Biomedical subjects
Publications and source records attributed to A W Cook.
The authors describe the effect of electrical stimulation of the spinal cord in multiple sclerosis. After considering the nature of multiple sclerosis, the authors describe the background, character, mode and method of delivering electrical fields to the spinal cord. The results of this form of treatment and the implications of these observations in terms of physiologic mechanisms are discussed.
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Paramyxovirus, presumably measles, has been recovered by cocultivation or cell-fusion techniques from jejunal biopsy specimens of 6 consecutive patients with multiple sclerosis. Virus has been identified by immunofluorescence of antigen in infected HEp-2 and BSC-1 cells, by electron microscopy, and by haemagglutination of rhesus-monkey erythrocytes.
Jejunal mucosa from 7 patients with amyotrophic lateral sclerosis (A.L.S.), 20 newly reported patients with multiple sclerosis (M.S.), and 35 control patients without either disease was studied by immunofluorescence. An immune reaction was present in all A.L.S. specimens and consisted of altered ratios of immunoglobulin-labelled cells in the lamina propria, complement-labelled cells in the same location, and, in some, immunoglobulin and complement deposits in the epithelial basement membrane. Poliovirus antigen was detected in 4 cases, and in 1 of the these cases measles antigen was also present. A fifth specimen showed large amounts of herpesvirus antigen. In 2 cases studied at necropsy, both viral infection and immunological change was confined to the proximal jejunum. Measles antigen was identified in every case of M.S., and in biopsy specimens from 16 of the 20 M.S. patients immunological reactions similar to those seen in A.L.S. were present. With 2 exceptions, the controls did not show these changes in the jejunal mucosa. The exceptions were a patient with Friedreich's ataxia, who had an increase of IgG-labelled cells and some complement-bearing cells in the lamina propria, and a patient diagnosed as having non-tropical sprue, in whom large quantities of herpes antigen were seen.
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We treated 40 patients who had multiple sclerosis and bladder symptoms with thoracic spinal cord electrical stimulation. Bladder and sphincter dysfunction was evaluated by cystometry and electromyography. Subjective improvement was noted in 77.5 per cent of the patients and documented improvement was found on cystometry and electromyography in 42.5 per cent. By electrical stimulation of the spinal cord we have demonstrated varying degrees of restoration of voluntary and reflex control of the bladder and sphincter.
The effect of commissural myelotomy in 24 cases with intractable pain is described. The operative technique employed with the operating microscope or magnifying glasses and a special myelotome is outlined. The results suggest an outstanding advantage in patients with bilateral metastases from malignancies except intrapelvic metastases. Patients with lumbar arachnoiditis showed a total failure of pain relief after 2 to 5 years, in spite of good relief temporarily.
Malabsorption tests were studied in 52 patients with multiple sclerosis. The stools were examined microscopically for fat and undigested meat fibers and were found to be abnormal in 41.6 and 40.9% respectively. Abnormally low five hour excretion of d-xylose was demonstrated in 26.6% cases. Malabsorption of Vitamin B12 was found in 11.9% cases. The jejunal mucosa was examined histologically and by tissue immune technic including viral studies. Histology showed normal mucosa in all except seven patients in whom an increased inflammatory infiltrate was present. Fluorescent antibody studies revealed the presence of measles virus antigen in all patients and immunofluorescent studies showed a variable degree of immune reaction in the majority of cases. The significance of these findings in the pathogenesis of multiple sclerosis is discussed.
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When electrodes were implanted in the spinal cord of a patient with MS--for dorsal column stimulation to relieve intractable pain--she regained considerable movement in her legs. Subsequently such stimulation has been employed in more than 70 other patients, and many have regained voluntary control over their arms, legs, and sphincters. The procedure is detailed and its implications are explored.
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