七年制医学课件 神经病学 5MULTIPLE SCLEROSIS.pptVIP

MULTIPLE SCLEROSIS (MS, P167-170) Prof. YAN YONG Dept.of Neurology, the 1st Hospital, Chongqing University of Medical Science PREFACE MS is one of demyelinative diseases, with multifocal damage of the white matter of central nervous system (CNS, ie. brain and spinal cord) at different times that occurs in young adults,with a peak incidence between age 20 and 40, women are affected nearly twice as often as men(2:1). A. ETIOLOGY OF MS The real cause of MS is unknown. 1.A role for immune-mediated or infections factors has been proposed,but data to support these postulates are fragmentary and indirect. 2.Incidence varies widely in different geographical areas. It is very low in the tropics and high in the temperate zones of both northern and southern hemispheres(between latitudes 400N and 400S). 3. A genetic predisposition is suggested by twin studies, the occasional familial incidence,and the strong association between the disease and specific HL- antigens(HLA DR2). 4.Present evidence supports the belief that the disease has an autoimmune basis. B. PATHOLOGY The disorder is characterized pathologically by the development of focal-often periventricular –scattered areas of demyelination followed by a reactive gliosis ; there may be axonal damage as well. These lesions occur in the CNS (eg.white matter of the brain , brainstem , spinal cord, cerebellum and in the optic (Ⅱ) nerve ). C. CLINICAL FINDINGS MS is a disease of young adults with a mean age of onset of 32 (ages 10~55, most 20~40). This disease usually presents in the form of recurrent attacks of focal or multifocal neurologic dysfunction,reflecting lesions within the CNS. Typical episode: Symptoms worsen gradually over a period of a few days to 2 – 3 weeks, and then remit.Recovery is usually lasting weeks or months. Remission may be complete, particularly after early attacks, however,remission of many patients is incom