Koppi S, Panayiotou P, Barolin G S
Ludwig-Boltzmann-Institut für Neuro-Rehabilitation und -Prophylaxe Vorarlberger Landes-Nervenkrankenhauses Valduna, Rankweil.
Wien Med Wochenschr. 1991;141(20):440-54.
The authors have conducted a longitudinal survey for a period of 14 years with 171 patients suffering from multiple sclerosis. In each case, therapeutic and diagnostic procedures were in accordance with the latest development. In almost half of the cases with a duration of illness up to 20 years the degree of impairment can be regarded as minimal, which can be used as an argument in favour of conscientious and continuous rehabilitative measures, including psychotherapy (this in opposition to a "rehabilitative pessimism"). Two thirds of the patients have been in employment with full working capacity during the first ten years of their illness. The consequences for social medicine and social policy are self-evident and imperative. In accordance with earlier studies, motor pareses are predominant among the first symptoms of multiple sclerosis, whereas disorders of cranial nerves, of urinary excretion and of cerebral function appear later in the course of the disease. Factor analysis did not yield any clues with respect to the predictability of the development of illness. Psychoreactive depression is relatively common in the earlier stages, later we can find somatogenic (psycho-organic) depressions, which respond relatively poor to treatment. Among the diagnostic tool, analysis of the critical flicker fusion frequency (CFFF) has proved to be very sensitive, by far not as cumbersome as visually evoked potentials and at least as reliable as the later. Therapeutic strategies should include: early treatment of any acute attack, consequent long-term care with modern nursing methods and rational concomitant medication, prophylaxis against infection. Multiple sclerosis represents itself as a problem of long-term rehabilitation, thus emphasizing the necessity of increased commitment to rehabilitation within a general framework of health care, which should include: a) better representation of rehabilitation as a discipline at the universities. b) systematic concomitant research in rehabilitation, c) legal and administrative adaptations, d) the development of a general "rehabilitation mentality" (as we have come to call it), which means involvement with the patient and his environment throughout his entire life-span.
作者对171例多发性硬化症患者进行了为期14年的纵向调查。在每种情况下，治疗和诊断程序均符合最新进展。在病程长达20年的病例中，几乎有一半的损伤程度可被视为轻微，这可作为支持认真且持续的康复措施（包括心理治疗）的论据（这与“康复悲观主义”相反）。三分之二的患者在患病的头十年里能够全负荷工作。其对社会医学和社会政策的影响不言而喻且势在必行。与早期研究一致，运动性轻瘫是多发性硬化症最早出现的症状之一，而颅神经、泌尿排泄和脑功能障碍则在疾病后期出现。因子分析未得出任何有关疾病发展可预测性的线索。心理反应性抑郁在早期相对常见，后期则会出现躯体性（精神器质性）抑郁，其对治疗的反应相对较差。在诊断工具中，临界闪烁融合频率（CFFF）分析已被证明非常敏感，远不像视觉诱发电位那么繁琐，且至少与后者一样可靠。治疗策略应包括：对任何急性发作进行早期治疗，采用现代护理方法进行后续长期护理并合理联合用药，预防感染。多发性硬化症是一个长期康复的问题，因此强调在医疗保健总体框架内加大康复投入的必要性，这应包括：a）在大学中更好地将康复作为一门学科进行展示。b）在康复方面进行系统性的伴随研究，c）法律和行政调整，d）培养一种普遍的“康复心态”（我们姑且这样称呼），这意味着在患者的整个生命周期内都要关注患者及其环境。
