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      Comparison of recent updates in genetics, immunology, biomarkers, and neuroimaging of primary‐progressive and relapsing‐remitting multiple sclerosis and the role of ocrelizumab in the management of their refractory cases

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          Abstract

          Background

          Primary‐progressive multiple sclerosis (PPMS) and relapsing‐remitting multiple sclerosis (RRMS) are two frequent multiple sclerosis (MS) subtypes that involve 10%–15% of patients. PPMS progresses slowly and is diagnosed later in life. Both subtypes are influenced by genetic and environmental factors such as smoking, obesity, and vitamin D insufficiency. Although there is no cure, ocrelizumab can reduce symptoms and delay disease development. RRMS is an autoimmune disease that causes inflammation, demyelination, and disability. Early detection, therapy, and lifestyle changes are critical. This study delves into genetics, immunology, biomarkers, neuroimaging, and the usefulness of ocrelizumab in the treatment of refractory patients of PPMS.

          Method

          In search of published literature providing up‐to‐date information on PPMS and RRMS, this review conducted numerous searches in databases such as PubMed, Google Scholar, MEDLINE, and Scopus. We looked into genetics, immunology, biomarkers, current breakthroughs in neuroimaging, and the role of ocrelizumab in refractory cases.

          Results

          Our comprehensive analysis found considerable advances in genetics, immunology, biomarkers, neuroimaging, and the efficacy of ocrelizumab in the treatment of refractory patients.

          Conclusion

          Early detection, timely intervention, and the adoption of lifestyle modifications play pivotal roles in enhancing treatment outcomes. Notably, ocrelizumab has demonstrated potential in symptom control and mitigating the rate of disease advancement, further underscoring its clinical significance in the management of MS.

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          Most cited references67

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          Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

          The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.
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            Multiple Sclerosis

            New England Journal of Medicine, 343(13), 938-952
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              Neurofilaments as biomarkers in neurological disorders

              Neuroaxonal damage is the pathological substrate of permanent disability in various neurological disorders. Reliable quantification and longitudinal follow-up of such damage are important for assessing disease activity, monitoring treatment responses, facilitating treatment development and determining prognosis. The neurofilament proteins have promise in this context because their levels rise upon neuroaxonal damage not only in the cerebrospinal fluid (CSF) but also in blood, and they indicate neuroaxonal injury independent of causal pathways. First-generation (immunoblot) and second-generation (enzyme-linked immunosorbent assay) neurofilament assays had limited sensitivity. Third-generation (electrochemiluminescence) and particularly fourth-generation (single-molecule array) assays enable the reliable measurement of neurofilaments throughout the range of concentrations found in blood samples. This technological advancement has paved the way to investigate neurofilaments in a range of neurological disorders. Here, we review what is known about the structure and function of neurofilaments, discuss analytical aspects and knowledge of age-dependent normal ranges of neurofilaments and provide a comprehensive overview of studies on neurofilament light chain as a marker of axonal injury in different neurological disorders, including multiple sclerosis, neurodegenerative dementia, stroke, traumatic brain injury, amyotrophic lateral sclerosis and Parkinson disease. We also consider work needed to explore the value of this axonal damage marker in managing neurological diseases in daily practice.
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                Author and article information

                Contributors
                omniatamir123@gmail.com
                Journal
                Health Sci Rep
                Health Sci Rep
                10.1002/(ISSN)2398-8835
                HSR2
                Health Science Reports
                John Wiley and Sons Inc. (Hoboken )
                2398-8835
                12 July 2023
                July 2023
                : 6
                : 7 ( doiID: 10.1002/hsr2.v6.7 )
                : e1422
                Affiliations
                [ 1 ] Department of Neurology Bharati Vidyapeeth University Medical College Pune Pune India
                [ 2 ] Internal Medicine Al‐Kindy College of Medicine University of Baghdad Baghdad Iraq
                [ 3 ] Internal Medicine, Travancore Medical College Kollam India
                [ 4 ] Internal Medicine, Government Medical College Chennai India
                [ 5 ] Internal Medicine, Mayo Clinic Rochester New York USA
                [ 6 ] Internal Medicine, Maharajgunj Medical Campus Tribhuvan University Kathmandu Nepal
                [ 7 ] Internal Medicine, B.J. Medical College Ahmedabad India
                [ 8 ] Department of Neurology Virginia Tech Carilion School of Medicine Roanoke Virginia USA
                [ 9 ] Internal Medicine, Al Manhal Academy Khartoum Sudan
                Author notes
                [*] [* ] Correspondence Omniat Amir, Almanhal University Academy of Science, Khartoum, Sudan.

                Email: omniatamir123@ 123456gmail.com

                Author information
                http://orcid.org/0000-0001-7894-1829
                http://orcid.org/0000-0002-3481-4534
                http://orcid.org/0000-0002-0282-0251
                http://orcid.org/0009-0005-4224-4323
                http://orcid.org/0000-0002-5021-263X
                Article
                HSR21422
                10.1002/hsr2.1422
                10337274
                37448727
                779e2176-1c99-470b-bf87-4318b75d4559
                © 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 June 2023
                : 29 April 2023
                : 01 July 2023
                Page count
                Figures: 3, Tables: 2, Pages: 10, Words: 6661
                Categories
                Narrative Review
                Narrative Review
                Custom metadata
                2.0
                July 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.1 mode:remove_FC converted:12.07.2023

                disease‐modifying therapy,multiple sclerosis,ocrelizumab,primary‐progressive multiple sclerosis,relapsing‐remitting multiple sclerosis

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