(神经病学)8.2GJC-multiple-sclerosis.ppt

Symptom management Spasm (alospasm) Baclofen 5mg tid; tizanidine 2mg tid; diazepam 10mg qn; dantrolene 10mg tid Fatigue Amantadine 0.1 bid; phenytoin 0.2 qd at morning; Ritalin drugs Bladder problems Urinary retention: cholinergic drugs Incontinence: imipramine 10mg qid or catheterization Tremor: artane 2mg tid; propranolol 10mg tid Questions in this section What is multiple sclerosis (definition)? Clinical features of multiple sclerosis? What is diagnostic criteria for general MS? Treatment principles of multiple sclerosis? Thank youAny questions? * CIS=clinically isolated Syndrome RIS=radiologically isolated syndrome * * * * * * * A diagram shows the absence of oligoclonal bands and the presence of them in CSF * A chart showing the visual evoked potentials * 2 pictures of brain x-rays * 2 more pictures of brain x-rays * 2 pictures of side view head x-rays * The picture of a spine x-ray in the middle * Multiple Sclerosis CHEN, Guo-Jun Ph. D. Department of Neurology The First Affiliated Hospital Chongqing Medical University Definition of Multiple Sclerosis An inflammatory demyelinating disease of the CNS where there is: Dissemination in space (DIS) Dissemination in time (DIT) No alternative neurologic disease MS is a clinical diagnosis Epidemiology of MS Age onset 20 – 50 years old Women are 2 times more likely to develop MS 500,000 cases in US Over 2.5 million people around the world More prevalent in whites of northern European ancestry Vitamin D3 Genetic Influences Prodromal and potential causal pathway for MS PATHOPHYSIOLOGY OF MS Destruction of Myelin, oligodendrocytes, nerve axons Hypothesis of molecular mimicry: infected virus share with myelin molecules common antigens Targeted antigens mimicked by virus Myelin basic protein (MBP) Myelin oligodendrocyte glycoprotein (MOG) Proteolipid protein (PLP) Myelin associated glycoprotein (MAG) PATHOPHYSIOLOGY OF MS Cells CD4 TH1, CD4 TH2 and CD8 T cells Macrophages and microglial cells Mast cells B ce