PubMed Health⌕ Search

Biomedical subjects

Raul N Mandler

Publications and source records attributed to Raul N Mandler.

5 recordsLinked to original sources
PubMed2006

Neuromyelitis optica - Devic's syndrome, update.

Neuromyelitis optica of Devic (NMO) is a syndrome which combines transverse myelitis and optic neuritis. For many years it was assumed that transverse myelitis and optic neuritis should be simultaneous, that optic neuritis should be bilateral, and that transverse myelitis must be complete. NMO was considered to be very rare. Through the 20th century there was a debate on whether NMO is a distinct nosologic entity or a form of MS. In 2005 it is now possible to distinguish NMO from MS on the basis of the clinical, imaging, serology and immunopathology profile. This distinction is necessary for the implementation of adequate treatments, as the relapsing form of the illness carries significant morbidity and mortality.

Causality↗
PubMed2006

Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis.

OBJECTIVE: To evaluate the efficacy and safety of DM/Q (capsules containing dextromethorphan [DM] and quinidine [Q]) compared with placebo, taken twice daily, for the treatment of pseudobulbar affect over a 12-week period in multiple sclerosis patients. METHODS: A total of 150 patients were randomized in a double-blind, placebo-controlled study to assess pseudobulbar affect with the validated Center for Neurologic Study-Lability Scale. Each patient also recorded the number of episodes experienced between visits, estimated quality of life and quality of relationships on visual analog scales, and completed a pain rating scale. RESULTS: Patients receiving DM/Q had greater reductions in Center for Neurologic Study-Lability Scale scores than those receiving placebo (p < 0.0001) at all clinic visits (days 15, 29, 57, and 85). All secondary end points also favored DM/Q, including the number of crying or laughing episodes (p <or= 0.0077), quality of life (p < 0.0001), quality of relationships (p = 0.0001), and pain intensity score (p = 0.0271). DM/Q was well tolerated; only dizziness occurred with greater frequency than with placebo. INTERPRETATION: Results in multiple sclerosis patients were similar to those of a previous study in amyotrophic lateral sclerosis, demonstrating that DM/Q may be beneficial in treating potentially disabling pseudobulbar affect in a variety of neurological disorders.

Affect↗
PubMed2005

Nerve conduction studies of the lateral femoral cutaneous nerve. Implications in the diagnosis of meralgia paresthetica.

The diagnosis of meralgia paresthetica, while based on clinical suspicion, can be confirmed via electrophysiological testing. Previous testing of the sensory conduction of the lateral femoral cutaneous nerve placed the stimulating electrode one centimeter medial to the anterior superior iliac spine (ASIS). This position is both uncomfortable for the patient and difficult for the operator to perform. The following article suggests an alternate position for the stimulating electrode, four centimeters distal to the ASIS. Twenty subjects served as their own controls and both the old technique and the new technique were performed. Using the old technique, the response rate was 35% (7 out of 20 subjects). Using the new technique, the response rate was 90% (18 out of 20 subjects). These results indicate a significantly higher response rate when the only variable altered is the electrode placement. This simple change in technique requires no more effort, cost, or training on the part of the operator yet produces a much higher percentage of responses.

Adult↗
PubMed2002

A role for humoral mechanisms in the pathogenesis of Devic's neuromyelitis optica.

Devic's disease [neuromyelitis optica (NMO)] is an idiopathic inflammatory demyelinating disease of the CNS, characterized by attacks of optic neuritis and myelitis. The mechanisms that result in selective localization of inflammatory demyelinating lesions to the optic nerves and spinal cord are unknown. Serological and clinical evidence of B cell autoimmunity has been observed in a high proportion of patients with NMO. The purpose of this study was to investigate the importance of humoral mechanisms, including complement activation, in producing the necrotizing demyelination seen in the spinal cord and optic nerves. Eighty-two lesions were examined from nine autopsy cases of clinically confirmed Devic's disease. Demyelinating activity in the lesions was immunocytochemically classified as early active (21 lesions), late active (18 lesions), inactive (35 lesions) or remyelinating (eight lesions) by examining the antigenic profile of myelin degradation products within macrophages. The pathology of the lesions was analysed using a broad spectrum of immunological and neurobiological markers, and lesions were defined on the basis of myelin protein loss, the geography and extension of plaques, the patterns of oligodendrocyte destruction and the immunopathological evidence of complement activation. The pathology was identical in all nine patients. Extensive demyelination was present across multiple spinal cord levels, associated with cavitation, necrosis and acute axonal pathology (spheroids), in both grey and white matter. There was a pronounced loss of oligodendrocytes within the lesions. The inflammatory infiltrates in active lesions were characterized by extensive macrophage infiltration associated with large numbers of perivascular granulocytes and eosinophils and rare CD3(+) and CD8(+) T cells. There was a pronounced perivascular deposition of immunoglobulins (mainly IgM) and complement C9neo antigen in active lesions associated with prominent vascular fibrosis and hyalinization in both active and inactive lesions. The extent of complement activation, eosinophilic infiltration and vascular fibrosis observed in the Devic NMO cases is more prominent compared with that in prototypic multiple sclerosis, and supports a role for humoral immunity in the pathogenesis of NMO. Based on this study, future therapeutic strategies designed to limit the deleterious effects of complement activation, eosinophil degranulation and neutrophil/macrophage/microglial activation are worthy of further investigation.

Antibody Formation↗