THERAPEUTIC OPTIONS FOR RELAPSINGREMITTING 对于relapsingremitting治疗选择.pptVIP

Neuroplasticity and Rehabilitation Strategies Robert K. Shin M.D. VA MS Center of Excellence Assistant Professor Departments of Neurology and Ophthalmology University of Maryland School of Medicine Neuroplasticity? The ability of cortex to reorganize in response to injury Question Is the brain compensating for damage from MS in order to maintain normal function? Functional MRI BOLD contrast analysis Oxyhemoglobin Deoxyhemoglobin Alternating periods of task vs. rest Activated regions determined statistically A line chart depicting activation on the y-axis and acquisition repetitions on the x-axis 8 x-rays highlighting certain areas from the top view Reddy et al. Neurology 2000;54:236-244 A dynamic cortical response? Initially increased activation of contralateral sensorimotor cortex Ipsilateral activation seen initially as well Activation gradually reduced as patient recovered Clinically isolated syndrome 16 consecutive patients with a CIS suggestive of multiple sclerosis 15 age- and sex-matched controls Functional MRI during finger flexion Rocca et al. NeuroImage 2003;18:847-855 6 3-D brain replications highlighting certain areas Rocca et al. NeuroImage 2003;18:847-855 A line chart showing decreased whole brain NAA (x-axis) opposed to SMC response (y-axis) A response to cortical pathology? Decreased NAA found in clinically stable CIS patients Increase in activation of somatomotor cortex correlated with worsening brain damage Another puzzle Optic neuritis causes vision loss and prolonged VEPs Vision in optic neuritis almost always recovers VEPs frequently remain abnormal 2 magnified views of veins Question Is the brain somehow compensating for impaired optic nerve function? Recovery from optic neurits 7 patients who had recovered from optic neuritis 7 controls Functional MRI during photic stimulation Werring, et al. JNNP 2000;68:441-449 12 brain scans highlighting activity of certain areas Werring, et al. JNNP 2000;