The clinical standard for the diagnosis and treatment of multiple sclerosis and neuromyelitis optica
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) with autoimmune features in the pathogenesis of disease prevalence in the Czech Republic according to recent data 170/100 000 population, with increasing incidence (now 11,7 / 100 000 inhabitants). The first symptoms usually appear between 20 - 40 years of age, but can occur in childhood, adolescence and the elderly.
In 85% of patients with MS disease runs through the first 10 years of attacks and remissions (with varying degrees of modification neurological findings) and changes in the chronic stage of progression with a permanent increase in disability. In 10-15% of patients increasing disability from disease onset, it is a form of primary progressive.
In 3% of patients with malignant RS is an early disability and between attacks. Only early initiation of immunomodulatory therapy may lead to the patient's disability, improving quality of life and pharmacoeconomic effectiveness of the treatment administered as late stages of disability (EDSS 7.5 to 9.5) are loaded to triple the cost to society.
Neuromyelitis optica (NMO) is a demyelinating disease of CNS, were often confused with MS, which is different immunopathological processes related to aquaporinových channels and clinical course. It is a rare but very serious illness with a prognosis of severe disability, many patients are kept for years under the diagnosis of multiple sclerosis and effective drugs are administered too late.
Care of patients with MS and NMO can be improved by early diagnosis and early start of immunomodulatory therapy. Its effectiveness and side effects should be monitored and treatment in case of unsatisfactory response time escalated.
Treatment of these patients requires a multidisciplinary team and is therefore concentrated in specialized centers.