TNN - jaargang 124, nummer 3, mei 2023
drs. T. van Osch , drs. B. Dekker , prof. dr. V. de Groot , drs. M.G.E. Huijsmans , dr. B.A. de Jong , dr. N.F. Kalkers
Multiple sclerose is in de westerse wereld de meest voorkomende oorzaak van niet-traumatische invaliditeit op jongvolwassen en middelbare leeftijd. In het beloop van de ziekte worden patiënten geconfronteerd met functionele beperkingen op verschillende domeinen. De ernst van deze problemen neemt toe bij een langere ziekteduur. Voor optimale zelfredzaamheid, eigen regievoering en maatschappelijke participatie is het belangrijk dat er in de spreekkamer aandacht is voor deze beperkingen en dat er zo nodig een revalidatietraject wordt ingezet. Afhankelijk van de ernst en de complexiteit kan dit in de eerste of tweede lijn plaatsvinden. In dit artikel worden puntsgewijs de aanbevelingen besproken uit de meest recente richtlijn.
(TIJDSCHR NEUROL NEUROCHIR 2023;124(3):117–22)
Lees verderTNN - jaargang 114, nummer 2, juni 2013
dr. N.F. Kalkers
With the increasing availability of magnetic resonance imaging (MRI), there is also an increase in incidental abnormal findings. MRI findings suggestive of multiple sclerosis in persons without typical multiple sclerosis symptoms and with normal neurological findings are defined as radiologically isolated syndrome (RIS). Half of the number of persons with RIS have their initial MRI because of headache and some have a subclinical cognitive impairment similar to that seen in multiple sclerosis. Radiological measurements also show a similarity between RIS and multiple sclerosis. Approximately two-thirds of patients with RIS show radiological progression and one-third develop neurological symptoms during mean follow-up times of up to five years. Cervical cord lesions are important predictors of clinical conversion. Management has to be individualised, but initiation of disease modifying therapy is controversial and not recommended outside of clinical trials since its effects have not been studied in RIS. Future studies should try to establish the prevalence and long-term prognosis of RIS, its impact on quality of life and define the role of disease modifying therapy in RIS.
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