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Results for “SCLEROSIS, MULTIPLE”

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PubMed1999

[Towards a reliable prognosis for multiple sclerosis].

Although the general course of multiple sclerosis is well known from natural history studies, the determination of a detailed prognosis in a given individual is almost an insurmountable task. Cerebral magnetic resonance imaging is the best predictor of conversion to definite multiple sclerosis after a first demyelinating event. The main factors indicative of long-term bad prognosis are: onset after the age of 40, initial pyramidal or cerebellar signs, high relapse rate during the first two years, and onset of the progressive phase. Altogether, up to 20% of patients have a benign course.

Age of Onset↗

PubMed1984

Deficient learning and memory in early and middle phases of multiple sclerosis.

Forty-three patients with multiple sclerosis showed disturbances in short-term memory, learning, and delayed recall which were associated with years of active disease (average was 4.5 years), age, presence of flareup, but not steroid/ACTH treatment. Unrecognised memory loss might be prevalent early in the natural history of multiple sclerosis and deserves neuropsychological assessment.

Adrenocorticotropic Hormone↗

PubMed1996

Quality of life as a measure of rehabilitation outcome in patients with multiple sclerosis.

A total of 43 patients with multiple sclerosis (MS) consecutively admitted to the Multiple Sclerosis Rehabilitation Hospital in Haslev completed a Danish version of the Laman & Lankhorst Questionnaire (LLQ) on quality of life (qol), and the Beck Depression Inventory (BDI). Twenty-one of the 43 pts completed the questionnaires at discharge as well. All patients received the standard multidisciplinary rehabilitative treatment. The purpose was to evaluate the LLQ as a measure of qol and as an outcome measure. The 43 MS-patients had low weighted qol scores on the following items: readily tired, fatigue, dependence on other people, worry about deterioration and walk. Correspondingly, the BDI showed high scores on fatigability, work difficulty and somatic preoccupation. The correlation between LLQ and BDI was statistically significant (0.54, p < 0002), but weak. ANOVA with repeated measures (LLQ and BDI at admission and discharge) was applied to evaluate rehabilitation outcome in 21 patients. LLQ: The patients experienced a significant reduction in disability on fatigue and mood; and in the importance of being able to climb stairs and to work. The weighted qol-scores increased significantly on physical endurance, work and mood. BDI scores showed a significant decrease on pessimism, irritability, loss of libido and total BDI-score. The changes measured by the LLQ were mainly on behavioral aspects. As the correlation coefficient was only 0.54, the LLQ and the BDI seem to address different aspects of quality of life.

Activities of Daily Living↗

PubMedDate not supplied

[IgM immunoglobulin in cerebrospinal fluid in cases of multiple sclerosis (preliminary report)].

In cases of multiple sclerosis, central nervous system syphilis and other neurological diseases the IgM was determined in the cerebrospinal fluid by means of radial diffusion. The control group comprised patients with neurosis. It was found that IgM determinations must be done in concentrated fluid when this method is used. Raised total and percent level of IgM in the cerebrospinal fluid was observed in 8 out of 29 cases of multiple sclerosis in the acute phase of the disease.

Acute Disease↗

PubMed1996

[Delusion of mercury poisoning in multiple sclerosis].

We confirmed the diagnosis of multiple sclerosis in a 54-year-old man. The patient rejected this diagnosis and was completely convinced that all his symptoms resulted from a chronic mercury intoxication. We found evidence that this delusional disorder was an independent illness, and not a "symptomatic psychosis in multiple sclerosis." So far, little notice has been taken in psychiatry of delusions of environmental poisoning, which cause difficulties in applying common criteria of delusion.

Delusions↗

PubMed1996

Paradoxical heat sensation in patients with multiple sclerosis. Evidence for a supraspinal integration of temperature sensation.

Temperature thresholds were determined in 16 patients with probable or definite multiple sclerosis, in six patients with possible but unconfirmed multiple sclerosis and in 34 healthy subjects, using the method of limits and the thermal sensory limen (TSL) of the MarStock technique. A significant proportion of the patients had thresholds outside the 2.5 SD range for normal subjects, both for warmth detection threshold and TSL. In addition, 10 patients with probable or definite multiple sclerosis and one patient with possible multiple sclerosis reported a paradoxical heat sensation, i.e. a sensation of warmth elicited by a cold stimulus. This illusion was almost exclusively observed with the alternating warm and cold stimuli of the TSL procedure. In contrast to experimental nerve block or peripheral demyelinating neuropathy, where paradoxical heat sensation has been described by various authors, in the patients with multiple sclerosis the demyelination sites were located in the central nervous system. The observation that multiple sclerosis patients had paradoxical heat sensation in addition to threshold abnormalities supports the view that supraspinal sites are important for the integration of temperature sensation.

Adult↗

PubMed1999

[Multiple sclerosis: epidemiology, molecular pathology and therapy].

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. It results from an autoimmune response against one of several antigens of cerebral white matter tissue. The pathogenesis of MS lesions consists in migration of auto-reactive T-cells and disruption of the blood-brain-barrier. B-cells and their products are, however, also important for demyelination together with various cytotoxic or pro-inflammatory cytokines. Recent advances in immunology and biotechnology and protein engineering techniques have opened the door for novel immunotherapies. Immune modulation with beta-interferon has shown beneficial effect, both in relapsing remitting and secondary progressive multiple sclerosis.

B-Lymphocytes↗

PubMed2000

Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis.

OBJECTIVES: To determine whether gut focused behavioural treatment (biofeedback) is a useful therapy in multiple sclerosis patients referred for constipation, incontinence, or a combination of these symptoms. Most patients with multiple sclerosis complain of constipation, faecal incontinence, or a combination of the two. Patients rate these bowel symptoms as having a major impact on their life. Until now the management of these problems has been empirical, with a lack of evaluated therapeutic regimes. METHODS: Thirteen patients (eight women, median age 38 years, median duration of multiple sclerosis 10 years) complaining of constipation, with or without faecal incontinence underwent a median of four sessions of behavioural treatment. Anorectal physiological tests were performed before therapy. Impairment and disability were rated with the Kurtzke score and the Cambridge multiple sclerosis basic score (CAMBS). Patients were contacted a median of 14 months after completion of treatment. RESULTS: A beneficial effect was attributed to biofeedback in five patients. Mild to moderate disability, quiescent and non-relapsing disease, and absence of progression of multiple sclerosis over the year before biofeedback were predictive of symptom improvement. No physiological test predicted the response to therapy. CONCLUSION: Biofeedback retraining is an effective treatment in some patients with multiple sclerosis complaining of constipation or faecal incontinence. A response is more likely in patients with limited disability and a non-progressive disease course.

Adult↗

PubMed1981

HLA antigens in multiple sclerosis amongst Indians.

The infrequency of multiple sclerosis in India may have genetic implications. We found (a) the HLA-A3 and HLA-B7 haplotypes amongst Indians to be lower than those reported in Caucasians, (b) no excess of HLA-A3 and HLA-B7 amongst our 27 multiple sclerosis patients compared to 330 controls; instead it was the reverse, (c) HLA-B12 as high as 74% in the "clinically definite" cases, against only 9% in controls, (d) a significant relative risk of MS amongst Indians with HLA-B12 haplotype. Attention is drawn to th higher incidence of MS amongst the small Parsee community and the high association of HLA-B12 in these patients.

HLA Antigens↗

PubMed2004

Timing of birth and risk of multiple sclerosis: population based study.

OBJECTIVES: To determine if risk of multiple sclerosis (MS) is associated with month of birth in countries in the northern hemisphere and if factors related to month of birth interact with genetic risk. DESIGN: Population based study with population and family based controls and a retrospective cohort identified from death certificates. A post hoc pooled analysis was carried out for large northern datasets including Sweden and Denmark. SETTING: 19 MS clinics in major cities across Canada (Canadian collaborative project on the genetic susceptibility to multiple sclerosis); incident cases of MS from a population based study in the Lothian and Border regions of Scotland; and death records from the UK Registrar General. POPULATIONS: 17,874 Canadian patients and 11,502 British patients with multiple sclerosis. MAIN OUTCOME MEASURE: Diagnosis of multiple sclerosis. RESULTS: In Canada (n = 17,874) significantly fewer patients with MS were born in November compared with controls from the population census and unaffected siblings. These observations were confirmed in a dataset of British patients (n = 11, 502), in which there was also an increase in the number of births in May. A pooled analysis of datasets from Canada, Great Britain, Denmark, and Sweden (n = 42,045) showed that significantly fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. For recent incident data, the effect of month of birth was most evident in Scotland, where MS prevalence is the highest. CONCLUSIONS: Month of birth and risk of MS are associated, more so in familial cases, implying interactions between genes and environment that are related to climate. Such interactions may act during gestation or shortly after birth in individuals born in the northern countries studied.

Canada↗

PubMed1991

Multiple sclerosis with abnormal cerebrospinal fluid--a case report.

Multiple sclerosis is an uncommon demyelinating condition in Singapore. The commonest mode of presentation here is in the form of Devic's syndrome. Although our patients here have shown classical findings with respect to clinical features, neuroimaging studies and electrophysiologic tests, abnormal cerebrospinal fluid changes have not been reported locally. We report the first case of multiple sclerosis with abnormal cerebrospinal fluid changes. We also reviewed cerebrospinal fluid changes in multiple sclerosis and recent advances in laboratory techniques of cerebrospinal fluid analyses.

Adolescent↗

PubMedDate not supplied

Anterior uveitis and multiple sclerosis.

Three patients with clinically definite multiple sclerosis and uveitis were studied. The uveitis presented as inflammation of the anterior segment of the eye (iridocyclitis) and was characterized by large keratic precipitates and posterior synechiae, consistent with a granulomatous iridocyclitis. Clinical and laboratory evidence militated against other central nervous system diseases often associated with uveitis including neurosarcoidosis, Behçet's syndrome, Vogt-Koyanagi-Harada disease, neurosyphilis, and tuberculosis. Further attention should be directed to the possibility of granulomatous anterior uveitis in patients with multiple sclerosis.

Adolescent↗

PubMed2000

Evidence for adaptive functional changes in the cerebral cortex with axonal injury from multiple sclerosis.

Axonal injury occurs even in the earliest stages of multiple sclerosis. Magnetic resonance spectroscopic imaging (MRSI) measurements of brain N:-acetylaspartate (NAA), a marker of axonal integrity, show that this axonal injury can occur even in the absence of clinically evident functional impairments. To test whether cortical adaptive responses contribute to the maintenance of normal motor function in patients with multiple sclerosis, we performed MRSI and functional MRI (fMRI) examinations of nine multiple sclerosis patients who had unimpaired hand function. We found that activation of the ipsilateral sensorimotor cortex with simple hand movements was increased by a mean of fivefold relative to normal controls (n = 8) and that the extent of this increase was strongly correlated (sigma = -0.93, P = 0.001) with decreases in brain NAA. These results suggest that compensatory cortical adaptive responses may help to account for the limited relationship between conventional MRI measures of lesion burden and clinical measures of disability, and that therapies directed towards promoting cortical reorganization in response to brain injury could enhance recovery from relapses of multiple sclerosis.

Aspartic Acid↗

PubMed1987

Parity as a factor in incontinence in multiple sclerosis.

Twelve consecutively selected patients with multiple sclerosis and incontinence had electrophysiologic studies performed of the pudendal and perineal innervations of the anal and urinary sphincter. Single-fiber electromyogram density measurements were obtained in the external anal sphincter. Fecal incontinence was found to be unexpectedly frequent. The results suggest that incontinence in patients with multiple sclerosis is often due to the interaction of several factors, including central lesions, lesions of the conus medullaris and, also, coincidental pelvic nerve lesions associated with childbirth. Thus, incontinence is especially a problem in women with this disease.

Action Potentials↗

PubMed1987

Facially distributed pattern-evoked potentials in multiple sclerosis.

Among 56 established cases of multiple sclerosis in our clinic from April 1978 to March 1985, optic neuritis was found in 38; 21 cases were bilateral. We studied pattern-evoked potentials detected with 16 electrodes placed on both the scalp and the facial area. Pattern-evoked potentials (PERGs) were obtainable at the facial area in multiple sclerosis patients with optic neuritis, except in long-standing cases. However, a significant reduction of amplitude was found even in cases without optic neuritis. No correlation was found between visual acuity and amplitude or peak latency of PERGs in MS patients.

Electroretinography↗

PubMedDate not supplied

Quantitative measurement of neurologic impairment in patients with multiple sclerosis.

Eleven patients with clinically diagnosed multiple sclerosis were simultaneously evaluated with history, physical, and neurologic evaluations and a series of objective neurophysiologic tests. Patients were then scored independently on clinical stage of their disease using a system based on symptoms in history or findings on physical or neurologic examination. Test scores on objective tests were compared with clinical scores with each evaluator. Patients with high test scores on clinical evaluation usually had high test scores on objective testing. Symptoms and physical findings were then correlated with abnormalities on objective tests. Objective abnormalities in visual evoked response and auditory evoked response on several occasions preceded the development of symptoms. All patients except for two had more than one abnormality on objective testing, suggesting a high likelihood that objective tests are helpful in the diagnosis of early-stage multiple sclerosis.

Evoked Potentials, Auditory↗

PubMed1985

Persistence of antibrain antibodies in cerebrospinal fluid during plasmapheresis for multiple sclerosis.

A man with chronic progressive multiple sclerosis received a 10 day course of treatment with adrenocorticotrophic hormone without beneficial effect. He then received six sessions of plasmapheresis, again without improvement. Treatment with adrenocorticotrophic hormone had no effect on serum antibrain antibody titres, but plasmapheresis virtually eliminated the antibodies from serum and caused a fall in serum IgG concentrations; neither treatment had any effect on the IgG concentration and antibody titre in the cerebrospinal fluid. Treatment with plasmapheresis may fail in patients with multiple sclerosis because it does not remove antibrain antibodies from the intrathecal space.

Adrenocorticotropic Hormone↗

PubMed2003

Self reported stressful life events and exacerbations in multiple sclerosis: prospective study.

OBJECTIVE: To study the relation between self reported stressful life events not related to multiple sclerosis and the occurrence of exacerbations in relapsing-remitting multiple sclerosis. DESIGN: Longitudinal, prospective cohort study. SETTING: Outpatient clinic of department of neurology in the Netherlands. PARTICIPANTS: Patients aged 18-55 with relapsing-remitting multiple sclerosis, who could walk with a cane or better (score of 0-6.0 on the expanded disability status scale), and had had at least two exacerbations in 24 months before inclusion in the study. Patients with other serious conditions were excluded. MAIN OUTCOME MEASURE: The risk of increased disease activity as measured by the occurrence of exacerbations after weeks with stressful events. RESULTS: Seventy out of 73 included patients (96%) reported at least one stressful event. In total, 457 stressful life events were reported that were not related to multiple sclerosis. Average follow up time was 1.4 years. Throughout the study, 134 exacerbations occurred in 56 patients and 136 infections occurred in 57 patients. Cox regression analysis with time dependent variables showed that stress was associated with a doubling of the exacerbation rate (relative risk 2.2, 95% confidence interval 1.2 to 4.0, P = 0.014) during the subsequent four weeks. Infections were associated with a threefold increase in the risk of exacerbation, but this effect was found to be independent of experienced stress. CONCLUSION: Stressful events were associated with increased exacerbations in relapsing-remitting multiple sclerosis. This association was independent of the triggering effect of infections on exacerbations of multiple sclerosis.

Adolescent↗