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Results for “SCLEROSIS, MULTIPLE”

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PubMed1989

Cyclosporin A curtails the progression of free light chain synthesis in the CSF of patients with multiple sclerosis.

Free light chains in the cerebrospinal fluid of patients with multiple sclerosis correlate closely with disease activity. As part of a double-blind placebo controlled trial of immunosuppression using cyclosporin A in patients with multiple sclerosis, light chain analysis was performed on pre- and post-treatment CSF samples in 19 patients, nine having received cyclosporin A and 10 placebo. The placebo treated patients showed continued immunological activity, as evidenced by an increase in both free kappa and lambda chains, but cyclosporin A treatment resulted in no change or an improvement in light chain response, indicative of suppression of continued activity. As cyclosporin A does not enter the CSF, this implies that systemic stimulation is at least partly responsible for continued disease activity in multiple sclerosis. Cyclosporin A may thus be effective in preventing the deterioration of patients with multiple sclerosis.

Adult↗

PubMed1998

The clinical value of commonly used spinal fluid diagnostic studies in the evaluation of patients with suspected multiple sclerosis.

OBJECTIVE: This study was designed to evaluate the diagnostic value of cerebrospinal fluid (CSF) oligoclonal banding and immunoglobulin G (IgG) production in the diagnosis of multiple sclerosis. STUDY DESIGN: Spinal fluid changes in patients with suspected multiple sclerosis were compared with clinical data to determine sensitivity, specificity, and predictive value of the procedures. The results were evaluated in terms of cost compared with clinical utility in the managed care environment. PATIENTS AND METHODS: The CSF oligoclonal banding and CSF IgG index were measured in 50 patients being evaluated for possible multiple sclerosis at a multispecialty group practice clinic. RESULTS: CSF oligoclonal banding had a sensitivity of 75% and a specificity of 92% in the diagnosis of multiple sclerosis. The CSF IgG index had a sensitivity of 75% and a specificity of 95% in the diagnosis of multiple sclerosis. CONCLUSIONS: Although neither test would identify 100% of patients with multiple sclerosis, the combination of CSF oligoclonal banding and an elevated CSF IgG index correctly identified most patients with multiple sclerosis and excluded all patients without the disease in this patient population.

Adolescent↗

PubMed2005

Effects of multiple sclerosis on respiratory functions.

OBJECTIVES: To measure respiratory functions of ambulatory patients with multiple sclerosis and compare the results with expected values from healthy general population data. Further, to study the correlation of respiratory function impairment with the multiple sclerosis-induced disability level. SUBJECTS: Thirty-eight patients with definite diagnosis of multiple sclerosis from the multiple sclerosis outpatient clinic. METHODS: The Expanded Disability Status Scale (EDSS) scores (mean 4.34+/-1.39) were evaluated to measure disability level. Respiratory functions tested in the laboratory included spirometric (FVC, FEV1, FEV1/FVC), maximal inspiratory (MIP) and expiratory (MEP) mouth pressure measurements. Patients were clinically assessed using a pulmonary dysfunction index (PDI) and dyspnoea index; various breathing features were also recorded. RESULTS: With respect to expected values from healthy general population, important decreases were found in mouth pressures with MIP (77%+/-23%, p approximately equal to 0) and MEP (60%+/-13%, p approximately equal to 0) while spirometric measures were significantly but less affected (FVC 94%+/-12%, p < 0.01, FEV1 91%+/-16%, p < 0.001). FEV1/FVC ratios were normal. Notable increases in PDI (5.58+/-0.68, p approximately equal to 0) and dyspnoea index (0.32+/-0.47, p approximately equal to 0) were observed. Significant relationships (p < 0.01) between respiratory function impairment and the multiple sclerosis disability level could be detected for FVC, MEP and PDI. CONCLUSIONS: Multiple sclerosis clearly impairs respiratory functions; maximal mouth pressures are more severely reduced. This impairment increases with multiple sclerosis-induced disability level but is found to be independent from duration of disease.

Adult↗

PubMed1965

Lipid studies in the blood and brain in multiple sclerosis and motor neurone disease.

The lipid patterns of plasma, red blood cells, and leucocytes from normal controls and from patients with multiple sclerosis and motor neurone disease have been studied by thin-layer chromatography. The fatty acid composition of cholesterol esters and lecithin in plasma from normal subjects and from patients with multiple sclerosis are reported. The fatty acid composition of lecithin of cerebral white matter from normal control subjects, from multiple sclerosis, and from motor neurone disease as well as of cholesterol esters in multiple sclerosis are recorded and compared. No significant abnormalities were found in the blood lipid profile in multiple sclerosis, but in motor neurone disease red cell sphingomyelin was slightly reduced and white cell lecithin slightly increased. The fatty acids of plasma cholesterol esters showed a slight decrease in palmitic and stearic acid in multiple sclerosis. The fatty acids in lecithin in multiple sclerosis, both in the apparently normal white matter and in the plaques, showed a slightly increased degree of saturation, while the loss of unsaturated acids was in oleic acids.

Brain↗

PubMed2004

Multiple sclerosis and gliomas. Clinical remarks on 10 cases and critical review of the literature.

The association between multiple sclerosis and tumours of the central nervous system is unusual. The authors analyzed the clinico-pathological elements of the correlation. The pertinent literature on this subject is critically reviewed. Ten cases of patients with an history of multiple sclerosis for more than 15 years and a clinical and radiological evidence of brain tumour were submitted to surgery in order to remove the lesion and/or to chemo- and radiotherapy. The various aspects of the association were studied in detail. A patient with multiple sclerosis, particularly with atypical symptoms, should be evaluated by an annual MRI investigation with intravenous paramagnetic contrast medium. The diagnostic work-up should be: clinical and radiological assessment; MRI in the event of atypical symptoms; Sstereotactic or neuronavigation-aided biopsy in any suspected lesions. Patients with multiple sclerosis and glioma present survival times identical to those observed in patients not suffering from multiple sclerosis. The coexistence of multiple sclerosis and brain tumours does not seem to influence the clinical evolution of either of these pathologies. We believe that it is important to achieve an early diagnosis of brain tumour in such patients with a clinical and neuroradiological follow up, so that they can be treated promptly.

Adult↗

PubMed1991

Empirical support for psychological profiles observed in multiple sclerosis.

Though increasing attention is being paid to psychological aspects of multiple sclerosis, much research continues to examine patients as differing in quantity rather than quality of psychological abnormality or response. Cluster analysis was used to identify distinctive psychological profiles in a large sample of patients with multiple sclerosis. It employed three measures, carefully chosen to capture the main responses historically observed in multiple sclerosis. These measures were (1) the patient's physical disability-impairment, assessed by a neurologist; (2) physical disability-impairment as perceived and reported by the patient; and (3) self-reported psychological well-being (or distress) independent of physical signs and symptoms. The optimal solution from the cluster analysis separated the 99 patients into 10 clusters, which were collapsed into four profiles, consistent with the labels "depression," "denial," "exaggerated somatic," and "severity-related." These data give strong empirical support to the existence of discrete and distinctive coping styles in multiple sclerosis.

Adult↗

PubMed1995

[Psychoses in multiple sclerosis--a reevaluation].

With the aim of reaching a new classification of psychoses with multiple sclerosis we reviewed the twentieth century literature for observations with regard to the subject, as well as 688 medical records of our patients, looking for the occurrence of paranoid and hallucinatory psychoses in the course of multiple sclerosis. Special attention was paid to the occurrence of cycloid psychoses. With multiple sclerosis, psychoses on the whole--but cycloid psychoses in particular--occur more frequently than in the general population. Women are affected just as frequently as men. Cycloid psychoses occur earlier in the course of the multiple sclerosis than the other psychoses; here, hallucinations occur with a higher frequency. Similar as in the case of HIV-infection, multiple sclerosis can act as a trigger of a cycloid psychosis. The results of our study indicate that men and women experience this disease as similarly threatening. A shortcoming of critical faculties based on the organic disease is an additional factor that favours the outbreak of such a psychosis.

Adult↗

PubMed1989

[Multiple sclerosis and psoriasis].

Among 51 patients with clinically probable multiple sclerosis three had typical chronic psoriasis. The incidence of psoriasis in the studies group of multiple sclerosis patients was higher (one case per 17 patients) than in the general population (one per 33 subjects). In all three cases psoriasis developed before the beginning of remitting multiple sclerosis and showed no correlation with the exacerbations of the neurological disease or with the degree of neurological function loss. The presence of histocompatibility antigens (HLA), immunopathological and biochemical changes in both diseases is discussed.

Adult↗

PubMed1986

A further study on the prevalence of multiple sclerosis in Sicily: Caltanissetta city.

The prevalence of probable multiple sclerosis (MS) in Caltanissetta city, Sicily, is at least 51 per 100,000. If possible multiple sclerosis patients are included, it is 54 per 100,000. This value is similar to that found in other cities in Sicily: Enna, Monreale and Agrigento. The high prevalence of multiple sclerosis in Caltanissetta confirms the previous data on Sicily and emphasises the importance of small population studies in the epidemiology of MS.

Adolescent↗

PubMed1988

Multiple sclerosis presenting as chronic atypical psychosis.

Two patients with multiple sclerosis are reported in whom psychopathological symptoms were present for many years. An exact psychiatric classification of the clinical syndrome was not possible. At no time during the illness were abnormal neurological findings observed. Multiple sclerosis was proven following necropsy in one patient. In the second patient a possible diagnosis of multiple sclerosis was made. This patient was found to have multiple lesions in the white matter which were evident on MRI and in the isoelectric focusing (IEF) of cerebrospinal fluid oligoclonal bands were found.

Adult↗

PubMed1991

Multiple sclerosis as a retroviral disease? Epidemiological considerations in relation to HTLV-I epidemiology.

The intrafamilial epidemiology of multiple sclerosis was compared with the known intrafamilial epidemiology of infections with HTLV-I. Infections with this retrovirus most often have a subclinical course, but can cause leukemia or a neurological disease resembling multiple sclerosis. Through the Danish Multiple Sclerosis Registry, information was obtained on 79 parent-child cases of multiple sclerosis, and in 55 cases further information was obtained through questionnaires. The study did not reveal any common intrafamilial pattern of MS and HTLV-I infections. It can be concluded that if multiple sclerosis is associated with a specific 'MS virus', it is hardly one with the same epidemiology as HTLV-I, maybe because MS could be a multifactorial disease only developing if various factors coincide in the same person.

Denmark↗

PubMed1999

Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups.

Sexual dysfunction is a very important but often overlooked symptom of multiple sclerosis. To investigate the type and frequency of symptoms of sexual dysfunction in patients suffering from multiple sclerosis, we performed a case-control study comparing 108 unselected patients with definite multiple sclerosis, 97 patients with chronic disease and 110 healthy individuals with regard to sexual function, sphincteric function, physical disorders impeding sexual activity and the impact of sexual dysfunction on social life. Information has been collected from a face-to-face structured interview performed by a doctor of the same gender as the patient. The disability, the cognitive performances, the psychiatric conditions and the psychological profile of patients and controls have been assessed. Sexual dysfunction was present in 73.1% of cases, in 39.2% of chronic disease controls and in 12.7% of healthy controls (P<0.0001). Male cases reported symptoms of sexual dysfunction more frequently than female cases (P<0.002). Symptoms of sexual dysfunction more commonly reported in patients with multiple sclerosis were anorgasmia or hyporgasmia (37.1%), decreased vaginal lubrication (35.7%) and reduced libido (31.4%) in women, and impotence or erectile dysfunction (63.2%), ejaculatory dysfunction and/or orgasmic dysfunction (50%) and reduced libido (39.5%) in men. Seventy-five per cent of cases, 51.5% of chronic disease controls and 28.2% of healthy controls (P<0.0001) experienced symptoms of sphincteric dysfunction. In conclusion, a substantial part of our sample of patients with multiple sclerosis reported symptoms of sexual and sphincteric dysfunction. Both sexual and sphincteric dysfunction were significantly more common in patients with multiple sclerosis than in either control group. Our findings suggest that a peculiar damage of the structures involved in sexual function is responsible for the dysfunction in patients with multiple sclerosis, but the highly significant lower frequency of symptoms of depression and anxiety in healthy controls may also imply a possible causative role of psychological factors.

Adult↗

PubMed2002

Hepatitis B vaccine and risk of multiple sclerosis.

The possibility that hepatitis B vaccine may cause or exacerbate multiple sclerosis stems from several case reports of onset or recurrence of symptoms of CNS demyelination shortly following vaccination. It is difficult, however, to infer causation from individual case reports since they may simply represent coincidental temporal associations with vaccination. There is only weak, nonspecific evidence to support the biological plausibility of an association between hepatitis B vaccine and multiple sclerosis. Epidemiological studies have found that hepatitis B vaccine does not increase the risk of developing multiple sclerosis or cause exacerbations. The US Institute of Medicine and other review panels have concluded that the evidence favors rejection of a causal association between hepatitis B vaccine and multiple sclerosis.

Demyelinating Diseases↗

PubMed1975

Visual evoked responses in the diagnosis and management of patients suspected of multiple sclerosis.

Averaged visual evoked responses to pattern reversal stimuli have been recorded in 54 control subjects, 51 patients with multiple sclerosis, and 55 patients with other neurological diseases which might involve the visual apparatus. The latency to the peak of the major positive potential in normal subjects under the age of 60 was 104 msec or less (mean 90-5 msec+3 SD). The latency of the VER was prolonged above this value in one or both eyes in 67 per cent of the patients with multiple sclerosis (in 84 per cent of those with definite multiple sclerosis, in 83 per cent of those with probable multiple sclerosis, and in 21 per cent of those with possible multiple sclerosis). The latency of the VER was also prolonged in 25 percent of those with an acute spinal cord lesion of unknown cause; in 46 per cent of those with an isolated brain-stem lesion unknown cause; and in 49 per cent of patients presenting with a progressive spastic paraparesis. The extra delay in latency varied from a few msec to as much as a 100 msec. In patients with multiple sclerosis, a delayed VER was found in the affected eye in all with a previous history of optic neuritis, and in 47 per cent of those with no such history....

Adolescent↗

PubMed2002

Brain atrophy in clinically early relapsing-remitting multiple sclerosis.

Brain atrophy measured by MRI is a potentially useful tool for monitoring disease progression in multiple sclerosis. The location, extent and mechanisms of brain atrophy in early disease are not well documented. Using quantitative MRI, this study investigated whole brain, grey and white matter atrophy in clinically early relapsing-remitting multiple sclerosis and its relationship to lesion measures. Data came from 27 normal control subjects (14 females and 13 males, mean age 36.1 years) and 26 subjects with clinically definite multiple sclerosis (18 females and eight males, mean age 35.1 years, mean delay from first symptom to scan 1.8 years, median Expanded Disability Status Scale score 1.0). All had three-dimensional fast spoiled gradient recall (3D FSPGR), T(1)-weighted pre- and post-gadolinium-enhanced and T(2)-weighted scans. The 3D FSPGR images were automatically segmented into grey and white matter and cerebrospinal fluid using SPM99. 3D FSPGR hypo-intense, T(2) hyper-intense, T(1) hypo-intense and T(1) post-gadolinium-enhancing lesion volumes were determined by semi-automatic lesion segmentation. The SPM99 output was combined with the 3D FSPGR lesion segmentations to quantify tissue volumes as fractions of total intracranial volumes, producing values for the brain parenchymal fraction (BPF), white matter fraction (WMF) and grey matter fraction (GMF). Comparing multiple sclerosis with control subjects, BPF, GMF and WMF were significantly reduced (P < 0.001 for all tissue fractions). Using Pearson correlations, T(2) hyper-intense and T(1) hypo-intense lesion volumes were inversely related to BPF (T(2) r = -0.78, P < 0.001; T(1) r = -0.59, P = 0.002) and GMF (T(2) r = -0.73, P < 0.001; T(1) r = -0.53, P = 0.006), but not WMF (T(2) r = -0.30, P = 0.134; T(1) r = -0.26, P = 0.199). T(1) post-gadolinium-enhancing lesion volumes were not correlated with any fractional volumes. These results indicate that significant brain atrophy, affecting both grey and white matter, occurs early in the clinical course of multiple sclerosis. The lack of correlation between lesion load measures and WMF suggests that pathological changes in white matter may occur by mechanisms which are at least partly independent from overt lesion genesis in early multiple sclerosis.

Adult↗

PubMed1993

Effects of neuropsychological treatment in patients with multiple sclerosis.

The chronic and progressive nature of multiple sclerosis (MS) often excludes patients from neuropsychological treatment. At the Multiple Sclerosis Rehabilitation Hospital, Haslev, 40 patients with mild to moderate cognitive and behavioral impairment associated with MS were randomized to either specific cognitive treatment (20 pts) by direct training, compensatory strategies and neuropsychotherapy, or to non-specific, deliberately diffuse mental stimulation (20 pts). Treatment was for a mean of 46 days. The effects of treatment were evaluated by neuropsychological tests before treatment, immediately after treatment (short-term effects) and 6 months later (long-term effects). After short-term treatment, effects on cognitive measures were not convincing, but on the Beck Depression Inventory (BDI) the specific cognitive treatment group reported significantly less depression. After 6 months only this group showed an effect, since the visuo-spatial memory was improved. However, the depression ratings (BDI) were almost maintained from the short-term level. Interestingly, the non-specific treatment group rated themselves as significantly more depressed. Conclusively, it is worth while to offer specific neuropsychological treatment to MS patients with cognitive and behavioral dysfunction.

Adult↗

PubMed1994

Pelvic floor function in multiple sclerosis.

The aim of this study was to define pelvic floor function in patients with multiple sclerosis and bowel dysfunction, either incontinence (MSI) or defecation difficulties without incontinence (MSC). Normal controls and patients with idiopathic neurogenic faecal incontinence without multiple sclerosis (FI, disease controls) were also studied. Thirty eight multiple sclerosis patients (20 incontinent, 18 incontinent) 73 normal controls, and 91 FI patients were studied. The FI group showed the characteristic combined sensorimotor deficit previously described in these patients of low resting and voluntary contraction and pressures, increased sensory threshold to mucosal stimulation, and increased pudendal nerve terminal motor latencies and fibre densities. MSI patients had significantly lower anal resting pressures (80 (30-140) cm H2O, median (range) v 98 (30-200), normal controls, p = 0.002) and both MSC and MSI patients had significantly lower anal maximum voluntary contraction pressures (65 (0-260) cm H2O, MSC and 25 (0-100), MSI v 120 (30-300), normal controls, p = < 0.0004) and higher external anal sphincter fibre densities (1.7 (1.1-2.6), MSC and 1.7 (1.1-2.4), MSI v 1.5 (1.1-1.75), normal controls, p < 0.006) compared with normal controls but pudendal nerve terminal motor latencies were similar and no sensory deficit was found. This contrasted with the idiopathic faecal incontinent patients who, in addition to significantly higher fibre densities (1.8 (1.1-3), p = 0.001) had increased pudendal latencies (2.5 (1.1-5.5) mS v 2.08 (1.4-2.6), p = 0.001) compared with normal controls. The idiopathic faecal incontinent group had significantly lower resting anal pressures (50 (10-160) cm H2O, p=0.02) than the MSI group. Comparison with the incontinent and continent multiple sclerosis groups showed that incontinence was associated with lower voluntary anal contraction pressures (25 (0-100) v 65 (0-260), p=0.03) but that there were no other differences between these two groups. Pelvic floor function is considerably disturbed in multiple sclerosis, showing muscular weakness with preservation of peripheral motor nerve conduction, providing indirect evidence that this is mainly a result of lesions within the central nervous system.

Adult↗

PubMed2004

Axonal loss in multiple sclerosis: a pathological survey of the corticospinal and sensory tracts.

Clinical, imaging, and pathological studies in multiple sclerosis have generally emphasized the relative preservation of axons in comparison with myelin. Recent evidence, however, demonstrates that axonal loss is also significant, affects long tracts such as the corticospinal and sensory tracts and relates closely to functional disability. Accordingly, the distribution and extent of this axonal loss is the focus of the current investigation. Post-mortem material of 55 multiple sclerosis patients and 32 matched controls was used to examine quantitatively the population of axons in the corticospinal tracts from the medulla to the lumbar spinal cord and the sensory tracts from the lumbar to the upper cervical spinal cord. Myelin- and axon-stained sections have been prepared to estimate the notional area and axon density, respectively of both tracts. Our results indicate that in the corticospinal tracts there is a significant reduction of the area and axon density at all levels investigated in multiple sclerosis cases when compared with controls. In contrast, the sensory tracts in multiple sclerosis cases showed a significant reduction in area and axon density only in the upper regions of the spinal cord. As has been found with MRI plaque load and T2 burden, correlations of axonal loss with duration of disease were not strong. Of the fibres lost in multiple sclerosis, we have found that small fibres (<3 microm2) seem to be particularly affected, with large fibres remaining relatively preserved in both the corticospinal and sensory tracts. In multiple sclerosis, axonal loss is widespread, and its extent is tract specific and size selective.

Adult↗