Naturalny przebieg stwardnienia rozsianego

Bonek, Robert; Maciejek, Zdzisław

Journal

Aktualności Neurologiczne

2009 | 9 | 2 | 116-125

Article title

Naturalny przebieg stwardnienia rozsianego

Authors

Robert Bonek , Zdzisław Maciejek

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Natural history of multiple sclerosis

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Abstracts

Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune disease of the central nervous system (CNS) of unknown aetiology. It affects mostly young adults and is characterised by multifocal and temporally scattered CNS damage of varied symptomatology and clinical course, eventually leading to significant motor impairment. Studies of the natural course of MS provide valuable data on the course of the disease in individual stages of multiple sclerosis. They allow to determine the frequency of relapses, duration of remission and, most importantly, to determine the motor disability increase rate and describe demographic and clinical factors of influence on benign or aggressive course of the disease. Data on the subject come mostly from four patient databases (Lyon; London, Ontario; Gothenburg; Vancouver) including from several hundred to five thousand patients. The results obtained from hitherto conducted analyses are often non - ‌uniform. Peak MS morbidity dates between 20 and 39 years of age. In primary progressive multiple sclerosis (PPMS) patients, the disease onset occurs on average 10 years later than in relapsing-remitting multiple sclerosis (RRMS) patients. The initial symptoms have monosymptomatic character in over 75% of patients. Pyramid signs are the most important predictive factor for clinically definite multiple sclerosis (CDMS) development after a clinically isolated syndrome (CIS) episode. The conversion of RRMS to secondary progressive multiple sclerosis (SPMS) occurs on average 10 years after onset of the disease. Significant motor disability develops after 15 - ‌20 years of multiple sclerosis, the strongest adverse prognostic factor is PPMS.

Stwardnienie rozsiane (łac. sclerosis multiplex, SM) jest przewlekłą, zapalną, autoimmunologiczną chorobą ośrodkowego układu nerwowego (OUN) o nieznanej etiologii. Występuje głównie u młodych dorosłych, cechuje się wieloogniskowym i rozsianym w czasie uszkodzeniem OUN, z różnorodną symptomatologią i przebiegiem klinicznym, prowadząc ostatecznie do znacznej niewydolności ruchowej. Badania naturalnego przebiegu SM dostarczają cennych danych dotyczących postępu choroby w poszczególnych postaciach stwardnienia rozsianego. Pozwalają określić częstość rzutów, czas trwania remisji, a przede wszystkim ustalić tempo narastania niesprawności ruchowej oraz ustalić, jakie czynniki demograficzne i kliniczne mają wpływ na łagodny bądź też agresywny przebieg choroby. Dane na temat tego zagadnienia na świecie pochodzą głównie z czterech baz chorych (Lyon, London w Ontario, Gothenburg oraz Vancouver) obejmujących od kilkuset do pięciu tysięcy chorych. Wyniki uzyskane na podstawie przeprowadzonych do tej pory analiz są często niejednorodne. Dotychczas przeprowadzone badania wykazały, że najwyższa zachorowalność na SM ma miejsce pomiędzy 20. a 39. rokiem życia. U chorych z postacią pierwotnie postępującą (PPMS) początek choroby występuje średnio o 10 lat później niż w postaci rzutowo-remisyjnej (RRMS). U ponad 75% pacjentów pierwsze objawy kliniczne mają charakter monosymptomatyczny. Objawy uszkodzenia drogi piramidowej są czynnikiem o najwyższym znaczeniu predylekcyjnym rozwoju rozwoju klinicznie pewnego stwardnienia rozsianego (CDMS) po przebyciu izolowanego zespołu klinicznego (CIS). RRMS ulega konwersji do postaci wtórnie postępującej (SPMS) średnio po 10 latach od wystąpienia pierwszych objawów chorobowych. Po 15 - ‌20 latach trwania SM dochodzi do rozwoju znacznej niesprawności ruchowej, najsilniejszym niekorzystnym czynnikiem rokowniczym jest PPMS.

Keywords

course czynniki prognostyczne disability multiple sclerosis natural history niewydolność ruchowa prognosis przebieg kliniczny przebieg naturalny stwardnienie rozsiane

Discipline

MEDICINE: MEDICINE

Publisher

Journal

Aktualności Neurologiczne

Year

2009

Volume

Issue

Pages

116-125

Physical description

Contributors

author

Robert Bonek

Klinika Neurologii, 10. Wojskowy Szpital Kliniczny z Polikliniką w Bydgoszczy, ul. Powstańców Warszawy 5, 85 - ‌915 Bydgoszcz, tel.: 052 378 61 46 (0 601 633 810)

author

Zdzisław Maciejek

Klinika Neurologii, 10. Wojskowy Szpital Kliniczny z Polikliniką w Bydgoszczy, ul. Powstańców Warszawy 5, 85 - ‌915 Bydgoszcz, tel.: 052 378 61 46 (0 601 633 810)

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