Neurológia pre prax 4/2016

Strategy initiation of treatment for multiple sclerosis

Multiple sclerosis is a chronic, disabling disease of the central nervous system with involvement of the inflammation and neurodegeneration. Treatment should be started shortly after the diagnosis of a clinically isolated syndrome or definite multiple sclerosis in the fulfillment of the requirement of dissemination of lesions in time and space according to the McDonald diagnostic criteria. The clinical course is heterogeneous and therefore it is necessary to consider the optimal treatment strategy for a particular patient. It is always appropriate to assess the available prognostic markers, and on this basis decide which medication to choose first. For highly active form of the disease it is possible to indicate an induction therapy. It is necessary to consider a number of other circumstances, e.g. the risk of treatment adherence, planned pregnancy, and others. When treatment is ineffective, therapy must be escalate. Drugs with comparable effect can be reversed due to poor tolerance. The aim of treatment is a state of NEDA (no evident disease activity).

Keywords: multiple sclerosis, start of treatment, escalation of treatment, NEDA