MS research in Switzerland.
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Forecasting↗
Biomedical subjects
J Kesselring
Publications and source records attributed to J Kesselring.
[The pathogenesis of multiple sclerosis].
Genetic factors determine susceptibility to multiple sclerosis (MS), and environmental factors influence the clinical manifestations of the disease. In recently formed plaques the blood-brain barrier is open for about 6 weeks. Water content is increased in white matter appearing normal macroscopically and in cortex of MS patients. Activated T-lymphocytes accumulate and stimulate microglia and macrophages, which initiate the demyelinating process. In chronic plaques astroglial cells form a scar tissue around axons devoid of myelin. Modern imaging techniques make it possible to differentiate inflammation and demyelination in vivo.
Adult↗
Acute disseminated encephalomyelitis. MRI findings and the distinction from multiple sclerosis.
Brain MRI was performed on 12 patients with acute disseminated encephalomyelitis (ADEM). Multifocal white matter lesions indistinguishable from those seen in multiple sclerosis (MS) were found in 10. In 5 there were rather extensive symmetric abnormalities in the cerebral (2) or cerebellar white matter (2), or basal ganglia (1). Follow-up MRI after intervals of 2 wks to 18 months demonstrated partial resolution of the abnormalities, but some persisting lesions. New MRI lesions were found at follow-up in only 1 case after an interval of 2 wks. Serial MRI makes a useful contribution to the distinction between MS and ADEM.
Acute Disease↗
Duration and selectivity of blood-brain barrier breakdown in chronic relapsing experimental allergic encephalomyelitis studied by gadolinium-DTPA and protein markers.
Gadolinium-DTPA (Gd-DTPA) enhancement seen with magnetic resonance imaging in chronic relapsing experimental allergic encephalomyelitis (CREAE) corresponded with sites of blood-brain barrier breakdown judged by traditional markers in areas of inflammatory demyelination. Duration of Gd-DTPA leakage for individual lesions in CREAE varied from 5 days to more than 5 wks. By contrast, in acute EAE leakage was of shorter duration (always less than 5 days). Selective enhancement was observed in CREAE lesions using Gd-protein markers. Gd-albumin enhancement was not always seen in areas of leakage of the smaller molecular weight compound Gd-DTPA. The addition of immunoglobulin to the gadolinium complex led to enhancement of lesions not seen with Gd-albumin alone. From the similarities between the histology and the patterns of Gd-enhancement in CREAE and multiple sclerosis, it is probable that Gd-enhancement reflects active inflammation (with or without demyelination) in the human disease.
Animals↗
[Neuroarthropathy, kyphoscoliosis and progressive tetraparesis in cervical syringomyelia].
The clinical picture of syringomyelia with special emphasis of its effects of the locomotor system is described on the basis of an individual case history. A 64 year old female patient experienced recurring subluxations of the right shoulder due to a neuroarthropathy. A marked throraco-lumbar kyphoscoliosis was present since childhood. The neurological picture was dominated by symmetrical muscular atrophy of both hands and an incomplete spastic paraparesis. Myelography of high cervical region shows an enlarged epidural space and atrophy of the myelon. MRI reveals a syrinx within the atrophied cervical spinal cord. Most likely the spinal cord has been enlarged and compressed from within by the syrinx which subsequently collapsed leaving the atrophied cervical spinal cord.
Arthropathy, Neurogenic↗
[Magnetic resonance tomography and multiple sclerosis].
Magnetic resonance tomography (MRI) is the imaging technique of first choice in diseases of the white matter of the central nervous system (CNS) including multiple sclerosis (MS). The signal changes observed are not specific, however, and have to be evaluated critically in the clinical context. The most difficult problems of differential diagnosis arise from other inflammatory diseases of the CNS like cerebral lupus, neurosarcoidosis, Behçet's syndrome and other vasculitides. MRI allows for the first time in vivo studies of the blood-brain barrier which is so important in MS pathogenesis. A great potential for MRI is in monitoring putative therapies in MS.
Adolescent↗
Human oligodendrocytes in dissociated cell culture.
Human oligodendrocytes have been successfully maintained in cell cultures for 14 weeks using a modification of a method used previously for animal brain cell cultures. Dissociated cell cultures from spinal cords of human foetuses of 10 to 20 weeks gestional age were investigated for up to 98 days. Oligodendrocytes were identified by monoclonal human antiserum specific for myelin-associated glycoprotein, by polyclonal rabbit antiserum against myelin basic protein, and by the mouse monoclonal antibody I6G1. Astrocytes were identified by polyclonal antibodies against glial fibrillary acidic protein. Immunocytochemical cell identification was corroborated by electron microscopy, by which glial cells were investigated both in situ and in culture. Immunocytochemical staining of myelin-associated glycoprotein showed specifically labelled oligodendrocytes on electron microscopy. The present study indicates that human oligodendrocytes, a putative target in demyelinating disease, can be studied in dissociated cell culture of human foetal spinal cord for several weeks in vitro under stable conditions.
Astrocytes↗
Quantitative magnetic resonance imaging in multiple sclerosis: the effect of high dose intravenous methylprednisolone.
Magnetic resonance imaging was performed on 50 patients with clinically definite or probable multiple sclerosis before and 15 days after starting treatment with intravenous methylprednisolone (0.5 g daily for 5 days). Scans were abnormal in 49 patients. New lesions had appeared on the second scan in nine individuals and in seven a single pre-existing lesion appeared to have become smaller but in no case were lesions seen to disappear. Two patients showed both reduction in the size of an abnormal area and development of a single new lesion indicating that corticosteroids do not appear rapidly to alter the process underlying plaque formation. Measurements of relaxation times were performed in 12 randomly selected patients. All showed elevated values in normal appearing white matter but not cortex before treatment compared with 18 healthy controls. After treatment a significant decrease of T1 and T2 was observed in cortex, and of T1 alone in normal appearing white matter. No significant change could be detected within lesions, a finding attributed to the wide range of relaxation values observed at these sites before treatment. Since brain water content is increased in normal appearing white matter of multiple sclerosis patients, and is significantly reduced by high-dose methylprednisolone, resolution of oedema may contribute to the rapid spontaneous or corticosteroid induced symptomatic recovery that characterises the disease in its early stages.
Adult↗
[Multiple sclerosis in the Bern canton (Switzerland). An epidemiologic study].
We conducted a study on the prevalence of multiple sclerosis in the canton of Berne (Switzerland) at the Department of Neurology (inpatient and outpatient sections) of the Inselspital hospital (University of Berne) in Berne. The canton of Berne is a heterogeneous region, geographically speaking, extending from the foot of the Jura mountains to high Alpine regions. There are approximately 920,000 inhabitants in an area of 6,000 square kilometers. Sources of our study were, besides the Department of Neurology of the University and the practising neurologists of Berne, the Association of Swiss Hospitals (VESKA) and the Swiss Multiple Sclerosis Society. For ensuring a safe diagnosis we employed a diagnosis score suggested by C. M. Poser et al (1983). This covered only safely established and probable cases of MS. To make sure of the actual residence of the retrospectively assessed patients we conducted a checkup with the relevant authorities. Besides personal data it was also possible, in a majority of patients, to obtain data on the onset and course of the disease. On 1, 1, 1986 1,016 MS patients were residents in the canton of Berne, according to our investigations. This corresponds to a prevalence rate of 110 MS patients for every 100.000 inhabitants. The sex ratio (female/male) is about 1.8: 1. The average age of the MS patients covered by the study was 50 years with an average duration of the disease of 18 years. From the data concerning the course of the disease our study was able to gain further pointers on the beginning of the disease, on the pattern of symptoms, course of the disease, and progression of multiple sclerosis.
Adolescent↗
[Involuntary movements in multiple sclerosis].
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Central Nervous System↗
Clinical data bank at the University Department of Neurology, Bern, Switzerland: basis for an epidemiological study of multiple sclerosis in a high prevalence area.
Clinical and laboratory data for over 1000 patients with definite multiple sclerosis living on prevalence day January 1st, 1986 in the Swiss Canton of Bern, a geographically heterogeneous region, are analysed retrospectively by means of a specially developed computer system. The consequent application of the "Minimal Record of Disability" (MRD) as proposed by the IFMSS forms the basis of data sampling. Details of clinical aspects gained from these records are presented together with an account on the applicability of this system in collaborative epidemiological investigations, for which the now ongoing prospective study based on the aforementioned retrospective one at our Institution may serve as an example.
Adolescent↗
[Polyneuropathy, organomegaly, endocrinopathy and skin changes in a case of solitary myeloma].
The case is reported of a 32-year-old woman with polyneuropathy, organomegaly, edema, endocrinopathy, dark skin and solitary myeloma with monoclonal gammopathy of IgG/lambda type. More than 100 cases of this rare disorder have been observed up to now, mainly in Japan. In recent reviews the terms POEMS-syndrome or Crow-Fukase-syndrome have been used. Local radiotherapy of the myeloma led to lasting regression of symptoms. Studies with immunocytochemistry and immunoelectroblotting revealed specific antibody activity against hypophysis, suggesting that the pathologic monoclonal myeloma antibodies may damage the neuroendocrinic centers in hypothalamus and hypophysis as the primary target. Most of the multisystemic symptoms would thus be explained as secondary alterations.
Adult↗
[Atypical neurologic symptoms in the course of acquired immunodeficiency syndrome (AIDS)].
Unusual neurological symptoms were observed in three homosexual men in whom antibodies against HTLV-III were demonstrated. In case 1, with a known Kaposi sarcoma, multiple intracerebral space-occupying lesions with severe perifocal oedema resulted in marked focal neurological deficits. In case 2, there occurred a transitory myelopathic syndrome lasting a few days, followed by severe retinal changes, associated with a generalized cytomegalic infection, and a cerebrovascular accident in the brainstem. In case 3, a severe myositis especially of the shoulder girdle was diagnosed and treated one year before the demonstration of the HTLV-III infection. The pathogenetic relationship between these illnesses and the HTLV-III infection remains unexplained.
Acquired Immunodeficiency Syndrome↗
[Neurologic manifestations in acquired immunodeficiency syndrome (AIDS)].
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Acquired Immunodeficiency Syndrome↗
[Paroxysmal phenomena in multiple sclerosis].
Paroxysmal phenomena are rare but relatively typical, and occasionally initial, clinical symptoms of multiple sclerosis. They should be recognized since they can serve as clinical indicators of the disease and can be treated efficiently with carbamazepine. Such shortlived clinical symptoms and signs are probably caused by ephaptic transmission due to myelinoaxonal dissociation within the demyelinated plaque. The clinical picture, pathophysiology and treatment of these disorders are discussed.
Brain Stem↗
Cellular distribution of 04 antigen and galactocerebroside in primary cultures of human foetal spinal cord.
The distribution of cell-surface 04 antigen and galactocerebroside (GC) was examined by dual-label indirect immunofluorescence assays on live primary cultures of human spinal cord cells dissociated from 8-12 week-old foetal tissue. Oligodendrocytes expressing GC on their surface were present in the cultures at early time points, and all GC-positive cells were found to also express cell-surface 04 antigen. The 04 antigen was found additionally on a further population of GC-negative cells in the spinal cord cultures, which did not react with antibodies to glial fibrillary acidic protein (GFAP), and were distinct from neuronal cells and cell processes which stained with anti-neurofilament antibody. Previous studies in mouse neural cell cultures have shown that 04 antigen-positive cells are direct precursors to GC-bearing oligodendrocytes (Schachner et al. 1982). In the human spinal cord cultures, a rapid decline in the number of cells expressing GC and/or the 04 antigen to a value below 1% was observed during the first 3 days in vitro. The present studies indicate that synthesis of GC occurs in the human spinal cord many weeks before myelination commences in vivo and that GC-negative oligodendrocyte precursors are present simultaneously with more mature GC-positive cells. In addition, it would appear that complex humoral or cellular ingredients may be required for the long-term in vitro maintenance of viable human foetal oligodendrocytes.
Antigens, Surface↗
[Therapy of acute lumbar disk herniation].
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Chymopapain↗
[Therapy of multiple sclerosis].
The present position on treatment of multiple sclerosis, which is to attempt to modify the course of the disease, has not produced satisfactory results to date. Hence there is all the more reason for making assiduous efforts to relieve symptoms, prevent complications and ameliorate the social, economic and psychological consequences of the disease.
Adrenocorticotropic Hormone↗