2023 年 40 巻 3 号 p. 311-314
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system that produces multiple inflammatory demyelinating lesions, and its T– and B–cell mediated autoimmune pathogenesis has been extensively studied. Patients with MS experience the disease relapses and remissions over many years, and often suffer from gradual progression of neurodegeneration, forcing them to live in a wheelchair. Early intervention with disease–modifying therapies has led to good outcomes in some cases. Several disease–modifying therapies are available for patients with MS, whereas disease status and condition would be different in each patient, further emphasizing the need for personalized medicine.
In advancing personalized medicine for patients with MS, a multifaceted assessment of disease status is important. In addition to neurological symptoms and clinical imaging findings, the cognitive assessment batteries and patient–reported outcomes may be useful in evaluating whether current treatment is optimal. Although the Expanded Disability Status Scale (EDSS) score has been used to assess neurological disability, a combined measure has been reported to better reflect the patient quality of life. In addition to MRI imaging, neuro–ophthalmologic testing or serum neurofilament light chain levels have been highlighted as objective hallmarks reflecting disease severity. While research into autoimmune pathogenesis has brought several therapies for patients with MS, there are surprisingly few immunological indices that reflect the pathophysiology of the disease and are useful for therapeutic strategies. This review provides an overview of the current status and outlines future perspectives for the development of personalized medicine in MS.
