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Biomedical subjects

M R Farlow

Publications and source records attributed to M R Farlow.

At least 91 records · Page 5Linked to original sources
PubMed1992

Abnormal eye movements in Gerstmann-Sträussler-Scheinker disease.

Gerstmann-Sträussler-Scheinker disease is a familial disorder of progressive ataxia and dementia in adulthood with extrapyramidal signs in some families. Neuro-ophthalmic examinations and eye movement recordings were performed in members of a large Indiana kindred. Five affected members and 11 members at risk were studied. Eye movements were recorded with videotape, electro-oculography, and/or magnetic scleral search coil. All affected members had abnormal eye movements characteristic of extrapyramidal diseases and cerebellar disorders. Nine members at risk had normal eye movements, but two others had slightly abnormal eye movements. Neuro-ophthalmic examination and eye movement recordings might be helpful in detecting early signs of Gerstmann-Sträussler-Scheinker disease in persons at risk.

Adolescent↗
PubMed1992

Linkage of the Indiana kindred of Gerstmann-Sträussler-Scheinker disease to the prion protein gene.

The Indiana kindred variant of Gerstmann-Sträussler-Scheinker disease has amyloid plaques that contain prion protein (PrP), but is atypical because neurofibrillary tangles like those of Alzheimer disease are present. To map the position of the disease causing gene, we used three markers for linkage analyses. A missense mutation at codon 198 of the PrP gene (PRNP) is found in all definitely affected individuals and yields a maximum lod score of 6.37 (theta = 0). The disease also is concordant with the two other PRNP-region markers. These results demonstrate tight linkage of the disease-causing gene to PRNP and support the hypothesis that the codon 198 mutation is the cause of IK-GSS. Our studies also suggest that methionine/valine heterozygotes at PRNP codon 129 have a later age of onset of the disease than codon 129 valine/valine homozygotes.

Adult↗
PubMed1992

Mutant prion proteins in Gerstmann-Sträussler-Scheinker disease with neurofibrillary tangles.

Two families with Gerstmann-Sträussler-Scheinker disease (GSS) are atypical in possessing neocortical neurofibrillary tangles (NFTs), which are few or absent in other kindreds with GSS, in addition to amyloid plaques that react with prion protein (PrP) antibodies and protease-resistant PrP accumulation in the brain. A leucine substitution at PrP codon 102 has been genetically linked to GSS in some families. We examined the PrP gene in these families. A serine for phenylalanine substitution was found at codon 198 in the Indiana patients; arginine for glutamine substitution at codon 217 in the Swedish patients. These mutations in PrP are the first to be associated with the appearance of both PrP amyloid plaques and neocortical NFTs in GSS patients.

Adult↗
PubMed1992

The cholinergic agonist carbachol reduces intracellular beta-amyloid precursor protein in PC 12 and C6 cells.

Amyloid beta-protein, the major constituent of amyloid plaques in Alzheimer's disease, is derived from larger amyloid precursor proteins (APP). Changes in the rates and or pathways of APP synthesis and degradation may be central to the deposition of beta-amyloid. We explored the possibility that APP processing is regulated by activation of endogenous cell-surface neurotransmitter receptors by stimulating C6, PC12 and neuroblastoma cells with the cholinergic agonist carbachol. We measured the intracellular APP in these cell lines by western blotting using three antibodies against different regions of APP. When cells were treated with carbachol for different periods, PC12 and C6 cells responded with a sharp decrease of APP bands. Similar blots probed with an antibody against heat-shock protein (HSP), showed no change in the intensity of the immunoreactive HSP-70 band. These results suggest that the decrease in intracellular APP seen after stimulation by carbachol has some specificity and that APP processing may be regulated by stimulation of cholinergic receptors on the surface of cells.

Amyloid beta-Protein Precursor↗
PubMed1991

Amyloid protein of Gerstmann-Sträussler-Scheinker disease (Indiana kindred) is an 11 kd fragment of prion protein with an N-terminal glycine at codon 58.

Gerstmann-Sträussler-Scheinker (GSS) disease is a familial neurological disorder pathologically characterized by amyloid deposition in the cerebrum and cerebellum. The GSS amyloid is immunoreactive to antisera raised against the hamster prion protein (PrP) 27-30. This is a proteinase K-resistant glycoprotein of 27-30 kd that is derived from an abnormal isoform of a neuronal glycoprotein of 33-35 kd designated PrPSc and is a molecular marker of amyloid fibrils isolated from animals with scrapie and humans with related disorders. We have purified and characterized proteins extracted from amyloid plaque cores isolated from two patients of the Indiana kindred of GSS disease. We found that the major component of GSS amyloid is an 11 kd degradation product of PrP, whose N-terminus corresponds to the glycine residue at position 58 of the amino acid sequence deduced from the human PrP cDNA. In addition, amyloid fractions contained larger PrP fragments with apparently intact N-termini and amyloid P component. These findings suggest that the disease process leads to proteolytic cleavage of PrP, generating an amyloidogenic peptide that polymerizes into insoluble fibrils. The N-terminal cleavage of PrP in GSS disease occurs at a tryptophan-glycine peptide bond identical to that cleaved by proteinase K in vitro to generate PrP 27-30 from hamster PrPSc at codon 90. Since no mutations of the structural PrP gene have been found in the Indiana family of GSS disease, it is conceivable that factors other than the primary structure of PrP play a crucial role in the process of amyloid formation and the development of clinical neurologic dysfunction.

Amino Acid Sequence↗
PubMed1990

Neurofibrillary tangles of the Indiana kindred of Gerstmann-Sträussler-Scheinker disease share antigenic determinants with those of Alzheimer disease.

In the Indiana kindred of Gerstmann-Sträussler-Scheinker disease, neurofibrillary tangles (NFT) with paired helical filaments (PHF) are numerous, widespread and consistently present in the cerebral cortex and several subcortical nuclei. Such tangles share antigenic determinants with those of Alzheimer disease; in fact, they are recognized by Alz50, anti-PHF and anti-ubiquitin antibodies. Thus, NFT with structural and immunocytochemical similarities are present in two distinct forms of amyloidosis of the central nervous system, i.e. the Indiana kindred of Gerstmann-Sträussler-Scheinker disease and Alzheimer disease.

Aged↗
PubMed1990

Foci of increased T2 signal intensity in MR images of healthy elderly subjects. A follow-up study.

An 18-month follow-up study was conducted on 26 healthy elderly subjects with and without foci of increased T2 signal intensity on MR imaging. The subjects did not differ with respect to health status or cognitive performance as measured by the Cognitive Subscale of the Cambridge Mental Disorders of the Elderly Examination and the Mini Mental State Examination at follow-up. There was a significant decline in performance on the Digit Symbol Substitution Test in subjects who had evidence of T2 foci compared to the performance of subjects without T2 foci. This may indicate that the presence of T2 foci is correlated with subtle difficulties in learning and memory.

Aged↗
PubMed1989

Brain-stem auditory evoked potential abnormalities with unilateral brain-stem lesions demonstrated by magnetic resonance imaging.

We correlated the brain-stem auditory evoked potential (BAEP) abnormalities in 24 patients with discrete unilateral brain-stem lesions demonstrated by magnetic resonance imaging. In 18 patients who had BAEP abnormalities either confined to or more severe on stimulation of one ear, the lesion on magnetic resonance imaging was in the brain stem ipsilateral to the corresponding ear. Mesencephalic lesions produced amplitude abnormalities of the IV/V complex while pontine lesions resulted in abnormalities of earlier components (wave II and/or III). Prolongation of the I-III interpeak latency tended to occur with pontine lesions and of the III-V interpeak latency with mesencephalic lesions. Unilateral brain-stem lesions, particularly at the mesencephalic level, often produced BAEP abnormalities on both ipsilateral and contralateral monaural stimulation.

Adult↗
PubMed1989

Gerstmann-Sträussler-Scheinker disease. I. Extending the clinical spectrum.

We present the clinical findings in affected members of a large kindred with Gerstmann-Sträussler-Scheinker disease. Sixty-four patients exhibited progressive ataxia, dementia, and parkinsonian features. Inheritance appears to be autosomal dominant. Impaired smooth-pursuit eye movements, defective short-term memory, clumsiness of the hands, and ataxia of gait develop in the late 30s to early 60s. Eye movement abnormalities are characteristic of cerebellar dysfunction. Dementia progresses gradually over several years. Later, rigidity and bradykinesia appear and, at this stage, there is often psychosis or severe depression with rapid weight loss. Death occurs in 6 months to 2 years after onset of rigidity. Magnetic resonance imaging in 2 affected individuals showed cerebellar atrophy. There is decreased T2 signal in the basal ganglia, consistent with iron deposition.

Adult↗
PubMed1989

Gerstmann-Sträussler-Scheinker disease. II. Neurofibrillary tangles and plaques with PrP-amyloid coexist in an affected family.

Azzarelli et al reported an Indiana kindred affected by a hereditary disorder, characterized clinically by ataxia, parkinsonism, and dementia. Recently, we studied neuropathologically the 3rd and 4th cases that came to autopsy among the patients of this family. As in 2 patients examined previously, amyloid plaques were widespread throughout the cerebrum and the cerebellum, whereas neurofibrillary tangles were numerous in the cerebral cortex, the hippocampus, and the substantia innominata. Amyloid plaques were not recognized by polyclonal antibodies against the Alzheimer's disease amyloid A4 protein, but did contain epitopes recognized by antibodies against a prion protein. Spongiform changes were occasionally observed and were mild. Our findings indicate that this familial disorder is a form of or is related to Gerstmann-Sträussler-Scheinker disease. The consistent presence of numerous neurofibrillary tangles may be important in differentiating a distinct subgroup of patients with familial Gerstmann-Sträussler-Scheinker disease, and indicates that a disturbance of the cytoskeleton might be part of the neuronal pathology of Gerstmann-Sträussler-Scheinker disease.

Amyloid↗
PubMed1987

X-linked recessive inheritance of ataxia and adult-onset dementia: clinical features and preliminary linkage analysis.

Three generations of a family exhibit a unique syndrome of X-linked ataxia, pyramidal tract signs, and adult-onset dementia. Initial signs, manifested by 2 to 3 years of age, are delayed walking and tremor. During their teens, the patients develop mild but progressive ataxia and pyramidal tract signs. Memory problems in the third decade initiate a progressive dementia, leading to death in the sixth decade. Laboratory investigations failed to disclose a biochemical basis for the syndrome. Preliminary molecular linkage studies have been conducted, and although the specific position of the responsible gene on the X chromosome has not yet been determined, the q26-qter region and much of the p arm are unlikely sites for this gene. The linkage studies are continuing.

Adolescent↗
PubMed1987

Magnetic resonance imaging in multiple sclerosis: analysis of correlations to peripheral blood and spinal fluid abnormalities.

MRI of the brain, peripheral blood (PB) T cell subsets and B cells, CSF T cell subsets, CSF IgG concentration and incidence of CSF oligoclonal bands (OB), and plasma cells were studied in 32 clinically suspected MS patients. The CSF in MS patients with MRI lesions showed increased IgG concentration and higher incidence of plasma cells and OB compared with those without MRI lesions. In PB, the percentage of kappa light-chain positive B cells was significantly increased in patients with abnormal MRI as compared with controls. The correlation of MRI of the head and immunologic studies in MS will be helpful in better understanding the pathogenesis and dynamics of the disease.

Adult↗
PubMed1986

Magnetic resonance imaging. Clinical correlation in 64 patients with multiple sclerosis.

Sixty-four patients with possible, probable, or definite multiple sclerosis (McAlpine criteria) were clinically evaluated using the expanded disability status scale (EDSS) and Scripps neurologic rating scale (NRS). All were examined with a 0.15T magnetic resonance scanner using T2- and T1-weighted images. Correlations between EDSS and NRS scores and severity of disease detected on magnetic resonance imaging were determined. Significant correlations existed between EDSS and NRS with magnetic resonance ratings. Moderate correlations were observed in the motor, cerebellar, and brainstem subgroups of the clinical scales. Significant low correlations existed in the mood/mentation, vision (optic nerves), and bowel/bladder subgroups. Clinical and neuroimaging limitations may account for the lack of higher correlations. Significant correlations suggest the utility of magnetic resonance imaging in monitoring disease progression, and it may prove to be the technique of choice in following up patients with multiple sclerosis.

Adolescent↗
PubMed1986

Multiple sclerosis: magnetic resonance imaging, evoked responses, and spinal fluid electrophoresis.

Magnetic resonance images (MRI), evoked responses (ER), and CSF findings were compared in 39 patients with possible, probable, or definite MS. MRI disclosed multiple lesions (72%) more often than ERs (55%) in the total group of patients. In possible MS, MRI showed multiple lesions in 71%, and ER abnormalities were found in 41%. MRI is the preferred test for patients with suspected MS, but ERs are useful when MRI is normal and in the evaluation of optic nerve or spinal cord lesions.

Adult↗
PubMed1986

Multiple sclerosis: MRI and clinical correlation.

Fifty-three consecutive patients with suspected multiple sclerosis were studied to determine if the extent of disease apparent on MRI correlated with the clinical severity of the disease. MRI images were evaluated and compared with an assessment of the patient's disability using three neurologic rating scales. The severity of the disease seen on MRI showed a strong statistically significant correlation (p = 0.0001) with two of the three methods of clinical evaluation and a significant correlation (p less than 0.01) with the third rating scale. The severity of disease shown on MRI correlated only weakly (p = 0.05) with the length of time the patients had been symptomatic. Normal controls did not show any abnormality characteristic of multiple sclerosis on MRI or on neurologic exam.

Brain↗
PubMedDate not supplied

Clinical trials in Alzheimer disease: debate on the use of placebo controls.

During the past 10 years, there has been a rapidly growing number of pharmaceutical industry-sponsored drug trials for treatment of Alzheimer disease (AD) and other neurodegenerative diseases. As public awareness and concerns about AD have grown, so has interest in developing drug therapies for retarding symptom progression, delaying onset, and ultimately curing the disease. Ethical debate on the use of placebo control trials in AD research has come of age in the United States with the availability of treatments approved by the Food and Drug Administration. The experts and the public agree that more effective therapies are necessary, and new therapeutic options are being developed as rapidly as possible. The arguments on each side of the debate are provocative and important but do not provide unequivocal justification for either the abandonment or the maintenance of placebo-controlled trials in all AD research. Clinical trials differ with respect to scientific and practical goals, and these factors inherently affect the ethical priorities of each study. We present these contrasting points of view to delineate some of the issues rather than to make specific recommendations other than to urge that all clinical trials in AD should be designed with careful consideration of the ethical issues surrounding the use of placebo controls. As new and more effective treatments emerge, the ethical framework for placebo use in AD studies will require frequent re-examination. To make wise choices, patients, caregivers, physicians, and ethicists (among others) must have a voice in this continuing discussion.

Alzheimer Disease↗