2023-10-25 14:20:15
Treatment with targeted therapies, for example on specific genomic alterations, also becomes precision, which can allow timely intervention or prevention of diseases such as epilepsy, myasthenia gravis, neuromyelitis optica spectrum disorders and multiple sclerosis. This is a a sort of ‘scientific Renaissance’ which, to overcome the limits of traditional diagnoses based on symptoms and signs, implements technological and scientific progress and focuses on the clinical development of ‘magic’ drugs to be used in heterogeneous target populations”. This was reiterated by the specialists of the Italian Society of Neurology (Sin) gathered in Naples for the national congress.
At the center of the event is ‘Precision Neurology’, i.e. “the ability to carry out targeted and personalized interventions in neurological diseases which in our country record important numbers: over 6 million people suffer from migraines, approximately 2/3 of them are women; 1 million those who live every day with Alzheimer’s disease and need constant assistance; 400 thousand with Parkinson’s disease; around 90 thousand women and men afflicted by multiple sclerosis, a disease which causes progressive disability; 500 thousand patients with epilepsy”, recalls Sin. Personalized medicine makes use of, in addition to traditional information obtained from the patient’s medical history, “clinical examination, imaging diagnostics, etc., also genomic, metabolomic and non-traditional information, such as speech analysis data or of those coming from wearable devices”, specifies Sin.
Beyond drugs. “Also making use of highly precise non-pharmacological treatments such as neurostimulation of precise brain areas through carefully calibrated electrical microstimulations (DBS and tDCS) or neurosurgery with imaging guidance for non-resolvable conditions such as drug-resistant epilepsy or focused ultrasound surgery guided by magnetic resonance imaging (MRgFU) for CNS tumors or intractable forms of dyskinesia and Parkinson’s disease”, underline the neurologists.
Parkinson’s disease marker. “In this last movement disorder, early identification is fundamental for the prognosis – underlines the president of Sin, Alfredo Berardelli – The diagnosis of Parkinson’s disease is still based on purely clinical criteria, but the discovery of alpha synuclein, mutated form of the synuclein protein which becomes toxic and is probably responsible for the neurodegeneration phenomena that characterize the disease, has opened the way to the identification of this mutated protein in various areas such as the skin, blood, cerebrospinal fluid and saliva as a possible marker biological. Saliva offers great potential for the future and it is demonstrated that alterations in salivary alpha-synuclein correlate with the clinical status of the patient suffering from the disease.”
“In populations at risk, it is conceivable that synuclein alterations can also be highlighted in the prodromal phases: various studies have shown that many years before the clinical onset of various diseases”, recalls Sin.
Multiple sclerosis. “Even in multiple sclerosis, recent years have seen a notable improvement driven by the evolution of therapeutic algorithms aimed at optimizing and personalizing therapy. We have moved from the old ‘escalation’ algorithm with an initial treatment based on low-efficacy drugs, but with an optimal safety profile to an ‘induction’ algorithm that uses drugs with higher efficacy and a lower safety profile. These treatments include highly effective monoclonal drugs which are increasingly used in the early stages of the disease allowing the majority of the patients treated to remain clinically stable with an excellent safety profile”, concludes Sin.
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