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Yıl:2009; Cilt: 3; Sayı: 1>> Özet
Klinik Aktüel Tıp NöroPsikiyatri Forumu; 2009;3(1):45-51
Amyotrofik Lateral Sklerozun Patogenezi
İŞ Şengün
Dokuz Eylül Üniv. Tıp Fak. Nöroloji ABD, İzmir
ilk kez 1869 yılında Jean Martin Charcot tarafından tanımlanan Amyotrofik Lateral Skleroz (ALS) yetişkinlerde en sık görülen motor nöron hastalığıdır. Hastalığın temel özelliği motor nöronların seçici disfonksiyonu ve ölümüdür. Bu durum kliniğe spastisite, hiperrefleksi, derin tendon reflekslerinde artış (üst motor nöron) ile jeneralize güçsüzlük ve kas atrofileri (ait motor nöron) şeklinde yansır. Genellikle 40-70 (ort. 55) yaşlarında başlar. Erkek/kadın oranı 3/2'dir. Hastalığın insidansı 1-2/100.000, prevalansı ise 4-6/100.000'dir. Diğer nörodejeneratif hastalıklardan farklı olarak kognitif yetenekler genellikle bozulmaz. Motor nöronlara özgü bir hastalık olmasına karşın ekstraoküler kasları innerve eden ve sfinkter kontrolünden sorumlu motor çekirdekler de etkilenmezler.
Olguların çoğunda hastalığın nedeni bugün için bilinmezken sadece %10'unda genetik bir bağlantının varlığı (familyal ALS:fALS) saptanmıştır. fALS'den sorumlu mutasyonların ilki Rosen ve ark. tarafından 21. kromozomda yer alan ve hücre içi serbest radikallerin temizlenmesinde rol oynayan Cu/Zn Süperoksit Dismutaz (SODİ) geninde saptanmıştır. Daha sonraları alsin, senataksin (SETX), VAPB (vesicle-associated membran protein-associated protein B) ve dynactin gibi aksonal vezikül transportunda rol oynayan başka genlerde de mutasyonlar bildirilmiştir,

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