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Optical coherence tomography in multiple sclerosis.
Lízrová-Preiningerová, Jana ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Taláb, Radomír (referee)
Spectral domain optical coherence tomography (SD-OCT), a non-invasive imaging method, is based on an analysis of a near-infrared light deflected from tisssue layers, that provides detailed images of retinal structures. Nerve cells of the retina, that originate from neuroectoderm, reflect neurodegeneration of the central nervous system (CNS), as well as acute damage of nerve structures caused by optic neuritis. The dissertation first presents established imaging protocol and quality standards for SD-OCT imaging in multiple sclerosis (MS). In the following section we introduce SD-OCT as a biomarker in MS. In a multicentric cross-sectional study, we had shown, that a single time measurement of peripapillary retinal nerve fiber layer thickness (RNFL) has a predictive value for a risk of disease progression in the next five years. Patients with a thickness of RNFL in the lowest tercile of the studied population had a relative risk of disease progression 2x higher than patients in the highest tercile. The second presented study tests whether the history of optic neuritis (ON) in MS is a risk factor for neurodegeneration of RNFL in later years. The study confirmed that long term changes of RNFL thickness in eyes post-ON and in eyes with no history of ON are not different. Therefore, we conclude that both,...
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Immunosuppression in active multiple sclerosis: combination treatment with interferon beta and azathioprine and fingolimod monotherapy
Tichá, Veronika ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Laczó, Jan (referee)
Introduction: Addition of a second drug used to be a strategy to achieve clinical stabilization of multiple sclerosis in many patients with on-going activity despite monotherapy. Modern immunosuppressive drugs used in monotherapy exert more specific mode of action. Methods: This retrospective observational study evaluated 5-year data from 85 patients with active multiple sclerosis despite monotherapy with either interferon beta or azathioprine, who received add-on azathioprine or interferon beta, respectively. In a subgroup of 23 patients 10- year data were analysed. In a second part of the study, a group of 126 patients switched either from interferon beta or glatiramer acetate to fingolimod was followed-up for one after the change of their treatment and a in a subgroup of 53 patients the 2-year data were assessed. Clinical (relapse frequency, disability) parameters were compared preceding and following the addition of second drug or the switch of treatment. Laboratory results and potential serious adverse events were evaluated in a group of patients with combination therapy. Results: The add-on treatment triggered a drop in annualised relapse rate by approximately 1.5 points sustained over 5 and 10 years. No effect on disability was observed. Simultaneously, white blood cell and lymphocyte counts...
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Various ways of therapeutic influence on multiple sclerosis
Chalachanová, Katarína ; Posová, Helena (advisor) ; Krulová, Magdaléna (referee)
Multiple sclerosis is an autoimmune demyelinating disease. It hits young adults, but can also break out in middle age. MS causes the permanent physical disability. Among young adults MS occurs as a relaps-remiting form, which later changes into a secondary progressive form. Among older patients, MS occurs from beginning as primary progressive form. The progressive-relapsing is a rare form of MS. The development of the disease is individual and so is the reaction to the treatment. Nowadays, 5 drugs are approved for the treatment of the multiple sclerosis. Most of these drugs reduce the relapse rate, the risk of disability progression and the number and the activity of active lesions. Here we offer the description of currently accessible drugs. The mechanism of immunomodulatory and neuroprotective effect is accented. In the last two sections we offer a short overview of monoclonal antibodies and oral drugs which are under the clinical trials. Keywords: multiple sclerosis, interferon-β, glatiramer acetate, natalizumab, mitoxantrone, fingolimod, corticoids
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