Secondary Progressive Multiple sclerosis-أ.د.عمرو حسن الحسني أستاذ المخ و الأعصاب

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11 ай бұрын

In multiple sclerosis, the immune system attacks the brain, spinal cord and optic nerves. These make up the central nervous system, which controls everything we do. Damage from the attack disrupts signals to and from the brain, causing the symptoms of MS. Secondary progressive multiple sclerosis (SPMS) follows the initial course of relapsing-remitting MS (RRMS). Some people who are diagnosed with RRMS eventually go on to have a secondary progressive course, in which neurologic function worsens over time and disability increases. According to estimates, in the United States, the prevalence of SPMS is 27-45 for every 100,000 members of the general population. SPMS can also be described as active (with relapses and/or evidence of new MRI activity during a specified period of time) or not active, as well as with progression (evidence of more disability over time, with or without relapses or new MRI activity) or without progression. Common signs and symptoms of secondary progressive MS Factors Prognostic for Evolution of SPMS Factors predicting progression to SPMS in patients with RRMS are not well established and, to some extent, contradictory results have been reported.33 Risk factors associated with progression to SPMS include older age at MS onset, male sex, early high relapse frequency, longer disease duration, higher baseline EDSS score, greater early increase in EDSS score, higher T2 lesion burden, spinal cord involvement, and lower brain volume. It is interesting to note that some patients may experience a plateau in disease progression, as evidenced by the results of an analysis of data from the population-based MS Lorraine registry, including patients over 50 years of age with no relapses for ≥3 years diagnosed with relapsing MS at onset. In this population, patients who discontinued DMTs (IFN, glatiramer acetate, fingolimod, dimethyl fumarate, or teriflunomide) did not have an increased risk of relapses or an increase in EDSS scores compared with those who continued treatment. However, discontinuation was associated with a higher risk of occurrence of an EDSS score of 6. Diagnosis of SPMS Challenges in the Diagnosis of SPMS Clinical diagnosis of SPMS is challenging and tends to be retrospective, based on the patient's history of worsening after an initial relapsing disease course,28 including the patient's description of symptom progression. Although a standardized objective definition of SPMS has not been broadly accepted, it is typically defined as deterioration independent of relapses for ≥6 months following an initial relapsing-remitting course. Popular opinion among physicians is that a patient needs to accumulate a minimum level of disability for a diagnosis to be made, although this is not specified in formal criteria.27 In many cases, initial symptoms of progressive MS manifest when the neurologic system is taxed, such as when walking long distances, climbing stairs, or carrying heavy objects. Occasionally, patients will report initial symptoms during aerobic exercise. In many cases, long-term worsening takes place in patients with RRMS independently of relapses. In these patients, progression accumulates over time in early RRMS, yet a diagnosis of SPMS is not made, possibly because the loss of function happens so gradually that it remains unnoticed by patients and physicians (so-called “silent progression”). Progression independent from relapsing activity is also recognized in clinical trials of relapsing MS that quantify EDSS scores more precisely and frequently than is commonly done in observational studies or in clinical practice. These recent studies highlight that progression of disability can occur in typical relapsing MS and does so without association with clinical relapses, underscoring the challenge in distinguishing RRMS from SPMS. Given that RRMS and SPMS form a continuum of disease with no clear-cut boundary between them, it is unsurprising that a period of diagnostic uncertainty, reported to last almost 3 years, often characterizes the clinical transition from RRMS to SPMS. Diagnostic Tools There is no definitive imaging or laboratory test indicative of progressive disease; however, measures of disability progression widely used in clinical practice include the EDSS, Timed 25-Foot Walk test (T25FW), and 9-Hole Peg Test (9HPT).e32 An objective evaluation of cognitive status is cognitive processing speed and that can be quantified using neuropsychologic tests such as the Symbol Digit Modalities Test (SDMT)46 or the Paced Auditory Serial Addition Test (PASAT).e33 The Multiple Sclerosis Functional Composite (a combination of the T25FW, 9HPT, and PASAT-3), An EDSS score of 4.0 or above, which focuses on motor performance and does not assess cognitive function,e35 is frequently required for SPMS diagnosis.27 However, cognitive function can be impaired even before (or without) physical disability.
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Пікірлер: 32

@mohamedabdelkhalek5119 10 ай бұрын

محاضره رائعه❤😊

@amrhasanneuro 10 ай бұрын

متشكر جدا لذوقك

@saharanights3518 3 ай бұрын

عربي يادكتور بليز. اهم سؤال عندي عدم اتزان في الراس يرتعش لمن استعمل اليد اليمني.. واليد اليمني ترتعش عند استعمالها. فهل جابنتين يوقف الرعشة ataxia😔😔