脱髄疾患：臨床症状と診断

抄録

Multiple sclerosis (MS) is a chronic disease that attacks the central nervous system. It affects the brain, spinal cord, and optic nerves. MS symptoms and signs depend on where the nerves are demyelinated and may include : visual changes including double vision or loss of vision, numbness, tingling or weakness (weakness may range from mild to severe), paralysis, vertigo or dizziness, erectile dysfunction (ED, impotence), pregnancy problems, incontinence (or conversely, urinary retention), muscle spasticity, incoordination of muscles, tremor, painful involuntary muscle contractions, slurred speech, fatigue. No single test can confirm a diagnosis, so several strategies are needed when deciding whether a patient meets the criteria for a diagnosis. There will be a neurologic exam, imaging scans, a test to measure the electrical activity of the brain, a cerebrospinal fluid (CSF) analysis, and possibly other tests. These can help rule out other possible causes of the symptoms. The McDonald diagnostic criteria, which was originally proposed in 2005, was updated at European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2017 and will allow earlier diagnosis. This new criteria includes the presence of oligoclonal bands (OB) in CSF in patients with a first symptom, as an alternative to waiting for additional symptoms or lesions to present. In a patient with a typical clinical isolated syndrome (CIS) and fulfillment of clinical or MRI criteria for “dissemination in space” and no better explanation for the clinical presentation, demonstration of CSF–specific OB allows an MS diagnosis to be made without the previously required “dissemination in time.” There is no cure for MS, so treatment focuses on suppressing the autoimmune response and managing symptoms. Corticosteroids are the most commonly prescribed drugs for MS at acute phase. They reduce inflammation and suppress the immune system. Several disease–modifying drugs (DMD) are approved for the relapsing forms of MS.