Personalized neurology

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released February 12, 2015; last updated February 8, 2017; expires February 8, 2020

This article includes discussion of personalized neurology, neurogenomics, neurogenetics, neuroproteomics, and neurometabolomics. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Personalized neurology is the application of principles of personalized medicine, ie, the prescription of specific therapeutics best suited for an individual taking into consideration both genetic and environmental factors that influence response to therapy. The aim is to improve the efficacy and reduce the adverse effects of various therapies. Several biotechnologies are being integrated to develop personalized medicine. Besides omics, eg, neurogenomics and neuroproteomics, nongenomic technologies such as cell therapy and nanobiotechnology are also used. Biomarkers and integration of diagnostics with therapeutics are important for the selection and monitoring of treatments. Examples of personalized approaches in the management of some neurologic disorders are described.

Key points

 

• Personalized neurology uses the principles of personalized medicine to select a treatment best suited for a patient.

 

• Although neurogenomics is an important basic, nongenomic technologies are also used.

 

• The aim is to improve efficacy and reduce adverse effects of therapy.

 

• Personalized neurology broadly covers early detection of disease, preventive measures, integration of diagnosis with therapy, and monitoring of treatment.

 

• A personalized approach can be incorporated in algorithms for the management of various neurologic disorders.

Historical note and terminology

Personalized neurology is the application of principles of personalized medicine, ie, the prescription of specific therapeutics best suited for an individual taking into consideration both genetic and environmental factors that influence response to therapy. Genomic/proteomic technologies have facilitated the development of personalized medicines, but other technologies such as metabolomics are also contributing to this effort (Jain 2015). Cell therapy is an example of nongenomic technology that provides personalized therapy. Personalized medicine is the best way to integrate new biotechnologies into medicine for improving the understanding of the pathomechanism of diseases and for management of patients. The broad scope of personalized medicine parallels that of systems biology and covers predictive, preventive, and participatory aspects as well.

On January 20, 2015, the President of the United States, during his State of the Union address, announced a research initiative that aims to accelerate progress toward a new era of personalized precision medicine. The time is right for this initiative, and the National Institutes of Health as well as other partners will work to achieve this vision (Collins and Varmus 2015).

Historically, differences among patients presenting with the same disease were recognized in ancient medical systems, and there was an emphasis on individualization of treatment. In modern medicine, pharmacogenetics has been recognized by pharmacologists since the 1950s based on observations that adverse reactions to drugs can be caused by genetically determined variations in enzyme activity. Further impetus for the development of personalized medicine was provided by the development of molecular diagnostics and sequencing of the human genome in the last decade of the 20th century.

“Personalized medicine,” an article published in 1971, referred only to ethical aspects of medical practice and suggestions for improved patient care as well as more personal attention (Gibson 1971). The term "personalized medicine" in the modern sense was first used as the title of a monograph (Jain 1998). There were no journal publications using this term for nearly 2 decades, and the next publication referring to personalized medicine in the context of developing drugs targeted to genetic profiles appeared in 1999; however, it was a reprint of an article published in the Wall Street Journal that described some of the concepts in the 1998 monograph (Langreth and Waldholz 1999). Thousands of publications on personalized medicine have appeared during the past decade. The bulk of the literature relevant to personalized medicine is still indexed under pharmacogenomics and pharmacogenetics. The term “personalized neurology” was introduced in 2005 (Jain 2005). Genomic neurology is not an appropriate synonym for personalized neurology as some personalized cell therapies do not require knowledge of the human genome, and several biomarkers guiding personalized treatment may be biochemical rather than genomic. The term “precision medicine” is being used as a synonym for personalized medicine, and some of the current literature is being indexed under this term. It denotes precise, rational, and targeted therapy, which are some of the features of personalized medicine.

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