2018 年 35 巻 4 号 p. 388-395
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. In Japan, interferon–beta, glatiramer acetate, fingolimod, dimethyl fumarate, and natalizumab are approved treatments for MS. These disease–modifying drugs (DMDs) are efficacious for reducing the frequency of relapses in relapsing remitting MS, but they are generally not effective for progressive MS. Because MS is heterogeneous in its clinical manifestations and disability progression, DMDs must be chosen carefully in consideration of each patient's condition and life stage. In this review, I discuss how to choose DMDs according to the following five standpoints of view on MS treatment : (1) window of opportunity (early initiation) of DMDs in the disease course of MS, (2) presence of benign MS, (3) cortical lesions and cognitive impairment, (4) atypical cases, and (5) occurrence of progressive multifocal leukoencephalopathy. In addition, it is important to monitor disease activity and emergence of atypical lesions suggestive of progressive multifocal leukoencephalopathy after introduction of DMDs by regularly conducting magnetic resonance imaging of the brain and spinal cord.
