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How to use the new 2017 Japanese guidelines for multiple sclerosis and neuromyelitis optica
Author(s) -
Matsui Makoto
Publication year - 2017
Publication title -
clinical and experimental neuroimmunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.297
H-Index - 15
ISSN - 1759-1961
DOI - 10.1111/cen3.12414
Subject(s) - neuromyelitis optica , medicine , multiple sclerosis , disease , intensive care medicine , etiology , pediatrics , demyelinating disease , clinical trial , physical therapy , psychiatry , pathology
New guidelines for the management of multiple sclerosis and neuromyelitis optica were published in Japan in 2017 for doctors and nurses, as well as patients and their family members. They consist of three major parts. The first includes a general discussion regarding the diseases, including brief reviews of seven inflammatory demyelinating diseases of the central nervous system, along with recent advances shown in epidemiological and etiological studies of multiple sclerosis and neuromyelitis optica. That is followed by part I of the detailed discussion section, which describes symptoms, measurements of disability, tests for diagnosis, diagnostic criteria, clinical course and prognosis, and information regarding medical economics and social resources. Finally, part II of the detailed discussion focuses on general treatment strategies, acute stage treatment, disease‐modifying therapy and symptomatic treatment for sequelae after relapse. There are 110 clinical questions covered. Physicians and patients are advised to first read chapter 1 in order to understand the current situation regarding related diseases. For treatment of acute stage patients, a common algorithm is proposed. In order to prevent relapse and suppress progression of disability, proper disease‐modifying therapy must be chosen for individual patients. Physicians are advised to not jump to the portion where a specific drug is discussed, but rather should first read chapter 13 for unbiased facts regarding the whole body of evidence for disease‐modifying therapy. In chapter 11, an escalation therapy strategy starting with baseline drugs is proposed, while induction therapy is mentioned as a possibility for patients with highly active disease.