王学峰《神经病学精品教学》2.2多发性硬化.docVIP

重庆医科大学临床学院教案及讲稿 （教 案） 课程名称 Neurology 年级 2010级 授课专业 心理系 教 师 陈国俊 职称 教授 授课方式 大课 学时 1 题目章节 Multiple sclerosis 教材名称 神经病学 作者 吴江 出 版 社 人民卫生出版社 版次 2005年8月第一版 教 学 目 的 要 求 Definition Causes Clinical manifestations Investigations Diagnosis Treatment 教 学 难 点 Clinical manifestations Treatment 教 学 重 点 Clinical manifestations Treatment 外语要求 English 教学方法手段 multimedia 参考资料 Textbook of Neurology. Julien Bogousslavsky, M.D. 教研室意见 教学组长： 王学峰 教研室主任：王学峰 2012 年 9 月 12 日 （讲 稿） 教学内容 辅助手段 时间分配 Conception: MS is characterized by destruction of the myelin sheath (demyelinazation) and subsequently causes axon loss within the central nervous system. Fact sheets: Risk for New England: 1 per 1,000 Risk for identical twin: 1 per 3 Risk for sibling: 1 per 25-50 Risk for parent or child: 1 per 100 Cause: Not completely understood Blood-brain barrier breakdown and autoimmune attack on CNS myelin are the central pathogenetic events MS classification Clinically isolated syndrome(CIS) (first attack) 临床孤立综合征 Relapsing-remitting (60-70%) Secondary progressive Primary progressive Clinical feature: Contractures of joints (limits in joint range of motion) Urinary tract infections Skin ulcers Pain Laboratory Findings: No specific laboratory tests available to test for MS. MRI’s are most often used in diagnosing and monitoring MS Spinal taps: +IgG oligoclonal banding(75–85%) Evoked potentials: Less activation to stimulation of the optic nerve and sensory nerves due to demyelination of such pathways. Diagnosis: 2 attacks An attack (relapse; exacerbation) is defined as patient-reported or objectively observed events typical of an acute inflammatory demyelinating event in the CNS, current or historical, with duration of at least 24 hours, in the absence of fever or infection. Objective clinical evidence of 2 lesions Treatment: There is currently no cure for MS. Treatments fo