SCLEROSE EN PLAQUE ET GESTION DE LAPTITUDE : A PROPOS DE DEUX CAS SUIVIS AU CENTRE DEXPERTISE MEDICAL DU PERSONNEL NAVIGANT DE RABAT

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system, with variable manifestations, it evolves in two main forms (relapsing and remitting) with an unpredictable evolution, theprognosis may range from minimal neurological deficit to severe disability. It mainly affects the young population. Several manifestations (organic and psychological) of MS can lead to an overall decrease in flight crew performance. It includes cognitive impairment, fatigue and depression. Episodes of spasms, dysarthria, ataxia, paresthesia, diplopia and also hemiplegia can that can affect flight safety. Disease-modifying therapiescould minimize relapse rates and slow disease progression, but are not free from sometimes major side effects that can compromise flight safety. We report our experience with two cabin crew members affected by MS and fitness management. The different manifestations of MS will be discussed with an emphasis on aeromedical implications.

多发性硬化（Multiple sclerosis, MS）是最常见的中枢神经系统炎性脱髓鞘疾病，临床表现多样，主要分为复发型与缓解型两种病程形式，病情进展难以预测，预后从轻微神经功能缺损至严重残疾不等。该病主要累及青壮年人群。多发性硬化的多种躯体及精神症状可整体降低民航机组人员的作业效能，包括认知障碍、疲劳与抑郁。痉挛发作、构音障碍、共济失调、感觉异常、复视甚至偏瘫等症状，均可能危及飞行安全。疾病修正治疗（disease-modifying therapies）可降低复发率、延缓疾病进展，但并非无严重不良反应风险，部分不良反应可危及飞行安全。本文报告2例罹患多发性硬化的民航机组人员及其健康管理经验，并将探讨该病的各类临床表现，重点阐述其航空医学相关影响。