# 復發緩解型多發性硬化症因新發右側無力與視神經炎急性惡化住院。應預期的處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374981&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

復發緩解型多發性硬化症因新發右側無力與視神經炎急性惡化住院。應預期的處置?複選。

1

IV methylprednisolone 1 g每日連續3-5天

2

啟動跌倒防範並會診物理治療

3

於無力肌肉敷熱以減輕痙攣

4

因復發而永久停用疾病修飾療法

5

類固醇前先篩檢潛在感染(尿液、CBC)

## 解析

急性MS復發以高劑量IV methylprednisolone(1 g 3-5天)治療,可縮短恢復但不改變長期預後。感染篩檢必要 — 感染引起的偽復發類似真復發,未察感染給類固醇有害。跌倒與行動防範為常規。疾病修飾療法通常持續 — 單次復發非自動停藥指徵。熱使MS症狀惡化(Uhthoff現象),宜降溫。

## 深入解析

偽復發:發燒或感染使舊MS缺損顯現(無新髓鞘破壞)。治療感染後症狀消退。

## 臨床情境

使用ocrelizumab疾病修飾療法。過往復發每8-10個月。目前無發燒。

## 重要概念

- **復發緩解型MS** — 最常見MS亞型 — 明確復發與發作間恢復。
- **Uhthoff現象** — 熱導致MS症狀惡化 — 脫髓鞘神經傳導變慢。
- **Ocrelizumab** — 抗CD20單株抗體,用作MS疾病修飾療法。

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