Multiple Sclerosis in Children: Clinical, Neuroimaging, and Neurophysiological Correlations

多發性硬化症罕見於小兒，且初期症狀常不典型。臨床上診斷此症必須具俻兩大條件，即在時間上須有兩次以上之再發與弛解，在空間上須有兩個以上不同中樞神經系統病變産生的症狀。在發病初期，有的病變的症狀不明顯，須仰杖實驗室的檢查來幫助診斷。本報告研究四名臨床確診的多發性硬化症的臨床表徽，多類型誘發電位，腦波，MRI, 脊髓液分析，並檢討臨床，神經影像及神經生理研究的相關性。初發年齡界於5至11歲之間，四名多發性硬化症病人皆屬於再發－弛解型。三名多發性硬化症病人MRI顯示有脫髓性病變散發在腦幹、小腦、大腦白質。另一名接受CT檢查病人則無呈現低密度病變。MRI並未發現視神經病變，但有三名病人呈現不正常的視覺誘發電位。三名病人有不正常的體位感覺誘發電位，兩名病人有不正常的聽覺誘發電位。我們的結論是(1)兒童多發性症病人初期症狀常不典型。(2)MRI對病變的檢出率雖然優於CT，但對於視神經及脊髓病變的靜出率低於誘發電位。(3)同時使用MRI及誘發電位有助於兒童多發性硬化症部位的定位及臨床不顯病變的早期檢出。

關鍵字

多發性硬化症；誘發電位；核磁共振影像

並列摘要

Four female children with clinically-definite diagnoses of multiple sclerosis (MS) were studied with multimodal evoked potentials (EPs), electroencephalogram (EEG), cerebrospinal fluid (CSF) analysis, computed tomography (CT) and magnetic resonance imaging (MRI). Correlations among the clinical features, neuroimaging and neurophysiological studies were also evaluated. Their ages of the onset ranged from 5 to 11 years. The clinical evolution in the all four MS cases was relapsing-remitting form. MRI studies in three cases showed abnormal demyelinating plaques in the brainstem, cerebellum and white matter of the cerebrum. CT examination, performed in the other MS case, did not reveal hypodensic lesion. Despite that MRI failed to document optical nerve lesions, three cases had abnormal visual evoked potentials (VEPs). Somatosensory evoked potentials (SSEPs) were abnormal in three cases. Brainstem auditory evoked potentials (BAEPs) were abnormal in two cases presenting with signs of brainstem dysfunction. The conclusion was that paraclinical evidences obtained from MR1 and multi- modal evoked potential studies are of value as an aid in localizing involved areas and detecting silent lesions in children with MS.

並列關鍵字

multiple sclerosis ； evoked potentials ； magnetic resonance imaging

國際替代計量

Multiple Sclerosis in Children: Clinical, Neuroimaging, and Neurophysiological Correlations

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