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PubMed1988

Fatigue in multiple sclerosis.

Fatigue is a frequent symptom in multiple sclerosis (MS) that can interfere with a patient's daily functioning. The cause of MS fatigue, its clinical characteristics, and its relationship to other symptoms remain poorly understood. Structured interviews were conducted with 32 patients with MS and 33 normal healthy adults. Fatigue proved to be both more frequent and more severe among the patients with MS. Multiple sclerosis fatigue was unrelated to either depression or global impairment. Multiple sclerosis fatigue appears to be a distinct clinical entity, often disabling, that can be distinguished from normal fatigue, affective disturbance, and neurologic impairment.

Adult↗

PubMed2001

Influence of cerebral lesion volume and lesion distribution on event-related brain potentials in multiple sclerosis.

Neurocognitive involvement in multiple sclerosis (MS) is heterogeneous with some authors suggesting a frontal pattern in patients with predominantly frontal lesions. To assess the relationship between the distribution of lesions and two cognitive components (visual N2, auditory P3a) of the event-related brain potential (ERP) receiving contributions from frontal lobe structures, we performed a combined ERP and magnetic resonance imaging (MRI) study. Thirty-four MS patients were assigned to "low lesion volume, (LLV)"(n = 12),"high lesion volume,(HLV)"(n = 12) and"frontal lesion volume, (FLV)" (n = 10) groups according to lesion volume and distribution on T2-weighted MRI-scans of the brain. ERPs in visual and auditory classification tasks as well as neuropsychological tests were carried out in patients and control subjects (n = 15). The index for automatic feature registration, the N2 component with its mainly frontal contribution in the visual task, was significantly reduced in amplitude in the FLV and HLV groups (both p < 0.01 vs. controls). Moreover its amplitude correlated with lesion volume (r=0.64, p < 0.001). In contrast neither P3a nor P3b subcomponents with a multiple generator nature in the auditory task varied systematically with lesion volume or distribution. Total lesion volume rather than predominant lesion arrangement appears to be the most important factor in neurocognitive changes in MS. This is most consistent with the view that MS lesions lead to partial disconnections within widespread cortical networks which in turn produce a pattern of neuropsychological deficits that reflect total lesion load more than lesion distribution.

Adult↗

PubMed1992

Natural history and treatment of multiple sclerosis.

The course of multiple sclerosis (MS) evolves over decades. Recent advances in our understanding of the spectrum and variability of the course of MS over the long term in large geographically based populations, and over the short term in selected subgroups randomized to the placebo limbs of controlled clinical trials are discussed. Trials of several toxic immunosuppressive drugs and plasma exchange (PE) show that these methods of treatment are unlikely to help MS patients, although azathioprine has some rationale in rapidly advancing cases. The triggering of attacks by viral infections makes one await the results of current trials of interferon-beta with special interest.

Combined Modality Therapy↗

PubMed2003

[Interferon beta treatment in multiple sclerosis].

Medical treatment of multiple sclerosis(MS) consists primarily of corticosteroid therapy to enhance recovery from relapse and drug interventions to help manage symptoms. However, disease-modifying drugs for the treatment of MS have been developed recent years, including interferon(IFN) beta, glatiramer acetate, and mitoxantrone. In addition to reductions in annual relapse rates and other measures of clinical disability, these drugs appear to reduce disease activity on MRI. In Japan, IFN beta-1b(Betaferon) is available as a disease-modifying drug from September 2000. This article focuses on the use of IFN beta for MS on the basis of available clinical data.

Antiviral Agents↗

PubMed1994

[Immune response against myelin basic protein and analysis of T-cell receptor in multiple sclerosis].

Human demyelinating disease, multiple sclerosis, is now though to be caused by autoreactive T cells against several antigens in central nervous system. In experimental allergic encephalomyelitis, animal model of the disease, successful treatment is reported using a monoclonal antibody to T-cell receptor (TCR) of encephalitogenic T cells. Analoging this model, researchers are now trying to intervene T cells suspected to elicit the disease. For this purpose, myelin basic protein, one of the candidate CNS antigens, reactive T cells and usage of TCR in those cells are extensively examined. Although no convincing result was obtained so far because of complexity of the disease and a genetic background of human beings, T cell intervention may be beneficial to some patients with this disease.

Humans↗

PubMed2000

[Early diagnosis of multiple sclerosis].

The diagnosis of multiple sclerosis is primarily based on clinical criteria considering the dissemination of neurological symptoms in time and space. Laboratory tests (magnetic resonance imaging, examination of cerebrospinal fluid, and evoked potentials) are important to confirm the diagnosis and assess disease activity. With the improvement of these methods, MS could be diagnosed at a very early stage of the disease allowing for the prompt initiation of immunotherapies. An early diagnosis and prediction of the future course of MS are also important for adequate counselling of the predominantly young patients about their professional plans. However, in the early stages of MS, prediction of disability remains difficult even if the patient is definitely diagnosed to suffer from MS.

Brain↗

PubMed1998

Diagnosis of multiple sclerosis.

The diagnosis of multiple sclerosis (MS) remains clinically determined, based on evidence for lesions disseminated over time and space. Evidence of multifocal disease can now be obtained through paraclinical tests, such as magnetic resonance imaging and evoked responses. Cerebrospinal fluid abnormalities may facilitate diagnosis. The disease is extremely protean in its manifestations, although early in the course, sensory symptoms, motor weakness, and optic neuritis occur most frequently. Once a diagnosis is established, patients should be so informed by their physician, so that they will be prepared to engage in dialogue about available treatment options. The diagnosis is not difficult in straightforward cases, but a large differential exists, which varies depending on the temporal and spatial profile of disease with which the patient presents.

Diagnosis, Differential↗

PubMedDate not supplied

Multiple sclerosis and its treatment.

Multiple sclerosis (MS) is a common neurological disorder responsible for substantial neurological morbidity. Although it is considered to be an autoimmune demyelinating disease of the central nervous system (CNS), mediated by antigen-specific CD4+ T helper (Th1) T-cells, therapeutic strategies aimed at generalised immunosuppression have been disappointing. Recently, immunomodulatory therapies like interferon (IFN)-beta and glatiramer acetate have proved more effective. They reduce the rate and severity of clinical relapses and, in the case of IFN-beta, delay the rate of disease progression. Symptomatic therapies and rehabilitation, however, remain the mainstay of treatment for the majority of patients with MS. The immunopathogenesis of MS and its treatments, both disease modifying and symptomatic, are reviewed below.

Disease Progression↗

PubMed2005

A randomized controlled crossover trial of aspirin for fatigue in multiple sclerosis.

Pharmacotherapeutic options for multiple sclerosis (MS)-related fatigue are limited. Thirty patients were randomly assigned to aspirin (ASA) 1,300 mg/day or placebo in a double-blind crossover study. Results favored ASA for the main clinical outcomes: Modified Fatigue Impact Scale scores (p = 0.043) and treatment preference (p = 0.012). There were no significant adverse effects. The results warrant further study and support a role for ASA-influenced mechanisms, perhaps immunologic, in the generation of MS-related chronic fatigue.

Administration, Oral↗

PubMed1997

[Fatty diet and multiple sclerosis].

INTRODUCTION AND DEVELOPMENT: Multiple sclerosis (ME) is an inflammatory disease of the myelin of the central nervous system, the origin of which is still unknown. Genetic, infectious, immunological and environmental factors have all been blamed, but none of these factors on their own can explain the whole spectrum of this disease. Of the environmental factors, fat in the diet has given rise to most discussion. At the present time, it is known that polyunsaturated essential fatty acids form a part of biological membranes. A relationship has been found between the dietary fat consumed and the plasma levels and cell membrane content. CONCLUSIONS: The possible immuno-modulation function of these fatty acids justify rigorous evaluation of this hypothesis.

Arteriosclerosis↗

PubMed2005

Historical descriptions of multiple sclerosis.

Modern understanding of multiple sclerosis is firmly founded on the labours of many neuroscientists of the last two centuries. The cost of the disease to its victims is nowhere better displayed than in their personal accounts of their illnesses. Two figures stand out: the high-born aristocrat, Augustus D'Este and his diaries of the early 19th century and the courageous if histrionic Bruce Frederick Cummings in the early 20th century. This paper cannot do justice to their major contributions, but seeks to summarise them to give the flavour of their symptoms, disabilities and the way they were regarded by doctors and the people at large. The early medical studies of Carswell, Cruveilhier, Charcot and many others are briefly reviewed as relevant settings to these personal histories.

History, 19th Century↗

PubMed2006

The role of CD8+ T-cells in lesion formation and axonal dysfunction in multiple sclerosis.

The etiology of multiple sclerosis (MS) remains unknown. However, both genetic and environmental factors play important roles in its pathogenesis. While demyelination of axons is a hallmark histological feature of MS, axonal and neuronal dysfunction may correlate better with clinical disability. All major immune cell types have been implicated in the pathogenesis of MS, with the CD4+ T-cells being the most commonly studied. In this review, we discuss the involvement of CD8+ T-cells in MS. In addition, we review the contribution of CD8+ T-cells to the pathogenesis of experimental autoimmune encephalitis (EAE) and Theiler's murine encephalomyelitis virus (TMEV) mouse models of MS, including the concept of CD8+ T-cell mediated axonal damage.

Animals↗

PubMed1997

The immunopathogenesis of multiple sclerosis.

The aetiology of multiple sclerosis (MS) remains unknown. Evidence from clinical and animal studies strongly supports MS as an organ-specific autoimmune disease mediated by T helper 1 CD4+ autoreactive T cells. This chapter will review the evidence in favour of this theory, discuss central nervous system autoimmune hypotheses and outline the important inflammatory mechanisms involved in the immunopathogenesis of MS. The immunology applicable to the acute or isolated MS lesion is presented. Relevant clinical aspects of the disease are discussed to support and highlight potential inconsistencies in current thinking. Hypotheses are presented where parts of the immunopathogenic jigsaw puzzle remain incomplete, for example the mechanisms responsible for disease evolution. Where necessary, supportive evidence from the animal model experimental allergic encephalomyelitis is presented.

Animals↗

PubMed1989

Visual function in multiple sclerosis.

126 patients with multiple sclerosis and normal visual acuity were submitted to a battery of tests of visual function. The investigation included visual evoked potential, contrast sensitivity by three methods, and a segment of the Farnsworth-Munsell 100 Hue test. 22 of the patients gave a history of unilateral acute optic neuritis and in these the abnormalities were greater in degree. Contrast sensitivity emerged as the most useful test and was abnormal in 92.2% of eyes. Visual evoked potential was delayed in 35.6% and colour vision was abnormal in less than a third. In general, contrast sensitivity was depressed at all frequencies and most of the abnormalities could be identified by testing at a single frequency of 4 cycles/degree.

Acute Disease↗

PubMed2001

Multiple sclerosis: current pathophysiological concepts.

Multiple sclerosis (MS) is an often disabling disease primarily affecting young adults that exhibits extraordinary clinical, radiological, and pathological heterogeneity. We review the following: (a) known environmental and genetic factors that contribute to MS susceptibility; (b) current knowledge regarding fundamental pathophysiological processes in MS, including immune cell recruitment and entry into the central nervous system (CNS), formation of the plaque, and orchestration of the immune response; (c) descriptive and qualitative distinct pathological patterns in MS and their implications; (d) the evidence supporting the causative role of direct toxins, cell-mediated and humorally mediated immune mechanisms, and the concept of a "primary oligodendrogliopathy" in demyelination and axonal injury; (e) the potential benefits of inflammation; (f) the prospects for remyelination; and (g) therapeutic implications and approaches suggested by putative pathophysiological mechanisms.

Humans↗

PubMed1997

[Diagnosis and differential diagnosis in multiple sclerosis].

The diagnosis of multiple sclerosis (MS) relies on the occurrence of characteristic symptoms, on the patient's history and on the correct interpretation of nowadays very sensitive but not very specific auxillary examinations. This paper reviews the diagnostic criteria and typical signs and symptoms of the disease. The significance of cerebrospinal fluid (CSF) analysis, magnetic resonance imaging (MRI) and evoked potentials is discussed, with emphasis on their predictive value concerning the development of MS after a first episode with symptoms suggestive of MS. A wide range of other diseases mimicking MS, like infectious, autoimmune, granulomatous, metabolic and hereditary diseases is reviewed. A checklist for important points in patient history and further investigations is proposed.

Adult↗

PubMed1977

Principles of albumin and IgG analyses in neurological disorders. III. Evaluation of IgG synthesis within the central nervous system in multiple sclerosis.

Fifty-nine multiple sclerosis patients were investigated with regard to blood-brain barrier function by determining the CSF-protein and the CSF/S albumin ratio. Abnormal values were found in 19% and 32% respectively. The occurrence of CSF-IgG elevation due to synthesis within the CNS was analysed by determining the CSF IgG/protein and CSF IgG/albumin ratios and the IgG-index = (CSF/S IgG ratio)/(CSF/S albumin ratio). Increased values were found in 75%, 80% and 86%, respectively. Oligoclonal IgG was found in CSF by agarose gel electrophoresis in 88% of the patients. The IgG-index is the parameter recommended for the demonstration of an IgG elevation in CSF due to synthesis within the CNS.

Adult↗

PubMedDate not supplied

Epidemiology and current treatment of multiple sclerosis in Europe today.

Multiple sclerosis (MS) is a chronic disease affecting the central nervous system, usually leading to early disablement in young adults. At least 350,000 persons in Europe have the disease. Wide variations exist both between and within European countries in the incidence and prevalence of the disease as well as in the general standard of care for MS patients. The needs, well-being, and social participation of people with MS are systematically influenced by their physical and cultural environment and the nature of the community services. Moreover, the rate of introduction of the new disease-modifying therapy also widely differs from country to country. This article helps clinical researchers to understand better the differences in epidemiology and in the current treatment of MS in Europe.

Combined Modality Therapy↗