multiple sclerosis

出典: meddic

多発性硬化症 MS

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/07/01 08:45:53」(JST)

wiki en

[Wiki en表示]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/09/16 00:29:11」(JST)

wiki en

[Wiki en表示]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2016/07/06 18:13:47」(JST)

wiki en

[Wiki en表示]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2017/02/13 02:07:03」(JST)

wiki en

[Wiki en表示]

英文文献

  • Alleviation of experimental allergic encephalomyelitis in C57BL/6 mice by soy daidzein.
  • Razeghi Jahromi S1, Arrefhosseini SR2, Ghaemi A3, Alizadeh A4, Moradi Tabriz H5, Togha M6.Author information 1Sina Hospital, Multiple Sclerosis Research Center- Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran and Shefa Neuroscience Research Center, Tehran, Iran. Razeghi@razi.tums.ac.ir.2Department of Nutrition and Health, Tabriz University of Medical Sciences, Tabriz, Iran. arrefhosseini@mail.com.3Shefa Neuroscience Research Center, Tehran, Iran and Infectious Diseases Research Center, Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran. ghaem_amir@yahoo.com.4Tissue Engineering Department, Advanced Technology in Medicine,Tehran University of Medical Sciences, Tehran, Iran. Alizadeh.akram@mail.com.5Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. hmoradi@razi.tums.ac.ir.6Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran and Iranian Center of Neurological Research-Neuroscience Institute,Tehran University of Medical Sciences, Tehran, Iran. toghae@sina.tums.ac.ir.AbstractExperimental allergic encephalomyelitis (EAE) is considered as the murine model of multiple sclerosis. Daidzein a phytostrogenic compound of soy is known to impose immunomodulatory and antioxidative effects. We conducted this study to assess the potential protective and therapeutic effects of daidzein on allergic encephalomyelitis.C57BL/6 mice were induced with allergic encephalomyelitis using myelin oligodendrocyte glycoprotein (35-55) and received daidzein or dimethyl sulfoxide as the vehicle control. To assess the protective effect of daidzein, the mice were administered with 20 mg/kg of daidzein from 21 days prior to 21 days post EAE induction on a daily basis. To evaluate the therapeutic effect of daidzein, mice were fed with 300 mg/kg daidzein after the appearance of the first clinical signs for 10 days. One day after the last gavage, the mice were sacrificed. Spleen and brain were removed for further histological and immunological analysis.Feeding mice with low dose of daidzein prior to disease induction did not affect disease severity. However, treating with high dose of daidzein after the onset of the disease reduced interferon-γ and interleukin-12 secretion, enhanced interleukin-10 production, suppressed lymphocyte proliferation, and decreased cytotoxicity as judged by lactate dehydrogenase release.In conclusion, daidzein reduced the extent of demyelination and disease severity. Chronic oral therapy with low dose of daidzein did not prevent experimental autoimmune encephalomyelitis. However, high doses of daidzein could prohibit disease exacerbation. 
  • Iranian journal of allergy, asthma, and immunology.Iran J Allergy Asthma Immunol.2014 Aug;13(4):256-64.
  • Experimental allergic encephalomyelitis (EAE) is considered as the murine model of multiple sclerosis. Daidzein a phytostrogenic compound of soy is known to impose immunomodulatory and antioxidative effects. We conducted this study to assess the potential protective and therapeutic effects of daidze
  • PMID 24659161
  • Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.
  • Urban-Kowalczyk M1, Rudecki T, Wróblewski D, Smigielski J, Kałużyńska O, Rabe-Jabłońska J.Author information 1a Affective and Psychotic Disorders Department , Medical University of Lodz , Lodz , Poland.AbstractSafety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.
  • Neurocase.Neurocase.2014 Aug;20(4):452-5. doi: 10.1080/13554794.2013.791865. Epub 2013 May 16.
  • Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of
  • PMID 23679561
  • Ex vivo T2 relaxation: associations with age-related neuropathology and cognition.
  • Dawe RJ1, Bennett DA2, Schneider JA3, Leurgans SE2, Kotrotsou A4, Boyle PA5, Arfanakis K6.Author information 1Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA.2Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.3Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Pathology, Rush University Medical Center, Chicago, IL, USA.4Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA.5Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.6Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA. Electronic address: arfanakis@iit.edu.AbstractThe transverse relaxation time constant, T2, is sensitive to brain tissue's free water content and the presence of paramagnetic materials such as iron. In this study, ex vivo magnetic resonance imaging was used to investigate alterations in T2 related to Alzheimer's disease (AD) pathology and other types of neuropathology common in old age, as well as the relationship between T2 alterations and cognition. Cerebral hemispheres were obtained from 371 deceased older adults. Using fast spin-echo imaging with multiple echo times, T2 maps were produced and warped to a study-specific template. Hemispheres underwent neuropathologic examination for identification of AD pathology and other common age-related neuropathologies. Voxelwise linear regression was carried out to detect regions of pathology-related T2 alterations and, in separate analyses, regions in which T2 alterations were linked to antemortem cognitive performance. AD pathology was associated with T2 prolongation in white matter of all lobes and T2 shortening in the basal ganglia and insula. Gross infarcts were associated with T2 prolongation in white matter of all lobes, and in the thalamus and basal ganglia. Hippocampal sclerosis was associated with T2 prolongation in the hippocampus and white matter of the temporal lobe. After controlling for neuropathology, T2 prolongation in the frontal lobe white matter was associated with lower performance in the episodic, semantic, and working memory domains. In addition, voxelwise analysis of in vivo and ex vivo T2 values indicated a positive relationship between the two, though further investigation is necessary to accurately translate findings of the present study to the in vivo case.
  • Neurobiology of aging.Neurobiol Aging.2014 Jul;35(7):1549-61. doi: 10.1016/j.neurobiolaging.2014.01.144. Epub 2014 Feb 6.
  • The transverse relaxation time constant, T2, is sensitive to brain tissue's free water content and the presence of paramagnetic materials such as iron. In this study, ex vivo magnetic resonance imaging was used to investigate alterations in T2 related to Alzheimer's disease (AD) pathology and other
  • PMID 24582637

和文文献

  • 多発性硬化症 (特集 免疫と精神神経疾患)
  • 多発性硬化症を抑制する制御性B細胞の同定 (特集 自己免疫疾患の病態解明の新展開)
  • 臨床免疫・アレルギー科 = Clinical immunology & allergology 64(3), 233-239, 2015-09
  • NAID 40020592737
  • 感染症と免疫性神経疾患 : 多発性硬化症・視神経脊髄炎とEBウイルス (増大特集 神経疾患と感染症update)
  • Brain and nerve : 神経研究の進歩 67(7), 881-890, 2015-07
  • NAID 40020532940

関連リンク

関連画像

Multiple Sclerosis Liberation Treatment in multiple_sclerosis_myelinMultiple Sclerosis – And Your Multiple Sclerosis and It’s Signs is Relapsing Remitting Multiple SclerosisMultiple Sclerosis - MS


★リンクテーブル★
リンク元サイトカイン」「多発性硬化症」「ヒト白血球抗原」「MS」「HLA-DR2
拡張検索chronic progressive multiple sclerosis」「secondary progressive multiple sclerosis
関連記事multiple」「sclerosis

サイトカイン」

  [★]

cyto=cell kin(e)=small substance
ex. manikine
細胞が分泌する糖タンパク質で、生物活性(増殖・分化・タンパク産生誘導などを)を有するもの
cytokine, cytokines
サイトカイン受容体インターロイキンリンホカイン

生態情報伝達方式

  • 傍分泌系、自己分泌系により情報を伝達する。局所ホルモンともいえる(ホルモンは血流を介して他臓器に働く)

産生細胞・機能による分類名

機能

機能 サブグループ サイトカイン 標的 機能
炎症性サイトカイン TNFファミリー TNF-α 白血球上皮細胞 活性化
インターロイキン IL-1 上皮細胞リンパ球 活性化
IL-6 種々の細胞 活性化
IL-8 白血球 炎症部位遊走
T細胞の増殖・分化 インターロイキン IL-2 T細胞 活性化。増殖
IL-4 T細胞 増殖
Th2細胞 分化誘導
IL-12 Th1細胞 分化誘導
インターフェロン IFN-γ Th2細胞 分化抑制
B細胞の増殖・分化 インターロイキン IL-2 B細胞 活性化
IL-4 B細胞 活性化、増殖、分化
IL-5 B細胞 活性化、増殖
IL-6 B細胞 増殖、分化
  TGF-β B細胞 分化(IgA分泌)
アレルギー調節サイトカイン インターロイキン IL-3 肥満細胞 増殖、分化促進
IL-4 B細胞 IgEクラススイッチ促進
IL-5 好酸球 増殖、分化促進
IL-13 B細胞 IgEクラススイッチ促進
インターフェロン IFN-γ B細胞 IgEクラススイッチ抑制
走化性サイトカイン(ケモカイン) CCケモカイン MIP-1 好中球 遊走
MIP-2
RANTES 単球
CXCケモカイン IL-8 好中球リンパ球好塩基球
SDF-1
造血系サイトカイン   SCF    
インターロイキン IL-7    
  erythropoietin    
コロニー刺激因子 GM-CSF    
G-CSF    
M-CSF    

サイトカインのシグナル伝達 JAK/STAT pathway (IMM.245-246)

組み換えサイトカインと臨床利用 first aid step1 2006 p.327

agent clinical uses
aldesleukin interleukin-2 renal cell carcinoma, metastatic melanoma
erythropoietin epoetin anemias (especially in renal failure)
filgrastim granulocyte colony-stimulating factor recovery of bone marrow
sargramostim granulocyte-macrophage colony stimulating factor recovery of bone marrow
α-interferon   hepatitis B and C, Kaposi's sarcoma, leukemias, malignant melanoma
β-interferon   multiple sclerosis
γ-interferon   chronic granulomatous disease
oprelvekin interleukin-11 thrombocytopenia
thrombopoietin   thrombocytopenia




多発性硬化症」

  [★]

multiple sclerosis, MS
脱髄疾患視神経脊髄炎症候群。急性型多発性硬化症 バロー同心円硬化症 Balo's concentric sclerosis
  • first aid step1 2006 p.191,327,332,350,353,358

概念

  • 中枢神経系の原因不明の脱髄疾患
  • 中枢神経系(大脳、小脳、脳幹、視神経)の白質に、多巣性の限局性脱髄疾患が生じ、さまざまな神経症候(空間的多発)が、再発と緩解を繰り返す(時間的多発)のが特徴

病因

  • 遺伝的要因
  • 環境要因

疫学

  • 緯度の高い地方に多発する傾向。(北欧・北米>アジア、アフリカ諸国)
  • 北欧・北米:30-80人/10万人 有病率
  • 日本:1-4人/10万人 有病率
  • 若年に発症(15-50歳で80-90%が発症。30歳がピーク)
  • 男:=1:1.3-3.2
  • HLA-DR2との関連

病理

  • 髄鞘の破壊。軸索、神経細胞は保持される。 ← 希突起膠細胞(oligodendroglia)が破壊される
  • 急性期:炎症性細胞浸潤
  • 慢性期:グリア線維に置換

症状

classical triad

  • 痙性麻痺
  • 感覚障害
  • 視力障害
  • 眼球運動障害
  • 複視、眼振
  • 膀胱直腸障害
  • 脳幹障害
  • 突発性
  • 低頻度
  • 神経心理学的症候:失語、失行、失認
  • 錐体外路症状:硬直、ジストニー

診断

検査

  • CTや核磁気共鳴法など:脱髄巣
  • CT:低吸収
  • MRI
  • T1:低信号
  • T2, FLAIR:高信号
[show details]
  • Gd造影:高信号
  • 髄液:免疫グロブリンの異常
  • 感覚誘発電位:異常

腰椎穿刺、髄液

  • 細胞・蛋白・IgG・ミエリン塩基性蛋白は軽度から中等度上昇
  • 電気泳動:60-80%でオリゴクローナルIgGバンド、ミエリンベーシック蛋白質陽性

治療

  • 急性期:急性増悪期の短縮、障害度の軽減
  • 副腎皮質ステロイド:即効性が期待できステロイドパスル療法として治療が行われる。
  • 血液浄化療法 plasmapheresis(血漿交換療法 PE):
  • 再発防止:再発防止、進行抑制

症例

  • 22歳女性、昨日より突然右の上下肢に力が入らなくなったので驚いて受診した。16歳の時に一過性の視力低下があった。20歳の時には小脳失調になったが数日で回復したという。MRI T2強調画像で白質に多発性の病変が見られる。

USMLE

  • Q book p.244 31

国試

参考

  • 1. 多発性硬化症治療ガイドライン2010
[display]http://www.neurology-jp.org/guidelinem/koukasyo.html
→acrobat reader Xやflash player 10が必要だったり、閲覧に苦労するかも。
  • 2.
[display]http://www.neuroimmunology.jp/MSgaido2009.pdf




ヒト白血球抗原」

  [★]

human leucocyte antigen, HLA
ヒト白血球型抗原HLA抗原 HLA antigenヒト組織適合性白血球抗原 human histocompatibility leukocyteantigen
主要組織適合抗原 MHC ← 免疫との関連はこちらを参照
骨髄バンクHLA抗原

疾患との関連

出典不明

強直性脊椎炎 B27
関節リウマチ DR4
重症筋無力症 DR9,DQ3
尋常性天疱瘡 A26,DR4
バセドウ病 DR5
I型糖尿病(インスリン依存性糖尿病) B54,DR4,DR9,DR53,DQ4
グレーブス病 DR5
ベーチェット病 B51
原田病 DR4,DR53
潰瘍性大腸炎 B52,DR2
クローン病 DR4,DQ3
高安病 B52,DR2,DQ1
バージャー病 B52,DR2,DQ1
ナルコレプシー DR2

first aid step1 2006 p.191

HLA-B27 psoriasis, ankylosing spondylitis, inflammatory bowel disease, Reiter's syndrome.
HLA-B8 Graves' disease, celiac sprue.
HLA-DR2 multiple sclerosis, hay fever, SLE, Goodpasture's syndrome.
HLA-DR3 diabetes mellitus type 1.
HLA-DR4 rheumatoid arthritis, diabetes mellitus type 1.
HLA-DR5 pernicious anemia → B12 deficiency, Hashimoto's thyroiditis.
HLA-DR7 steroid-responsive nephrotic syndrome.

まとめ



MS」

  [★]

PrepTutorEJDIC   license prepejdic

「Mississippi」

HLA-DR2」

  [★]

HLA


chronic progressive multiple sclerosis」

  [★]

慢性進行性多発性硬化症

primary progressive multiple sclerosissecondary progressive multiple sclerosis


secondary progressive multiple sclerosis」

  [★]

二次性進行型多発性硬化症

chronic progressive multiple sclerosisprimary progressive multiple sclerosis

multiple」

  [★]

  • n.
  • 倍数
  • adj.
multifocalitymultiplexplural

WordNet   license wordnet

「having or involving or consisting of more than one part or entity or individual; "multiple birth"; "multiple ownership"; "made multiple copies of the speech"; "his multiple achievements in public life"; "her multiple personalities"; "a pineapple is a multiple fruit"」

WordNet   license wordnet

「the product of a quantity by an integer; "36 is a multiple of 9"」

PrepTutorEJDIC   license prepejdic

「多数の部分(要素)から成る,複合の,複式の / 倍数」


sclerosis」

  [★]

WordNet   license wordnet

「any pathological hardening or thickening of tissue」
induration

PrepTutorEJDIC   license prepejdic

「(組織・血管などの)硬化,硬化症」




★コメント★

[メモ入力エリア]
※コメント5000文字まで
ニックネーム:
コメント:




表示
個人用ツール


  meddic.jp

リンク
連絡