MRI的效用怀疑女士:Subcommitte疗法和技术评估的报告

我们感谢戈登博士对他的评论。我们的纸是prinicipally关注一个非常受限的问题:什么是核磁共振成像的作用在临床孤立综合征(CIS)在预测未来转化为临床明确的女士吗?这将导致另一个有争议的,但非常重要的问题:排除模仿条件后,病人的独联体和伴随的MRI异常的特征女士已经有了疾病和疾病修改治疗这些病人适当的候选人吗?这个问题是特别重要的上下文中的两类临床试验在CIS患者受益于疾病的临床和影像学代理标记活动。[1,2]戈登的评论是核心的影响提出的指导方针,我们应该治疗?我们的指南并不是要禁止的对个别病人的治疗。有关研究分析统计的风险转化为明确的女士没有直接适用于个别病人的评估。诊断和治疗干预女士应该在负责任的神经病学家的自由裁量权。与女士作为一个临床医生照顾很多病人,我提倡开始疾病修饰治疗一旦女士证实了诊断。我同意目前治疗是昂贵的。 MS-related disability is substantially more expensive in terms of physical and cognitive disability and it may result in the patient being incapable of achieving personal, educational, economic, and family goals. It is difficult to predict which patients at baseline are destined for a milder versus a more aggressive course of the disease. Natural history studies have been instructive in confirming that, over time, the majority of patients will have significant and limiting disability. As such, early diagnosis and treatment of MS should be considered as a prevention treatment strategy. References 1. Jacobs, L.D., Beck, R.W., Simon, J.H., et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating eventinmultiple sclerosis. N Engl J Med 2000;343:898-904. 2. Comi, G., Filippi, M., Barkhof, F., et al. Effect of earlyinterferon treatment on conversion to definite multiple sclerosis:a randomizedstudy.Lancet 2001;357:1576-1582.