Rae-Grant Alexander D
Mellen Center for Multiple Sclerosis, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Continuum (Minneap Minn). 2013 Aug;19(4 Multiple Sclerosis):992-1006. doi: 10.1212/01.CON.0000433287.30715.07.
In multiple sclerosis (MS), symptoms vary widely from patient to patient. Certain events in MS are well recognized (eg, optic neuritis, brainstem and spinal cord relapses) and do not lead to much clinical confusion. However, other events that occur in MS may be less expected and may be underrecognized by some clinicians and may lead to an extensive and potentially unnecessary investigation for what is a known problem in MS.
This article reviews Lhermitte sign, Pulfrich phenomenon, Uhthoff phenomenon, and the useless hand of Oppenheim, along with the underrecognized phenomena of transient neurologic events (including tonic spasms). Disorders of temperature regulation in MS (likely based on hypothalamic involvement) which can present with bizarre behavioral change and evade diagnosis, are also discussed. The article concludes with a review of epilepsy and sleep disorders in MS, both of which appear to occur at an increased frequency in the MS population and may have implications for therapy.
This article is meant to help clinicians recognize and treat this fascinating set of underrecognized phenomena in MS and perhaps save patients trips to the emergency department, extraneous testing, and ineffective intervention.
在多发性硬化症（MS）中，患者的症状差异很大。MS中的某些事件已得到充分认识（如视神经炎、脑干和脊髓复发），不会导致太多临床混淆。然而，MS中发生的其他事件可能较难预料，一些临床医生可能认识不足，可能会针对MS中已知问题进行广泛且可能不必要的检查。
本文回顾了莱尔米特征、普尔弗里希现象、Uhthoff现象和奥本海姆氏“无用手”，以及未被充分认识的短暂性神经事件（包括强直性痉挛）现象。还讨论了MS中体温调节障碍（可能基于下丘脑受累），其可表现为怪异的行为改变且易漏诊。文章最后回顾了MS中的癫痫和睡眠障碍，这两者在MS人群中似乎发病率更高，可能对治疗有影响。
本文旨在帮助临床医生识别和治疗MS中这一系列未被充分认识的有趣现象，或许能避免患者前往急诊科、进行不必要的检查和无效干预。
