418
Ex vivo gene therapy involves the genetic modifi cation of the patient’s cells
in vitro, mostly by use of viral vectors, prior to reimplanting these cells into the tis-
sues of the patient’s body. This is a form of individualized therapy. Personalized
cell/gene therapies are described under neurological disorders where applicable.
Apart from infectious diseases involving the nervous system, therapeutic vaccines
are in development for malignant tumors (e.g. glioblastoma multiforme) autoimmune
disorders (e.g. multiple sclerosis), and degenerative disorders (e.g. Alzheimer dis-
ease). Alzheimer disease and stroke have important infl ammatory and immune com-
ponents and may be amenable to treatment by antiinfl ammatory and immunotherapeutic
approaches including vaccines. Cancer vaccination involves attempts to activate
immune responses against antigens to which the immune system has already been
exposed. Some of the vaccines are personalized and will be mentioned along with
personalized approaches to individual disorders in the following sections.
Monoclonal antibodies (MABs) play an important role in personalized neurol-
ogy both as diagnostic and therapeutic agents. Designed to bind to specifi c recep-
tors, MABs can be used to guide passage of nanomedicines across the BBB to
specifi c targets in the brain such as glioblastoma multiforme.
Personalized Management of Alzheimer Disease
Introduction to Alzheimer Disease
Alzheimer’s disease (AD) is a progressive degenerative disorder of the brain that
begins with memory impairment and eventually progresses to dementia, physical
impairment, and death. The cause of AD is not well understood but it likely com-
prises several processes that lead to intrinsic neuronal cell killing. Patients develop
various psychiatric and neurological signs during the course of the disease. The
prevalence rates of dementia vary signifi cantly in different countries, but range
from 2.1 % to 10.5 %. AD is the most common type of dementia, accounting for
50–60 % of all cases.
Diagnosis of AD
The diagnosis of AD is currently based on clinical and neuropsychological exami-
nation. There is currently no validated or approved biomarker of AD for early detec-
tion. MRI and CT scan images of hippocampus shrinkage and, later on, global brain
shrinkage are used to help diagnose advanced disease. To date there is no approved
blood test available that can discriminate dementia patients from healthy individu-
als. A combination of characteristic plaque markers tau and amyloid (Aβ) may con-
stitute a specifi c and sensitive CSF marker for AD. Genetic tests exist to identify
individuals with familial forms of AD who have AD-linked mutations in the prese-
nilin gene, and those who have specifi c variations in the ApoE gene linked to higher
12 Personalized Management of Neurological Disorders