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神 经 病 学 研 究 所读 书 报 告 会 Treatment of progressive multiple sclerosis: what works, what does not, and what is needed 进展型多发性硬化十大常见症状的治疗策略 Lancet Neurol 2015; 14: 194–207 报告人：项尚 导师： 胡纪源 多发性硬化的定义 多发性硬化（multiple sclerosis,MS）是世界性分布的中枢神经系统（CNS）白质脱髓鞘疾病，是遗传易感个体与环境因素共同作用导致的自身免疫病。 主要临床特征： 1.症状和体征的空间多发性 2.病程的时间多发性。 多发性硬化的病因及发病机制 多发性硬化的病因及发病机制迄今不明，目前普遍认为， MS是在复杂的遗传易感性背景下，由于环境因素如地域、气候及感染等的参与，引发的免疫系统的异常，导致中枢神经系统炎性脱髓鞘性病变。 多发性硬化的临床分型 1.复发缓解型MS(RRMS):是临床最常见的类型，多在20至40岁发病，急性或亚急性起病，神经系统症状一般持续24小时以上，在其后数日内症状部分或完全缓解。 2.原发进展型MS(PPMS):约占10%，起病年龄多在40岁后，隐袭或慢性起病，起病后轻截瘫或轻偏瘫在数周至数月至数年缓慢进展，病变主要累及脊髓，常见肢体无力，下肢麻木，以及共济失调，呈渐进性恶化病程，预后不良。 3.继发进展型MS(SPMS):大多数RRMS患者经一段时间可转变为此型，病情逐渐进展而无明显缓解。 4.进展复发型MS(PRMS)：临床少见，病情呈逐渐进展，随后又有加重或复发。 目录 Introduction Disease-modifying drugs have mostly failed as treatments for progressive multiple sclerosis. Management of the disease therefore solely aims to minimise symptoms and, if possible, improve function. Symptoms Treatment  1.Balance and mobility impairment (平衡与运动功能障碍) Multiple sclerosis causes a wide range of neurological deficits, which often interact to cause mobility difficulties. Within 10–15 years of disease onset, 80% of patients have walking difficulties, which is of major concern to people with the disorder who report mobility as their most valued bodily function, with more impairment in people with progressive forms of multiple sclerosis than in those with RRMS. Treatment  1.1 the cause of impaired balance and mobility is probably multifactorial and hypotheses about the key mechanisms vary. impaired central integration of visua,vestibular, and somatosensory input is key, the cerebellum could be the main contributor. Treatment  1.2 A range of interventions aimed at enhancing balance in standing and walking are used in clinical practice, the most common of which is physiotherapy. specific balance exercises, neuromuscular facilitation resistance training, a