Treatment of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders정일억

S114

Treatment of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders

정일억

고려대학교 안산병원 신경과

ISSN: 2234-0971

대한안신경의학회지: 제9권 Supplement 2

Clin Neuroophthalmol 9(Suppl 2):S114-114, October 2019

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated demyelinating disease of the central nervous systems characterized by immunological and pathological fea- tures. MS is considered an autoimmune disease mediated by autoreac- tive T-lymphocytes, specifically CD4+T-helper cells. NMOSD are a class of antigen-antibody-mediated CNS inflammatory demyelinating dis- ease that are primarily mediated by humoral immnunity, with or with- out AQP4 positivity. The primary goal of therapy in the acute phase in patients with MS and NMOSD is to alleviate symptoms, shorten the dis- ease course, and prevent complications. The treatment of acute attacks includes intravenous methylprednisolone (IVP) pulse therapy, plasma exchange (PE), and intravenous immunoglobulin (IVIG). For severe at- tacks, PE and IA can be used as initial therapies, however, this recom- mendation is based on clinically experience, because of a lack of trials on IVIG monotherapy during acute attacks. The actions of corticosteroids

include anti-inflammatory effects, hematologic reaction and cellular ef- fect on inflammatory and structural cells. PE is to remove circulating au- toantibodies, immune complexes, inflammatory cytokines, and other mediators. IVIG is to affect immunomodulatory and antigenic-recogni- tion pathways and to reduce anti-AQP4 levels.

The disease-modifying drugs for MS and NMOSD include conven-

tional immunosuppressants and some new immunomodulators as well

as biological agents. There exists differences in the mechanisms of ac-

tions, routes of administration, and approved indications of different

drugs. However it should be noted that most studies on this drugs were

not based on the well-controlled or randomized results. There is no con-

sensus on the best strategies or treatment regimens. More efficacious

therapies are required, therefore, future studies on large and well-de-

signed cohort are needed.