多发性硬化症(MS)是一种以炎症为特征的中枢神经系统(CNS)的异质性自身免疫介导的疾病,脱髓鞘和慢性进行性神经变性。在其广泛而不可预测的神经精神症状中,行为变化很常见,甚至从疾病的早期阶段开始,虽然它们与高级MS的认知缺陷有关。根据DSM-5,行为障碍包括注意力缺陷,反对,挑衅和行为障碍,焦虑,恐慌,强迫症(强迫症),破坏性和情绪障碍,而其他人也包括烦躁,激动,侵略和执行功能障碍。大约30%至80%的MS患者表现出与疾病进展相关的行为变化。它们通常与抑郁症和其他神经精神疾病相结合,但通常与运动障碍无关,提示不同的病理机制。这些和其他改变导致MS的残疾。虽然没有关于MS行为变化的具体神经病理学数据,脱髓鞘动物模型与人类白质和神经炎症异常有相似之处。神经影像学显示前额叶皮质萎缩,半球间抑制和破坏额叶-纹状体-丘脑和额顶网络。这表明MS病理学中脑紊乱的多区域模式,尽管其致病机制有待进一步阐明。社会的好处,心理,报告了行为干预和运动。在对PubMed进行系统分析的基础上,谷歌学者和科克伦图书馆,目前的流行病学,临床,回顾了神经影像学和致病证据,这些证据可能有助于早期识别MS的行为症状,并推广新的治疗目标和策略。
Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.