lucrare de licenta scleroza multipla

8/12/2019 Lucrare de licenta scleroza multipla

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RCUPRR N SCLRZMULTIPL

1


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CUPRINS:

INTRDUCR...............................................................................................................3

PRT I. SPCT TRTIC.............................................................................5CPITLUL I. SCLRZ. SPCT INTRDUCTIV......................................5

1.1. Dfini i .....................................................................................................................5

1.2. Istric ! crct"rii #i$%i!&ic 'n SM.................................................................(

1.). *r% i %nifst"ri c!inic. Di&nstic+! c!inic ! SM ........................................1,

CPITLUL II. FCTL SCLRZI MULTIPL I RCUPRR N

SCLRZ MULTIPL...........................................................................................................26

2.1. T+!-+r"ri! $ ci!i-r+ i cr$nr .....................................................................2(

2.2. fct! ! !c+! $ %+nc".......................................................................................2/

2.). fct! s+#r 0i ii f%i!i! i sci! ................................................................2,

2.. Disf+nc i snri!" ...............................................................................................)3

2.5. Dirtri i $isf&i ..................................................................................................)2

2.(. Disf+nc i c&niti0" i t+!-+r"ri! % in!. Pr-!% #siic ...........................)2

2./. S#sticitt.............................................................................................................3

PRT II-. SPCT PRCTIC....................................................................43

CPITLUL III. RCUPERAREA CHILIRULUI N RTSTTISM !I MRSULUI L LNVII D SCLRZ MULTIPL..................................................43

).1. Mtri! 4i %t$...................................................................................................)

).2. I#t crct"rii.....................................................................................................5)

).). -icti0! #r&r%+!+i $ rc+#rr...................................................................5)

).. Pr&r%+! intic....................................................................................................5

).5. n!i 4i intr#rtr r+!tt!r.........................................................................5,

).(. Cnc!+ii! st+$i+!+i................................................................................................()

CNCLUZII....................................................................................................................64

ILI"RFI..............................................................................................................66

2


3/65

INTRDUCR

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tr#+tic i s#ci!i4ti!r $in $%ni+. Crct"ri! 'n $%ni+ i%+n!&ii9 tnicii $

$i&nstic9 in$+strii fr%c+tic $in +!ti%+! $cni+ + c!i#st #rc$nt! 3 $ ni9 c


4/65

cti0it"6ii i!nic cti$in 4i '%-+n"t"6ir -i!it"6i!r in$i0i$+! i #cin6i!r 'n 0i6 !r9 'n

%$i+ !r -it+!. n #!+s9 Aist" r&+%nt 4tiin6ific c r s+&r c" r-i!itr #t #r0ni

c%#!ic6ii! sc+n$r9 '%-+n"t"6i c!itt 0i6ii 4i r$+c #!+ri ! 'n&ri;iri s#it!ic4ti. S#r

A%#!+ cti0itt fiic" s+ Arci6ii! fiic + fst $0$it fi -nfic #rsn!r c+ SM

7Pt;n EF G##%nir 9 Hit T9 1(8. ntrir9 #cin6ii c+ SM + fst $sc+r;6i $

cr4t cti0itt !r fiic"9 cnsi$rt fiin$ c" strs+! fiic r #+t %"ri cti0itt %!$ii.

cst %it fst risi#it 'n ti%# #rin A#rin6". cti0itt fiic" %ic4rt" $+c ! !t !i%it"ri

fiic 7I-i$J%89 ir incti0itt #t cr4t +nr c%#!ic6ii sc+n$r9 c $ A%#!+ rstric6i

'n 0!+%+! %i4c"ri!r rtic+!r9 scr9 $#rsi9 tc.

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s#cific #ntr+ ficr #cint. R-i!itr n+r!&ic" st +n #rcs cti0 $ 'n0"6r9 #rin

cr #rsn c+ SM cii6in" c+n4tin6 4i -i!it"6i ncsr #ntr+ f+nc6inr #ti%"

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#cint+!+i 'n c$r+ sci! #r#ri+9 #t fi $i0it 'n #tr+ t# A%inr9 str sc#+!+i9

trt%nt 4i 0!+r.


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PRT I. SPCT TRTIC

CPITLUL I. SCLRZ. SPCT INTRDUCTIV

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6/65

D4i r&+%nt! #ntr+ %cnis%+! +ti%+n s+nt 0i$nt9 r+!tt! ni!r tr#ii

%$ic%nts s+nt $ifrit. Un s#ri;in 0!rs 'n intr$+cr ni!r tr#ii r#rint" i%&ri

#rin RMN. P


7/65

In$ic! $ #r0!n6" st n+%"r+! $ c+ri $ -!" ! +n n+%it %%nt $t 7i+ $

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s+sc#ti-i!itt &ntic"9 fctrii $ risc i %$i+!+i9 #rfsin!i9 !i%ntri 4i infc6i4i + fst

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ti#t&ni SM.

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ri&in i%+nitr" +nr $in cst fc6i+ni st st-i!it" 4i $ci +n %cnis% $

c4i nt+r" r #+t fi i%#!ict 'n SM.

Prin crctr+! s"+ f+nc6in! sist%+! E.L.. ;c" +n r! $ #ri% r$in 'n $finir%$!it"6ii rcti0 i%+nitr +n+i r&nis%.

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fst 0ct r+!tt! crct"ri!r s+#r 0ri6ii!r c!itti0 cii!r &r4i i 6s+t+!+i

cr-r! 4i i %i!ini9 'n f+nc6i $ !i%nt6i. !i%nt6i -&t" 'n cii &r4i9 #!ist+r6i 4i

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f#t #"r+t $st+! $ crnt #ntr+ ;+stific st+$i+! ficcit"6ii r&i%+ri!r -&t 'n cii

&r4i nst+r6i 'n SM.

Cncrt9 $isc+t


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!i%nt6i -&t" 'n &r"si%i %"r4t ri&i$itt %%-rn!r c!+!r9 stf! c!+! st %i

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s+nt st+$ii %+!ti#! cr s+s6in c" +n r&i% !i%ntr s"rc 'n !i#i$ r +n r! #iti0 'n 0!+6i

SM9 n+ Aist" st+$ii A#ri%nt! 4i c!inic cr s" $%nstr Aistn6 +n+i r#rt 'ntr

$ficit+! $ +!i+ri 4i n%!ii! #ri0in$ i%+nitt +%r!" 4i c!+!r" 'n SM.

Crctr #i$%i!&ic" s:r #+t $0!t 4i 'n !t $irc6ii. Pr&rs! cntin+i ! tnici!r

$ &ntic" %!c+!r" incit" ! st+$ir n+%itr s#ct $ #i$%i!&i &ntic" SM9 %i

!s 'n fr%! f%i!i!. Difrit! !%nt #i$%i!&ic c!inic 4i &ntic s+&r" c"9 SM

st -!" tr&n"9 $ +n$ intrs+! #tn6i! $ st+$i s#rt fr%! c+ #+s c+t 4i

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5 $in c+ri9 r$in si%#t%!r fiin$ n0rit #tic" )(9 #rstii )5 4i $ficit+! %tr

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n+%i s+-icti0"9 ns#cific" +ni -!i n+r!&ic9 r#rntt" #rintr:+n t-!+ n0rtic. cst

ti# $ $-+t fst n+%it $ c"tr HILSN ti# =#r$is%inn$9 #+t


9/65

Prsn!9 cnsi$r cst $-+t $st+! $ frc0nt 4i !:4 n+%i dbutpsudnurstnic,

crctrit #rin $+" %ri si%#t% c"rr $ %+!t ri n+r!&+! n+ ! $" tn6i c+0nit"

stni fizic prmnnt4i prstzii cu lclizr slttri. A%inr n+r!&ic" tnt"

'ns6it" $ A%in"ri #rc!inic 7i%+n!&i !ici$+!+i cf!ri$in9 rnn6 %&ntic"

n+c!r"8 n ;+t" s" #+n% $i&nstic+! $ SM #si-i!" 'n cst" f"9 0it


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Dc" !i+ni! s+nt %+!ti#! ! ni0!+! %isfr!r cr-r!9 #r t+!-+r"ri $ &


11/65

D+#" cns+!t6ii %+!ti#! ! $ifrit si%#in intrn6in!9 KUR 71,38 #r#+s

$ifrit critrii c!inic $ $i&nstic 'n f+nc6i $ st$i+! c!inic ! -!ii.

stf! % 0

1. SM 0rifict" ! A%n+! nt%ic.

2. SM $finit" c!inic

: 0!+6i c+ #+s 4i r%isi+ni $ c! #+6in $+" ri9 s#rt $ c! #+6in !+n"

intr0!F

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+n! s#it!. stf!9 critrii! !+i MC DNLD 4i ELIDO 71//8 ni s #r ! 'n$%


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#ri6i +ni sc"$ri c+it"6ii 0i+!9 #i ( !+ni %i t


14/65


15/65

"+0 : $finit" c!inic r $+" fr%

1 : c


16/65

CPITLUL II. FCTL SCLRZI MULTIPL I

RCUPRR N SCLRZ MULTIPL

2.#. T+/+&$ 1$ $,7&&+ & ,**+1*'+$

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17/65

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#ntr+ #cin6ii c+ SM %-+!trii. cst %i;!c $ $#!sr 'i ;+t" 'n cn%isir

nr&ii 4i 'n $#!sr c+ 0it" s#rit" # $istn6 %i %ri. Prscrir $c0t" sc+n+!+i

# rti! c $i%nsi+n9 s+#rt #i6i9 4i s#ct $#tti0 st sn6i!" #ntr+ %-i!itt

#ti%" c+ ;+tr+! sc+n+!+i r+!nt. $#t"ri! s#ci! c%#ns" cntr!+! ncrs#+n"tr

! tr+nci+!+i s+ s#s%! Atr%it"6i!r infrir.

Dficit! cr-!s 4i c&niti0 #t !i%it +nri +ti!ir in$#n$nt" sc+n+!+i

r+!nt. ! tr-+i tt+4i 'ncrct 4i 'n s%n sit+6ii9 $rc $ %+!t ri9 $+#" +n ti%#9

%i4c"ri! tAic s #t r$+c. List %i;!c!r +Ai!ir #ntr+ $#!sr -!n0i!r c+ SM

crsc+t n $ n9 $rc cst s+nt cnsi$rt #&rs cnsi$r-i! 'n sistn6 %$ic!"

4i sci!" -!n0i!r.

2.2. %$,)$$ *, 1$ ',/

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ci 4i $trit" t%ri!r c+t $ -!". *ctrii #rinci#!i cr '%#i$ic" nr% 'ntr&" #ntr+

-!n0ii c+ SM s+nt %-i!itt r$+s"9 ncr$nr9 $isf+nc6i 0icii9 -s!9 $ficit!

0i+!9 t+!-+r"ri! $ #rc#6i 4i c%+nicr9 $ific+!t"6i! $ trns#rt9 $#rsi9 ntici#rin0!i$it"6ii 4i t%ri! #trni!r.

Pr-!% c+#6in! ! -!n0i!r c+ SM tr-+i #+s $0r% 7%i !s c" -!n0ii

s+nt tinri89 $rc st %i +4r #ntr+ %ni s":4i %n6in"9 $c


18/65

SM cr r"%


19/65

s+ficint" 'n f#t+! c" #t s" %n6in" -!n0+! 'n $ifrit cti0it"6i sci!. C#iii9 'n s#ci!9

ncsit" ;+tr 'n 'n6!&r fct+!+i c '! r SM s+#r +n+i #"rint. i tr-+i s" fi

$s#0"r6i $ #rs+#+s c+!#" 4i si&+r6i $ #rn6 cntin+" $r&sti #"rint4ti.

In c! $in +r%"9 #cin6i!r tr-+i s" !i s %intsc" f#t+! c" st %i i%#rtnt cin

s+nt i $c


20/65

Pcin6ii $0in c#-i!i s" cc#t r!itt $ 0 SM9 t


21/65

cntin+"9 fiin$ $scris" c str


22/65

SM st c +n 4c9 c sn6i $ c+rnt !ctric9 'nc#


23/65

Disf+nc i c&niti0"9 t+!-+r"ri! % in! i c! #siic 'n SM s+nt 'nt

frc0nt. St+$ii ! !+i MNTRUIL 4i DRUSN 7118 rt" c" $trit" !i+ni!r $in

%isfr! cr-r!9 ! -!n0ii c+ SM s+nt #rnt t+!-+r"ri #siic $ intnsitt +4r" s+

%$rt"9 tMi s+nt 4i !t %ti0 cr A#!ic" cst" sit+6i # $ #rt $iscr$n6 r+!tt!r

st+$ii!r c !:+ fst cnscrt9 $iscr$n6" $t" $ $i0rsitt %t$!r $ st+$i+ f!sit 4i

$ 0ri-i!itt 4ntin!r st+$itF # $ !t" #rt9 snti%nt+! c" #+n ccnt+! # cst

t+!-+r"ri 'n -sn6 +ni tr#+tici ficint n+ fc $c


24/65

Dtr" +nr #r-!% %t$!&ic !&t $ instr+%nt! f!sit #ntr+ ! sct

'n 0i$n6"9 $ 4ntin+! st+$it 4i $ &r+#+! $ cntr!. Tt+4i9 frc0n6 t+!-+r"ri!r c&niti0

fst 0!+t"9 'n %$ cn0r&nt9 'n %i %+!t !+cr"ri rcnt9 'n ;+r $ 55:(3 $in c+ri

7ROSR . M. 4i c!-rtrii9 1,3F TRULL 4i c!-rtrii9 1,/8.

Dficit+! int!ct+! 0i$nt ! A%n+! c!inic st %i rr 'nt

RKIMS P. .9 +ti!i s+nt %+!t %i si%#! 4i s+-ic6ii =nr%!i> tr-+i

s" -6in" nt %Ai%". R#i$itt 4i si%#!itt tst+!+i #r%it s" s #rc$ ! 0!+r9 f"r"

2


25/65

0 c%#tn6" #si!&ic" $s-it". Cnsi$r"% $ s%n c" tst+! H..I.S. st

ncsr fi $scris9 $trit" f!sirii !+i %i frc0nt.

Scr $ int!i&n6" !+i HCESLR #ntr+ $+!6i 7tst+! H..I.S.8 st sc!"

c%#it"9 t!nt" # 0


26/65

ni0! c+!t+r!. In sci%- s #t st-i!i cr!6i 'ntr intnsitt $ficit!r #siic 4i

0!+%+! 0ntric+!i!r cr-r!i 0i+!i6i #rin scnnr9 trfi cr#+!+i c!s9 ri Atnsii

!i+ni!r $%i!init9 -icti0t #rin rnn6" %&ntic" n+c!r" 4i $s%n9 c+

sc"$r %t-!is%+!+i cr-r! %"s+rt #rin t%&rf c%#+trit c+ %isi $ #itrni.

n+%i6i +tri + s+&rt c" $ficit! int!ct+! r #+t fi 'n r#rt9 fi c+ #rn6 +nr #!"ci

!tnt n+r!&ic9 fi c+ #rt+r-r cti0it"6i!r r&i+ni!r frnt!9 !&t" $ !c!ir

#rfrn6i!" #!"ci!r 'n r&i+ni! #ri0ntric+!r9 #r#iin$+:s stf! $ cnc#t+! $

=$%n6" s+-crtic!" . !6ii + s+-!init Aistn6 +ni 'nctiniri #rcs+!+i $ infr%6i9

cr r #+t fi ! ri&in $ficin6!r -sr0t 7LITN 4i c!-rtrii9 1,,8.

a) T+!-+r"ri! $ %%ri s+nt f"r" 'n$i!" c! %i frc0nt 4i c! %i st+$it.

#rAi%ti0 (3:,3 $in -!n0ii c+ SM + t+!-+r"ri %nic. K!n0ii c+ SM #rint" +n

cficint %nic infrir c+ 13 #+nct9 'n r#rt c+ ##+!6i cntr!9 #tri0it sc"rii $ %%ri !+i HCESLR. Difrit st+$ii + 0i$n6it $i%in+r c#cit"6ii $ 'n0"6r +n+i

%tri! 0r-! s+ nn:0r-!9 cr r fi !&t" $ $ific+!tt $ 'ncifrr s%ntic" s+ $

#rt+r-r %%rii $ !+cr+ 4i +n $ficit ! %%ri"rii $ $+rt"9 'n ti%# c %%ri

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rc+n4tr.

T+!-+r"ri! $ %%ri n+ #r %i c!r cr!t c+ s0ritt n$ic#+!+i n+r!&ic

%"s+rt c+ scr BURZTB9 nici c+ $+rt -!ii9 $4i +n! st+$ii + s+-!init ccnt+r !r 'n

c+rs+! 0!+6ii -!ii. St+$ii! $ &r+# %sc" tr&nitt ##+!6ii. stf! R S. 4i

c!-rtrii + $istins tri &r+# $ #cin6i +nii #rnt+ #rfr%n6 %nic nr%!9

ci!!6i 0+ t+!-+r"ri %nic %$rt9 $s scit c+ $#rsi9 +!ti%ii #rnt+

t+!-+r"ri $ %%ri ccnt+t" cr r+ scit c+ #rt+r-"ri ! !tr f+nc6ii c&niti09 'ntr:+n

t-!+ $ $trirr int!ct+!" &!-!". C! tri &r+# n+ s $s-+ 'n f+nc6i $ $+rt s+

s0ritt -!ii. cst $t + fst cnfir%t 'ntr:+n st+$i+ fct+t $ NNBNS:

SCEINBL . 4i c!-rtrii 71389 # #cin6i c+ $istn6" 'ntr #+s. In cst st+$i+9 5(

$in #cin6i #rnt+ #rfr%n6 si%i!r c+ s+-ic6ii $ cntr!. Din ci r"%4i 71/

#cin6i89 2 r+ %nici9 ir 5 #rnt+ $ficit c&niti09 'n s#ci! 'n #r-! $ 'n0"6r

+$iti0:0r-!. T+!-+r"ri! $ %%ri r fi !&t $ 'nctinir #rcs!r $ trt%nt !

infr%6ii9 0i$n6it c+ +n tst s#ci!.

2(


27/65

St+$i+! t+!-+r"ri!r c&niti0 fst #

st #ti%ist 'n c c #ri04t 0iitr+!. cst" str s $s-4t $ !-i!itt %6in!"

r


28/65

c!-rtrii 71,89 Aistn6 +ni $#rsii9 $finit" #rin critrii! D.S.M. III9 fst -sr0t" !

5, $in #cin6ii c"rr -!" 0!+ $ %i #+6in $ $i ni 4i 1/ $in #cin6ii c"rr -!"

r %i 0c $ $i ni. S0ritt si%#t:%t!&ii $#rsii9 %"s+rt" c+ scr !+i

EMILTN9 r $ s%n %i ccnt+t" ! #cin6ii c"rr -!" r %i rcnt". D#rsi

st $ -ici %$rt"9 #cint+! fiin$ irit-i!9 $sc+r;t9 n!ini4tit9 &itt. nci$r 'n sin9

snti%nt+! $ 0in0"6i9 $intrs+!9 s+nt %i rr. Sin+ci$r fst -sr0t" ! 2:5.

+ fst #r#+s %i %+!t i#t #ntr+ A#!ic $#rsi scit" SM. I#t +ni

cinci$n6 s !04t $ %i %r frc0n6" $#rsii ! c4ti #cin6i9 $c


29/65

n+ s+nt 'ns6it $ tr"ir s+-icti0"9 $ cr ! #t s" fi $iscit 7-!n0+! s#+n c" st trist 'n

c+rs+! +n+i ccs $ r

c. *bilitt minl si incntinn fctiv.S+nt $s cnf+n$t c+ r


30/65

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