- 期刊
亞洲型多發性硬化症之臨床經驗
Clinical Experience in Asian Type Multiple Sclerosis
摘要
多發性硬化症為美國中年人最常見之失能性神經疾病；其中發病區域侷限在脊髓及視神經的亞洲型並不罕見，且往往造成嚴重的殘障，需要更多的復健醫療介入。本研究採回溯性病歷研究，蒐集近十年經台大醫院診斷為視神經脊髓型多發性硬化症之患者27人。其發病年齡平均為33.6歲，罹病期間平均為10.0年，男女比例約為1:8，復發率平均為每年0.79次，臨床表現以復發緩解型者為最多，續發漸進型居次，原發漸進型最少；初發症狀依出現頻率依次為：感覺消退(81%)、運動障礙(74%)、異常感覺(72%)、排尿障礙(59%)、視力障礙(44%)、及排便障礙(41%)。發病年齡於男女間並無差異，於臨床表現則以原發漸進型發病最早(26.0歲)、復發緩解型次之(33.1歲)、而續發漸進型為最晚(39.5歲)。復發率則以復發緩解型最為頻繁(0.83次/年)、續發漸進型最少(0.60次/年)。初發症狀之分析中發現：續發漸進型病患均有運動障礙、排尿障礙、及感覺消退；而復發緩解型患者則分別有67%，48%及81%的發生率。運動障礙以四肢輕癱最多(36.8%)，其次依序為雙下肢輕癱、雙下肢癱瘓、單一肢體無力及肢體僵硬、顏面麻痺。脊髓磁振攝影顯示約有八成的病患可在T2WI發現強訊號，好發部位以T2-7最常見。排尿障礙則以尿液滯留比例最高(53.3%)；尿路動力學檢查結果，上運動神經元損傷佔接受檢查者之46.7%。在患者預後方面，隨著年齡及罹病時間的增加，其殘障程度也隨之增加，然僅有近三成之病患接受過復健科住院治療，平均住院日數50.3+18.1日，復健後之獨立程度及功能均有進步。本研究為台灣地區探討視神經脊髓型多發性硬化症臨床特點之首篇，由此得知其具有較懸殊之男女性別比、較嚴重之殘障、分歧的臨床表現及較頻繁之復發率，將可作為未來進一步研究疾病分型及治療之參考。
並列摘要
Multiple sclerosis is a heterogeneous disease entity, and also the most common disabling neurological disorder of people in middle life in USA. The prevalence of multiple sclerosis in Asia is lower than that in Western countries of similar latitude. Besides, there are some different features, clinically as well as pathologically, between this disease in Asia and in Western countries. We collected 27 cases diagnosed as clinically definite MS at NTUH between 1990-2000, whose clinical presentations are restricted to optic nerves and spinal cord. Their clinical charts were reviewed retrospectively, and the data was collected in a standard coding sheet. The ratio of male to female is 1:8. The average age of onset is 33.6 years old, and the duration of illness is 10.0 years. Seventy-eight percents of total cases belong to the relapse-remitting type, 15% to the secondary progressive type, and 7% to the primary progressive type. The relapse rate is around 0.8 time/year. The most common initial symptoms are sensory loss (81%), motor weakness (74%), and paresthesia (72%). The positive rate of spine MRI is 83.3%. The segments involved most are T2-7. Urinary retention is more common than urgency and impaired sensation. Urodynamic studies revealed 47% of cases to be the upper motor neuron type bladder. Although the impairment caused by MS is severe, only one third of patients received intensive rehabilitation. Those who received intensive rehabilitation showed improvment in both functional status and independence of ADL.