Nelson D A
Section of Neurology, Medical Center of Delaware, Wilmington 19801.
Med Hypotheses. 1993 May;40(5):278-83. doi: 10.1016/0306-9877(93)90006-c.
There are presently two competitive theories that attempt to explain the etiology of multiple sclerosis (MS). Briefly summarized, they are: 1. An infection, probably of viral type, may attack the oligodendroglia of the central nervous system; or, 2. An autoimmune process may begin with an infection of the peripheral lymphatic immune system, producing antibodies that cross the blood-brain barrier, leading to myelinoclasia. Since 1935, research has been directed toward myelin of the central nervous system and the myelin sheaths of peripheral nerve; however, dorsal root and cranial sensory ganglia (DRG) have apparently not been studied. The present hypothesis states that an infectious agent (probably viral) finds privileged sanctuary in the dorsal root and cranial sensory ganglia (DRG): thereafter periodically invading the spinal cord, brain, or peripheral nerve. Previously reported erratic spinal fluid viral titers and cultures can be explained by differences in the anatomy of the DRG in which there is a variable and limited contact of spinal fluid with sensory ganglia. Clues to this hypothesis were noted by the author during routine neurological examinations of patients with MS, in which sensory signs and symptoms were frequently encountered. This clinical observation has also been reported by others who found such symptoms in 75% of MS patients, ranking second only to incoordination.
目前有两种相互竞争的理论试图解释多发性硬化症（MS）的病因。简要概括如下：1. 一种感染，可能是病毒感染，可能会攻击中枢神经系统的少突胶质细胞；或者，2. 自身免疫过程可能始于外周淋巴免疫系统的感染，产生穿越血脑屏障的抗体，导致髓鞘脱失。自1935年以来，研究一直针对中枢神经系统的髓鞘和外周神经的髓鞘；然而，背根神经节和颅感觉神经节（DRG）显然尚未得到研究。目前的假说认为，一种感染因子（可能是病毒）在背根神经节和颅感觉神经节（DRG）中找到特殊的庇护所：此后周期性地侵入脊髓、大脑或外周神经。先前报道的不稳定的脑脊液病毒滴度和培养结果可以通过DRG的解剖结构差异来解释，在DRG中脑脊液与感觉神经节的接触是可变且有限的。作者在对MS患者进行常规神经检查时注意到了这一假说的线索，在这些检查中经常遇到感觉体征和症状。其他研究人员也报道了这一临床观察结果，他们发现75%的MS患者有此类症状，仅次于不协调症状。
