多发性硬化--英文

International Journal of MS Care
Multiple Sclerosis
Multiple Sclerosis
• A chronic, autoimmune disease • Affects central nervous system the myelin sheath covering of nerve fibers in the brain and spinal cord • Impairs the nerves ability to send electrical impulses
MS Statistics
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Approximately 400,000 Americans are diagnosed with MS – Affects 2.5 million people worldwide Symptom onset and diagnosis occur typically between the ages of 20-50 2.5:1 women:man ratio People of Northern European descent are afflicted most commonly More common above 40° latitude in areas like western New York. Women are 2 times more likely to get the disease (i.e. 2 women for every 1 men) More common in Northern European descendants than any other race Found in people who live in temperate climates Onset occurs between ages of 20 and 40
Secondary-Progressive MS (SPMS)
A progression of RRMS • More common before advent of disease-modifying medications
• Approximately 50% of patients progressed to SPMS after 10-15 years with RRMS
Incidence has since decreased This disease course is steadily progressing. Can present with or without clear-cut relapses.
http://multiplesclerosis. net/what-isms/statistics/
Symptoms of MS
Muscle weakness Visual symptoms
Blurry vision • Double visΒιβλιοθήκη Baiduon
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Unsteady gait/balance issues Pain/Paresthesias Emotional/Cognitive disturbances
Diagnosis by Poser Criteria Clinically definite MS • 2 attacks and clinical evidence of 2 separate lesions Laboratory supported Definite MS • 2 attacks, either clinical or paraclinical evidence of 1 lesion, and CSF immunologic abnormalities • 1 attack, clinical evidence of 2 separate lesions & CSF abnormalities 1 attack, • clinical evidence of 1 and paraclinical evidence of another separate lesion, & CSF abnormalities
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Multiple Sclerosis
“Multiple”- multiple areas of lost myelin “Sclerosis”- Scarring MS is a chronic autoimmune inflammatory disease Affects Central Nervous System (brain, spinal chord and optic nerves)
MRI MRI findings that strongly suggestive of MS • 4 or more white matter lesions (each > 3mm) •3 white matter lesions, 1 periventricular Lesions 6 mm diameter or greater •Ovoid lesions, oriented perpendicular to ventricles •Corpus callosum lesions Brainstem lesions •Open ring appearance of gadolinium enhancement
Diagnosing MS
A diagnosis by exclusion eliminate other disease states that may explain symptoms before suggesting MS Patients undergo clinical, laboratory (hematology and CSF panels), and imaging studies to confirm diagnosis
Relapsing-Remitting MS (RRMS)
• Most common, affecting 85% of patients. • Patients experience worsening of pre-existing symptoms or onset of new symptoms for periods of greater than 48 hours without concomitant fever, known as relapses, flare-ups, or exacerbations, of MS. • Contrasted by symptom-free periods, known as remissions, where the patient’s symptoms partially or completely disappear.
Cerebral Spinal Fluid Studies Strongly suggestive of MS
•Normal Red Blood Cells and glucose • Normal or mildly elevated protein 520 mononuclear cells/ul •Intrathecal IgG synthesis •Increased IgG index or 24 hour synthesis rate Increased free kappa light chains • Oligoclonal bands
Multiple Sclerosis and Currently Available Treatments in the US
Michelle Rainka, Pharm.D., CCRP Dent Institute University at Buffalo mrainka@dentinstitute.com mmrainka@buffalo.edu
Frequency • Loss of control
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Multiple Sclerosis Kurtzke disability status scale
1 No disability & minimal neurologic sign 2 Minimal disability - slight weakness or stiffness, mild disturbance of gait or mild visual disturbance 3 Moderate disability - monoparesis (partial or incomplete paralysis affecting one or part of one extremity) mild hemiparesis (slight paralysis affecting one side of body) moderate ataxia, disturbing sensory loss, prominent urinary or eye symptom, or a combination of lesser dysfunction 4 Relatively severe disability, but fully ambulatory without aid, self sufficient and able to be up and about 12 hours a day, does not prevent the ability to work or carry on normal living activities, excluding sexual dysfunction 5 Disability is severe enough to preclude working, maximal motor function involves walking unaided up to 500 meters 6 Needs assistance walking, for example a cane, crutches, or braces 7 Essentially restricted to a wheelchair but able to wheel oneself and enter and leave the chair without assistance 8 Essentially restricted to bed or a chair, retains many self care functions and has effective use of arms 9 Helpless and bedridden 10 Death due to MS - results from respiratory paralysis, coma of uncertain origin, or following repeated or prolonged epileptic seizures
The axial T2WI shows peri-ventricular flameshaped hyperintense areas
MRI Imaging
Normal Brain Patient with MS
MS Lesions “Dawson’s Fingers”
MS Lesions in Spine
Short term memory loss • Inability to concentrate
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Fatigue Sexual Dysfunction Speech Swallowing Abnormal sensations
Tingling • Numbness
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Sensitivity to heat Bladder and bowel problems