MS. These data support earlier diagnosis and treatment by using DMT in MS. Based on these moves, the McDonald MS diagnostic criteria has been revised in 2010 and the revision allows some patients with a single clinical episode to be diagnosed with MS based on the single scan criterion for dissemination in time and space, reducing the number of patients who will be categorized as CIS. The development of imaging and biological biomarkers is necessary to define the exact clinical courses of MS/CIS due to realize the earlier diagnosis and treatment of MS.
