revue des principales nouvelles neurologiques de 2014

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revue des principales nouvelles neurologiques de 2014

Message par Magie le Mar 16 Déc - 13:44

Ce matin, l'Association des neurologues du Québec, via sa page Facebook nous informait des nouvelles pratiques en neurologie suite aux différents congres. L'article est en anglais en utilisant un traducteur sur le web, l'article est facilement compréhensible. Les pages 2 et 3 concernent la sep. Il faut toutefois être abonné au site Medscape pour lire l'article au complet. C'est gratuit et donne accès a tous les résumés d'article scientifique et d'éditoriaux.

Voici le lien de l'article ''Neurology Practice Changers 2014'': http://www.medscape.com/viewarticle/835822_1

Pour ceux qui ne désire pas s'inscrire au site, je vais mettre la section sur la sep plus bas.

Bonne lecture
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Magie

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Re: revue des principales nouvelles neurologiques de 2014

Message par Magie le Mar 16 Déc - 13:46

Le copier-coller des pages concernant la sp:

Understanding MS

The etiology of multiple sclerosis (MS) is far from fully understood—but it's becoming increasingly clear.

It's been thought for years that MS might have an autoimmune component, and growing evidence suggests that this is the case. At this year's MSBoston 2014 conference, Dr David Hafler from Yale University School of Medicine in New Haven, Connecticut, proclaimed that there is no longer any doubt that MS is an immune-mediated disease with genetic and environmental components. And there's plenty of evidence backing up this claim: Over 180 genetic variants have now been linked with MS, most of which are immune genes; there is an increase in autoreactive white blood cells in MS; and—most important—if you treat MS patients with anti-immune therapies, they improve considerably.[9]

What some experts don't agree on is whether or not the autoimmune activity is the primary pathology in MS. Stephen Krieger, MD, assistant professor at Icahn School of Medicine at Mount Sinai in New York, New York, commented to Medscape:

I believe the autoimmune nature of MS is a crucial element in the disease pathogenesis as we understand it.... The piece that remains incompletely explained is whether there are additional factors driving a neurodegenerative process. This is suggested by the failure of our immune-modulating agents in primary progressive MS and secondary progressive MS without evidence of inflammatory activity. However, no underlying non–immune-mediated mechanisms have been worked out, whereas a great many of the autoimmune mechanisms have.
And it gets still more complicated. As a number of studies [10-12] presented at MSBoston found, the microbiota—the trillions of bacteria, fungi, and other single-celled organisms that reside in our gastrointestinal tracts—also appears to influence MS. This has also been shown in other autoimmune disorders, including rheumatoid arthritis and inflammatory bowel disease. Patients with MS appear to have unique proinflammatory gut flora, whereas work in mice has shown that yeast ingestion can prevent the development of MS. Dietary, probiotic, and antibiotic therapy in MS might be a ways away, but these approaches appear worth pursuing.

Environmental factors, including increased salt consumption, vitamin D deficiency, Epstein-Barr virus exposure, and smoking, also appear to increase MS risk. The mechanisms behind these relationships are currently unknown; however, direct interaction with the immune system, or perhaps their influence on the gastrointestinal microbiome, are etiologic possibilities.

Dr Hafler explained that the immune process of MS begins outside the brain, which is affected after peripheral T cells enter the central nervous system via the choroid plexus and cerebrospinal fluid. These are followed by Th17 T cells and Th1 cells that enter the brain parenchyma, which results in chronic inflammation. However, many more details need to be understood to fully explain the pathogenesis of MS inflammation and neurodegeneration.

More on MS: A New Goal, a New Therapy

Dr Krieger also highlighted two other areas he feels represent major, if gradual, advances this year in MS.

"I think that this year, we saw a turning point in MS research and care in two ways: First is the emphasis on 'no evidence of disease activity' as a potentially achievable goal in relapsing forms of MS," commented Krieger. "The other is the move to put progressive forms of MS front and center in clinical trials," he continued. "Both of these reflect the increasing ambitions we have to treat MS as efficaciously as possible, and to tackle forms of the disease for which we still have significant unmet need."

Krieger pointed out that in the coming months, we will see top-line data from trials on primary and secondary progressive MS, some assessing already available agents and others looking at novel compounds. "This has the potential to transform how we care for these patients in practice," says Dr Krieger.

Is an MS Generic on the Horizon?

2014 also saw a potentially important pharmacotherapeutic advance in MS. The GATE trial [13] compared generic glatiramer acetate with Copaxone® and placebo. The study found that both generic glatiramer acetate and Copaxone were significantly better than placebo, the primary endpoint being T1 gadolinium-enhancing lesions. Also, the agents were nearly identical in terms of outcomes, safety, and tolerability.

MS drugs cost many thousands of dollars per year. To date, no generic preparation of any MS drugs is available. Because glatiramer acetate is one of the most commonly prescribed drugs for MS, a generic preparation could potentially (but not necessarily) decrease the cost of treatment for many patients. A lower-cost option might also decrease the number of patients who remain untreated owing to unaffordable medication costs.
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Re: revue des principales nouvelles neurologiques de 2014

Message par kosok le Mar 16 Déc - 19:24

Merci Magie
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Re: revue des principales nouvelles neurologiques de 2014

Message par Magie le Mer 17 Déc - 2:09

J'me disais bien que tu aimerais Wink
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Re: revue des principales nouvelles neurologiques de 2014

Message par Lelette le Mer 17 Déc - 15:15

Ben voui, le développement de protocoles pour les progressives, c'est plutôt une bonne nouvelle !!!
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Re: revue des principales nouvelles neurologiques de 2014

Message par Magie le Mer 17 Déc - 15:34

Oui, Lelette, enfin, il était temps.
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Re: revue des principales nouvelles neurologiques de 2014

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