Filippi M, Campi A, Mammi S, Martinelli V, Locatelli T, Scotti G, Amadio S, Canal N, Comi G
Department of Neurology, Ospedale San Raffaele, University of Milan, Italy.
J Neurol Neurosurg Psychiatry. 1995 Jan;58(1):31-7. doi: 10.1136/jnnp.58.1.31.
Brain MRI and multimodal evoked potentials (EPs) were obtained for 13 patients with benign multiple sclerosis and 13 patients with secondary progressive multiple sclerosis, matched for age and duration of the disease, to investigate the nature of the disability in multiple sclerosis. Patients with secondary progressive multiple sclerosis had significantly greater lesion loads for five of seven periventricular regions and for three of nine regions separate from the ventricles. Patients with secondary progressive multiple sclerosis also had more severe infratentorial atrophy scores (p = 0.04), whereas there were no differences between the two groups in number and extent of enhancing lesions. The frequencies were significantly higher and severities greater for multimodal EP abnormalities of all the modalities in patients with secondary progressive multiple sclerosis. At least one EP component was absent in 12 (92%) patients with secondary progressive multiple sclerosis but in only one patient (8%) with benign multiple sclerosis (p < 0.001). There was neurophysiological evidence for cervical cord involvement in eight (61%) patients with secondary progressive multiple sclerosis and in one with benign multiple sclerosis (p < 0.01). These data indicate that the total amount of lesions, the distribution, and the nature of the pathological process might all account for the development of disability in multiple sclerosis.
对13例良性多发性硬化患者和13例继发进展型多发性硬化患者进行了脑部磁共振成像（MRI）和多模式诱发电位（EP）检查，两组患者年龄和病程相匹配，以研究多发性硬化症患者残疾的本质。继发进展型多发性硬化患者在七个脑室周围区域中的五个以及与脑室分开的九个区域中的三个区域的病灶负荷明显更大。继发进展型多发性硬化患者的幕下萎缩评分也更高（p = 0.04），而两组在强化病灶的数量和范围上没有差异。继发进展型多发性硬化患者所有模式的多模式EP异常的频率明显更高，严重程度更大。12例（92%）继发进展型多发性硬化患者至少有一个EP成分缺失，而良性多发性硬化患者中只有1例（8%）出现这种情况（p < 0.001）。有神经生理学证据表明，8例（61%）继发进展型多发性硬化患者和1例良性多发性硬化患者存在颈髓受累（p < 0.01）。这些数据表明，病灶的总量、分布以及病理过程的性质可能都与多发性硬化症患者残疾的发展有关。
