视神经脊髓炎谱系病患者痛性强直痉挛发作的临床特点
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摘要
目的探讨视神经脊髓炎谱系病(NMOSD)患者痛性强直痉挛发作(PTS)的临床特点。方法回顾性分析143例NMOSD患者的临床表现、实验室检查以及影像学资料等,探讨NMOSD与PTS发生的关系。结果 39例(27.3%)NMOSD患者有PTS表现,其中37/39例(94.9%)与脊髓病变相关,25/37例(67.6%)于首次脊髓炎发作后出现;伴发PTS的NMOSD患者发病年龄、年复发率及脊髓炎为首发症状的比例较无伴发PTS的NMOSD患者高(P<0.05);两者脊髓病变分布、EDSS评分等则差异无显著性(P>0.05)。结论 PTS多伴发于年龄较大及以脊髓炎发作为主的NMOSD患者,伴发PTS患者的复发风险可能高于无伴发PTS患者。
Aim To investigate the clinical features of painful tonic spasm(PTS) in the patients with neuromyelitis optica spectrum disorder(NMOSD). Methods The clinical data, laboratory examination and imaging data of 143 patients with NMOSD were retrospectively analyzed, and the difference between NMOSD patients with PTS and those without PTS were discussed. Results 39 NMOSD patients(27.3%) presented with PTS, and among of them, 37 cases(94.9%) had spinal cord lesions, PTS in 25 cases(67.6%) emerged after the first myelitis attack. NMOSD patients with PTS had older age of disease onset, more frequent annual recurrence rate and higher proportion of myelitis as the first symptoms than patients without PTS(P<0.05). Other clinical data, such as length and segmental location of the affected spinal cord, EDSS score, were not significantly different between NMOSD patients with PTS and those without PTS(P>0.05). Conclusion PTS is more likely to be experienced by older NMOSD patients with onset symptoms of myelitis, and had a higher recurrent risk.
Aim To investigate the clinical features of painful tonic spasm(PTS) in the patients with neuromyelitis optica spectrum disorder(NMOSD). Methods The clinical data, laboratory examination and imaging data of 143 patients with NMOSD were retrospectively analyzed, and the difference between NMOSD patients with PTS and those without PTS were discussed. Results 39 NMOSD patients(27.3%) presented with PTS, and among of them, 37 cases(94.9%) had spinal cord lesions, PTS in 25 cases(67.6%) emerged after the first myelitis attack. NMOSD patients with PTS had older age of disease onset, more frequent annual recurrence rate and higher proportion of myelitis as the first symptoms than patients without PTS(P<0.05). Other clinical data, such as length and segmental location of the affected spinal cord, EDSS score, were not significantly different between NMOSD patients with PTS and those without PTS(P>0.05). Conclusion PTS is more likely to be experienced by older NMOSD patients with onset symptoms of myelitis, and had a higher recurrent risk.
引文
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[15]Ostermann PO,Westerberg CE.Paroxysmal attacks in multiple sclerosis[J].Brain,1975,98:189-202
[16]Usmani N,Bedi G,Lam BL,et al.Association between paroxysmal tonic spasms and neuromyelitisoptica[J].Arch Neurol,2012,69:121-124
[17]Borsani E.Aquaporins in sensory and pain transmission[J].Curr Neuropharmacol,2010,8:122-127
[18]Nesic O,Guest JD,Zivadinovic D,et al.Aquaporins in spinal cord injury:the janus face of aquaporin 4[J].Neuroscience,2010,168:1019-1035
[19]Carnero Contentti E.Commentary on painful tonic spasms and brainstem involvement in a patient with neuromyelitisoptica spectrum disorder[J].Neurol Neurochir Pol,2016,50:517-518
[2]Wingerchuk DM,Banwell B,Bennett JL,et al.International consensus diagnostic criteria for neuromyelitisoptica spectrum disorders[J].Neurology,2015,85:177-189
[3]Liu J,Zhang Q,Lian Z,et al.Painful tonic spasm in neuromyelitisoptica spectrum disorders:Prevalence,clinical implications and treatment options[J].Mult Scler Relat Disord,2017,17:99-102
[4]Kim SM,Go MJ,Sung JJ,et al.Painful tonic spasm in neuromyelitisoptica:incidence,diagnostic utility,and clinical characteristics[J].Arch Neurol,2012,69:1026-1031
[5]Andrade C,Massano J,Guimar?es J,et al.Stretching the limbs?Tonic spasms in multiple sclerosis[J].BMJ Case Rep,2012,pii:bcr2012007513
[6]张祥,俞海,邓波,等.光相干连续断层成像术在视神经脊髓炎谱系病的临床应用[J].中国临床神经科学,2017,25:176-182
[7]Kurtzke JF.Rating neurologic impairment in multiple sclerosis:an expanded disability status scale(EDSS)[J].Neurology,1983,33:1444-1452
[8]Matthews WB.Tonic seizures in disseminated sclerosis[J].Brain,1958,81:193-206
[9]Jabbari B,Salardini A.Painful tonic/dystonic spasms in Sjogren’s syndrome[J].Mov Disord,1999,14:860-864
[10]Kellett MW,Young GR,Fletcher NA.Painful tonic spasms and pure motor hemiparesis due to lacunar pontine infarct[J].Mov Disord,1997,12:1094-1096
[11]Fuh JL,Chang DB,Wang SJ,et al.Painful tonic spasms:an interesting phenomenon in cerebral ischemia[J].Acta Neurol Scand,1991,84:534-536
[12]Carnero Contentti E,Leguizamón F,Hryb JP,et al.Neuromyelitisoptica:association with paroxysmal painful tonic spasms[J].Neurologia,2016,31:511-515
[13]Bradl M,Kanamori Y,Nakashima I,et al.Pain in neuromyelitisoptica--prevalence,pathogenesis and therapy[J].Nat Rev Neurol,2014,10:529-536
[14]Spissu A,Cannas A,Ferrigno P,et al.Anatomic correlates of painful tonic spasms in multiple sclerosis[J].Mov Disord,1999,14:331-335
[15]Ostermann PO,Westerberg CE.Paroxysmal attacks in multiple sclerosis[J].Brain,1975,98:189-202
[16]Usmani N,Bedi G,Lam BL,et al.Association between paroxysmal tonic spasms and neuromyelitisoptica[J].Arch Neurol,2012,69:121-124
[17]Borsani E.Aquaporins in sensory and pain transmission[J].Curr Neuropharmacol,2010,8:122-127
[18]Nesic O,Guest JD,Zivadinovic D,et al.Aquaporins in spinal cord injury:the janus face of aquaporin 4[J].Neuroscience,2010,168:1019-1035
[19]Carnero Contentti E.Commentary on painful tonic spasms and brainstem involvement in a patient with neuromyelitisoptica spectrum disorder[J].Neurol Neurochir Pol,2016,50:517-518