Biomedical subjects
Publications and source records attributed to D Paty.
Standardized and computerized neurological data will be a requirement for clinical studies in the future. MS COSTAR is a system that has been designed for multiple sclerosis clinical research. Adoption of standards and a computer method for recording and storing these data should be a high priority for the design and future of multi-center studies on multiple sclerosis.
We exploit the intrinsic difference in magnetic resonance spin-spin relaxation time, T2, between water associated with myelin sheaths and water in other central nervous system tissue in order to measure myelin water content within any region of an image or to generate indirectly a myelin map of the brain. In normal volunteers, myelin water maps give the expected myelin distribution. In multiple sclerosis patients, lesions exhibit different myelin water contents providing insight into the demyelination process unavailable from conventional magnetic resonance images. In vivo myelin measurement has important applications in the clinical management of multiple sclerosis and other white matter diseases.
The purpose of the current study was to describe four models of cognitive deficit and to outline the statistical hypotheses underlying each model. The four models of cognitive deficit were (a) specific deficit; (b) subgroup deficit; (c) a syndrome dissociation model; and (d) a global function dissociation model. Neuropsychological data are analyzed to examine each of these four models in a sample of mild Multiple Sclerosis (MS) patients. The results suggest that for these subjects and tests, the specific deficit model best fits the data. The results are reviewed initially in the context of MS. There follows a consideration of statistical caveats and finally, general applications of the proposed procedures.
We examined the prevalence of sleep problems in a sample of patients with mild but clinically definite multiple sclerosis (n = 143) and sought to determine whether there was a relationship between the presence of sleep complaints and the level of depression. As magnetic resonance imaging scans were available for a subsample of the patients with multiple sclerosis (n = 117), we also wanted to determine whether there was a relationship between the site of the lesion and the presence of sleep difficulties. The prevalence of sleep difficulties was three times higher in the patients with multiple sclerosis than the control group (25.2% vs 8.2%). Moreover, the presence of sleep complaints was associated with higher levels of depression. Three lesion sites that subserve supplemental motor areas were significantly related to the presence of sleep complaints. These findings suggest that, for some patients with MS, sleep disturbance and accompanying increases in depression may be a function of the lesion site resulting in nocturnal spasms.
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The purpose of this study was to explore further the hypothesis that changes in cognitive function may occur in the mild stages of multiple sclerosis (MS) by determining whether ventricular enlargement was related to cognitive function. Ten measures of ventricular size were made in a sample of 123 MS patients with mild disability and 60 well-matched healthy controls. In addition, sixteen tests of cognitive function and the Beck Depression Inventory were administered. For the MS group, there were significant correlations between the ventricular measures and cognitive performance but not for the normal controls. Scores on the Beck Depression Inventory were not correlated with either cognitive performance or ventricular enlargement. These findings suggest that for the MS group cognitive impairment was related to the disease process but not to the level of depression.
Although changes in cognitive function in patients with multiple sclerosis (MS) have been reported, these changes have been traditionally associated with the later stages of the disease. In the current study, a comprehensive neuropsychological battery was administered to MS patients (N = 86) in whom the disease progression was relatively mild and in remission and a demographically well-matched control group (N = 46). Besides the expected differences in tests of motor function, the two groups also differed on a number of cognitive tests with no motor demands. The two cognitive functions that appear impaired were learning and memory. Given that similar deficits have been found in MS patients with more severe symptoms, it is argued that changes in cognitive function can occur in the mild stages of the disease.
Two hundred patients suspected of having multiple sclerosis (MS), including 42 with progressive myelopathy and 11 with optic neuritis, were investigated with somatosensory evoked potentials (SEPs) and magnetic resonance imaging (MRI). Most had minimal neurological deficit, the mean Kurtzke scale being 2.65. There were 117 patients had two or more MRI lesions suggestive of MS, with a total of 527 lesions identified; 290 (55%) involved the somatosensory pathways, most commonly lying in the mid-periventricular region (thalamo-cortical radiations). There was good correlation between positive and negative MRIs and SEPs. The MRI was abnormal more frequently than the SEP, except in progressive myelopathy when both were abnormal with equal frequency. It is proposed that some cases of myelopathy in MS may be due to periventricular rather than spinal pathology. The morphology of the MRI lesion would favor conduction block not slowing of the SEP as being the prime abnormality. This appeared to be true of leg SEPs.
The performances of three groups of patients were compared during two conditions of interference on a visual retention task. During the noninterference condition, the psychiatric, multiple-sclerosis, and brain-damaged patients functioned at a comparable level. The introduction of a distracting background reduced the level of functioning for only the brain-damaged group. This effect remained significant for the correct score when age and postmorbid intelligence functioning were controlled. These results were interpreted as reflecting the cortical nature of the deficits in resisting the distracting influence of the background interference procedure. Serial testing was recommended for the evaluation of the multiple-sclerosis group.
73 MS patients were graded on a 5-point Sexual Functioning Scale in the process of routine data collection for the Minimal Record of Disability in MS. 45% of the patients were less sexually active or inactive since the onset of MS. 27% were concerned about this situation. The Demographic features, impairment, disability and handicap profile of patients in the various Sexual functioning Scale categories was analysed. The sexually less active or inactive patients were different from the active-as-before-MS patients in various ways, but most significantly in their difficulties with toilet transfer and bladder functioning. The concerned patients were bladder functioning. The concerned patients were also different from not concerned patient in various ways, but most significantly in their problems with ambulation and in maintaining their usual financial standards. Further studies are required to begin to understand the natural history of sex problems in MS.
The nature, incidence, prevalence, etiology and management of sexual problems in MS has not been well defined yet. Sexual dysfunctions in MS seem to be related to a combination of the neurological consequences of MS and the personal, partner and social reactions to this condition. A sexual history is valuable in defining the specific areas of concern, and bringing into focus the patient's and the couple's sexual resources. Physical examination and investigations may assist in clarifying the extent of the sexual impairment and disability, and its relationship to MS. Treatment strategies include: relevant information, education, physical rehabilitation and supportive therapy in combination with medical intervention, and when indicated, surgical treatment or sex therapy. Long-range prognosis with or without treatment is not clear yet.
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When multiple sclerosis (MS) presents late in life (after the age of 50), it frequently gives diagnostic difficulty. In a large MS clinic population (N = 838), 9.4% of the patients had late onset of MS. Slow deterioration of motor function characterized the initial symptoms and subsequent course of this group of older patients. Progression of disability was more rapid than in younger patients. Evoked response studies and CSF electrophoresis were of high diagnostic yield in the older patient group. Reasons for the differing clinical features in the late-onset patients are discussed. We suggest that the age-of-onset criterion for MS be raised to 60 in adequately investigated cases.
Somatosensory evoked potentials (SEPs) were recorded following trigeminal nerve stimulation in 25 normal subjects. Mucosal stimulation of the lip resulted in a reduced stimulus artefact. The three initial peaks, N13, P19, and N30, measured respectively 12.8 +/- 0.9 S-3, 19.3 +/- 1.4 S-3, and 28.6 +/- 1.7 S-3. Blink reflex studies were also performed in most of these subjects. In 41.4% of 29 patients with established or suspected multiple sclerosis, the trigeminal SEP was abnormal. Additional use of the blink reflex raised the overall incidence of trigeminal nerve dysfunction to 51.7%. None of the patients had clinical evidence of fifth nerve involvement either historically or on examination. Four of seven patients with progressive spinal MS and two patients whose only deficit was that of optic neuritis, had abnormal trigeminal SEPs. It is concluded that occult involvement of the pontine fifth nerve structures occurs frequently in MS despite the rarity of corresponding clinical findings. The trigeminal SEP is a useful additional neurophysiological method.
Supernormality is a regular part of the recovery cycle of nerve. Supernormality was expressed in terms of amplitude, and in 20 control subjects the mean (S2 conditioned/S2 unconditioned) ratio of the median sensory nerve action potential amplitude recorded at the elbow measured 285 +/- 174 (range 119 to 783). A supramaximal conditioning shock was delivered 6 msec in advance of the test pulse. Seventeen (42.5%) of 40 patients with multiple sclerosis (MS) failed to demonstrate supernormality, the (S2 conditioned/S2 unconditioned) ratio being less than 100. This abnormality probably reflects a delay in recovery cycle and is additional evidence implicating peripheral nervous system involvement in multiple sclerosis.