?????(MS) ??

1
?????(MS) ??
2
Multiple Sclerosis ? Causes by The
immune ? The myelin is damaged causing the nerve
fibers not to work. ? The CNS includes the
brain,optic nerves,and spinal cord.
3
Myelin sheath
Neuron
Axon
Axon
Axoplasm
Oligodendrocyte
Myelin sheath
Node of Ranvier
Adapted from Snell R.S. Clinical Neuroanatomy 3rd
edition 2001. Lippincott Williams Wilkins.
4
McDonald??(2005)

• ?? ?? ??MS???? ????
• ?? ?? ???? ????
  MS
• 2 2 ??? ???
  ?
• 2 1 MRI??????? ???
  ?
• ?????????
• MS???????MRI
• ??????CSF??
• ???????????      
• 1 2 ??? MRI?????
  ?
• ??????
• ????
• 1 1 MRI???????,? MRI??????? ?
• ????????MS ????????
• ???????MRI?? ????CSF??

5
???????

• ????1?
• ????????
• a,?MRI 9????????4-8????VEP??
• b,?????????
• c,?????(??????IgG????)

6
MS?????

• MS??????????,????????
• ??????????????,???????????
• MRI
• ????(??????????)
• ??????????(IgG Index)?????(OCB)
• CT????????

7
?????(IgG????)??????????????????????????ABC???,
???????????
8
?????(IgG????)2

• ??MS????????CSF?????8?4??????,?4????MS????????
  ???,???????

9
McDonald????????

• ???CSF??
• ??????CSF??????????? ??????IgG????
• ???VEP??
• VEP??????

10
McDonald????????

• ????
• ???????????????????????????24??

11
McDonald????????

• MRI???????
• ??4????3?
• (1)1???Gd??????9?T2W?????
• (2)??1??????
• (3)??1??????
• (4)??3???????
• ???????????3mm??
• ??
• ???????????????,
• 1??????????1??????,
• 1???T2?????1?????

12
McDonald????????

• MRI???????
• ???????3?MRI????Gd????
• ??
• ???????30?,?????????T2W???

13
?MS?MRI????1

• ?T2???A,??????B,??????????????C,????,??????????
  ?D,??????????E,???????????
• F,??????

14
?MS?MRI????2 T1???????????black hole.
15
MRI T2?
Before Treatment
After Treatment
16

• ???
• ??

17

• ????(T2)
• Lesion in brainstem
•  

18
????(T2) Cerebellar lesion
19
????????(T2) lesion adjacent to ventricle 
20
MRI?MS???????

• ?????
• ??????
• ??????

21

• .??????,????
• The new is one kind of active lesion

22

• ??????,?????
• The enlarged is another kind of active lesion

23

• ??????,GD???????
• GD enhanced lesion is the third kind of active
  lesions.
•  

24
MS??????????298?????????????????????????
????
25
?1 ???? Fig1 rounded lesion
26
?2 ????? Fig2 Ovale lesion
27
?3 ????Fig3 ring lesion 
28
?4 ???? Fig4 arcuate lesion
29
?5 ???? Fig5 spot lesion
30
?6 ????? Fig6 irregular lesion
31

• GD
• ???
• ??

32

• MS ???? CNS????
• ?????????????
• ?????????,???????
• ???????????????.
• ?????????,??????????????

33

• ?????MS???????.
• ?????????(??)??,??????????
• ????????MS,????????
• ???????????, FLAIR????,?????

34

• ????????????--????
• ?????????,????
• ???????1??,53-4??,?????MS??

35

• ?????????????????????????????,????????.
• ????T1???black holes,??????
• ??????????????
• ?? 12 ? MS patients????????????(???????)

36
MS??????

• 75 ???????
• ???????? 50 ???????
• T1??????(5??)
• ???????
• ????2?????(NMO??)
• ?????????

37
MS??????

• 1?????? (?????????????)
• ??????
• ???,???, ?????????????
• ????MS??????
• ??????
• ????????
• ??????1???,????3-4??,?3?, ???????????,?3????,?
  ????3?,????,??28???
• ????????3??5??????,?3??5?????????1g/?,?3-5??

38
MS??????

• ????????MS???
• ???????
• ??????????????,????????????
• ????????
• ???????
• ?????????,????MS????????
• ?????????????,?????????? ?????
• ????????????,??????????????
• ????????????,???????,??? ??????

39
MS??????

• 2?????(??????)
• MS??????,?????????????,???????????????????????
• 3?????????????(IVIG)
• ????????,?????????????
• ???????????????????

40
MS??????

• 4?????
• ???
• ??????????,?????????????????????,??????????????
• ?????
• ????????,?????????,??????????????????????
• ?????
• ???MS????????,?????????
• ?????????
• ???????????????????

41
MS??????

• 1????-ß??(?????????????)
• ??MS????????????????(Hidden Pathology),
• ????ß????????????,????ß??????,?????????????,??????
  ???
• ???????????ß????????????,??????ß1a(44 mcg
  ????,??3?)?????????????ß1a(30 mcg ????,??1?)?
• ??(Rebif)?????????????????(SFDA)??????MS???????ß
  1a?

42
??MS????ß????ß1a ????ß1b
Within same bioassay vs Standard NIH 531 (Study
GF 8105) and Pharm. Res 1998, 15,641
43
MS??????

• 2?Glatiramer Acetate(Copaxone)(?????????????)
• ? ?????4???????????
• ? ????????????MBP
• ? ????????????MBP
• ? ??????????
• 3?Natalizumab (?????????????)
• ??????????a4???(a4-integrin)??????
• ?????????????????????
• ??????????????????(PML)
• ???????????????

44
MS??????

• 4???????
• ?IVIG
• ????????????,??????????MRI????
• ?????(Cyclophosphamide,CTX)
• ???????????????MS??,??????????
• ?????(Azathioprine)
• ?????????????????????????????????,????????????
  ??

45
MS??????

• ?????????
• ????????IVIg?CTX??????????MS?????,???????
  ???????-ß,?????????????,???????????????,??????????
  ,????,????????,??????????

46
MS??????

• ?????,?????????????
• ?????,??????,?????????
• ?????,???MRI??????????????????
• ???????,???????????CIS???CDMS
• ??????,????????????
• ???????-???????,????????????

47
????????,?????????
??DSS?? lt6 ()

??DSS?? lt6 ()

Plt0.0001
Plt0.0001
50
40
30
20
10
0
50
40
30
20
10
0
?????????? (?)
MS????? (?)
Weinshenker BG et al. Brain 19891121422
Weinshenker BG et al. Brain 19891121422
48
????,????
SP-MS
RR-MS ???
?????
????
????
?????
????
????
MRI ??
??