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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↗
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↗
PubMed2006

Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents.

OBJECTIVE: To examine adjustment in children of a parent with multiple sclerosis within a stress and coping framework and compare them with those who have 'healthy' parents. SUBJECTS: A total of 193 participants between 10 and 25 years completed questionnaires; 48 youngsters who had a parent with multiple sclerosis and 145 youngsters who reported that they did not have a parent with an illness or disability. METHOD: A questionnaire survey methodology was used. Variable sets included caregiving context (e.g. additional parental illness, family responsibilities, parental functional impairment, choice in helping), social support (network size, satisfaction), stress appraisal, coping (problem solving, seeking support, acceptance, wishful thinking, denial), and positive (life satisfaction, positive affect, benefits) and negative (distress, health) adjustment outcomes. RESULTS: Caregiving context variables significantly correlated with poorer adjustment in children of a parent with multiple sclerosis included additional parental illness, higher family responsibilities, parental functional impairment and unpredictability of the parent's multiple sclerosis, and less choice in helping. As predicted, better adjustment in children of a parent with multiple sclerosis was related to higher levels of social support, lower stress appraisals, greater reliance on approach coping strategies (problem solving, seeking support and acceptance) and less reliance on avoidant coping (wishful thinking and denial). Compared with children of 'healthy' parents, children of a parent with multiple sclerosis reported greater family responsibilities, less reliance on problem solving and seeking social support coping, higher somatization and lower life satisfaction and positive affect. CONCLUSIONS: Findings delineate the key impacts of young caregiving and support a stress and coping model of adjustment in children of a parent with multiple sclerosis.

Adaptation, Psychological↗
PubMed1994

The fornix in patients with seizures caused by unilateral hippocampal sclerosis: detection of unilateral volume loss on MR images.

OBJECTIVE: Because some of the axons of the fornix originate in the pyramidal cells of the hippocampus, we hypothesize that neuronal loss within the hippocampus may result in wallerian degeneration and subsequent atrophy of the ipsilateral fornix. Using high-resolution MR imaging, we evaluated the size of the fornix in patients who had lateralizing partial complex temporal lobe seizures after unilateral hippocampal sclerosis. The expectation is that unilateral forniceal atrophy will provide an additional, objective imaging criterion for determining the side of seizure involvement. MATERIALS AND METHODS: We retrospectively reviewed preoperative MR images of 13 patients with temporal lobe epilepsy who subsequently had unilateral hippocampal sclerosis proved surgically. The images were obtained with specially designed bilateral phased-array coils that permitted high-resolution (512 x 512, 16-cm field of view) T2-weighted fast spin-echo imaging of oblique coronal sections. The width of each rostral crus of the fornix was measured by three neuroradiologists who did not know the patients' history and surgical findings, and consensus measurements were obtained. The side with the smaller fornix was interpreted as abnormal. All 13 patients had lateralizing findings on EEG, unilateral anterior temporal lobectomy, and histologic findings of hippocampal sclerosis. RESULTS: The fornix was smaller on the side of hippocampal sclerosis in 12 (92%) of 13 patients. The percentage of asymmetry between the fornices (smallest/largest x 100) varied from 41% to 82% (mean, 68%). CONCLUSION: Our experience indicates that volume loss in the ipsilateral crus of the fornix can be seen on MR images in patients with unilateral hippocampal sclerosis. The size of the fornices should be analyzed in all patients being examined for temporal lobe epilepsy, as asymmetry in the size of the fornices may reveal the side of hippocampal sclerosis. Such knowledge can assist in the preoperative workup of patients with intractable temporal lobe epilepsy related to hippocampal sclerosis.

Atrophy↗
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↗
PubMed2000

[What's new in primary lateral sclerosis?].

Primary lateral sclerosis as a nosological entity distinct from amyotrophic lateral sclerosis has been the subject of controversy since it was first described in the nineteenth century. Primary lateral sclerosis has been defined as a rare, non-hereditary disease characterized by highly progressive spinobulbar spasticity, related to the exclusive loss of precentral pyramidal neurons, with secondary pyramidal tract degeneration and preservation of anterior horn motor neurons. We carried out a study in nine patients with a diagnosis of primary lateral sclerosis. Our clinical, electrophysiological and pathological investigations provide evidence that the disease has a heterogeneous clinical presentation and that degeneration is not restricted to the central motor system but also affects the lower motor neuron. In view of this similarity with amyotrophic lateral sclerosis, primary lateral sclerosis may represent a slowly progressive syndrome closely related to motor neuron disease and amyotrophic lateral sclerosis.

Adult↗
PubMed2000

Sclerosis of the third carpal bone. A prospective study of its significance in a group of young standardbred trotters.

To assess the significance of radiographic signs of sclerosis of the third carpal bone (C3) in young Standardbred trotters in relation to performance, lameness and bone turnover both carpi in 14 Standardbred trotters were radiographically and scintigraphically examined 6 times, from the beginning of speed training until the beginning of racing, between the mean ages of 20 and 42 months. At the end of the study 8 horses had raced in official qualifying races and 14 limbs in 11 horses had been diagnosed with carpal lameness. All horses but 2 developed sclerosis and all but one had increased bone turnover in the C3 area by scintigraphy. C3 sclerosis increased continuously over time and with increased performance. Carpal lameness was significantly associated with progression of sclerosis but in most cases sclerosis developed without concomitant signs of carpal lameness. No association between carpal lameness and increased scintigraphic uptake was found, but horses that had qualified for racing had significantly higher C3 to carpus ratio of radiopharmaceutical uptake. We conclude that there is a continuous increase in C3 radiographic sclerosis with time in young Standardbred trotters in professional training, but radiographic sclerosis appears to be of limited value as an indicator of clinical carpal disease or level of performance in Standardbred trotters.

Animals↗
PubMed2001

[Vesico-sphincter dysfunction in 108 cases of multiple sclerosis].

OBJECTIVE: To study vesicosphincteric dysfunction in 108 patients with multiple sclerosis. METHODS: We reviewed the clinical records of 108 patients with multiple sclerosis and analyzed those with voiding symptoms ascribable to multiple sclerosis. These patients underwent complete urodynamic assessment and complementary tests according to their symptoms. The Blaivas classification was used for the clinical classification of multiple sclerosis. RESULTS: 64 of the 108 patients presented voiding symptoms ascribable to multiple sclerosis (59.2%). The clinical features presented as episodes in 75% and were progressive in 25% of the cases. In 6% of the patients, the voiding symptoms were the first symptoms of multiple sclerosis. Urodynamic assessment showed detrusor hyperreflexia in 73% of the patients, hyporeflexia in 14%, and 13% showed normal urodynamics. All complications were infective; no patient showed upper urinary tract complications. CONCLUSIONS: Vesicosphincteric dysfunction in multiple sclerosis is frequent. Most of the patients present bladder hyperreflexia. The urological complications are usually infective. Involvement of the upper urinary tract is rare.

Adult↗
PubMed2001

[Genetic factors in multiple sclerosis].

GENERAL DATA: The clinical manifestations and neuropathological signs of multiple sclerosis have been recognized for more than one hundred years, but the cause remains unknown. EPIDEMIOLOGY: Multiple sclerosis is not evenly distributed throughout the world. There is an important north-south gradient in the northern hemisphere and inversely in the southern hemisphere; multiple sclerosis is more frequent in the higher altitudes. For a given latitude, there is a difference by ethnic origin. These observations indicate that multiple sclerosis is a multifactorial condition determined by both genetic and environmental factors. STRATEGIES OF GENETIC STUDIES: Progress in our knowledge of the human genome and statistical analysis techniques have made it possible to search for genetic factors in multiple sclerosis using two complementary approaches. The first is by anonymous screening and the second is to search for a candidate gene. The HLA locus is the only one with an identified predisposing effect for multiple sclerosis. It only accounts for 10 to 20% of the genetic predisposition for multiple sclerosis and many factors remain to be discovered.

Genetic Predisposition to Disease↗
PubMedDate not supplied

[Cognitive impairment, clinic forms and progression in multiple sclerosis].

INTRODUCTION: Multiple sclerosis-related cognitive impairment is an important clinical dimension of the disease by virtue of its prevalence and its functional significance. It is directly related to cerebral multiple sclerosis pathology, but relatively independent of physical impairment. DEVELOPMENT: Thus, the assessment of neuropsychologic outcomes complements the assessment of physical outcomes in multiples sclerosis clinical trials. Neuropsychologic measures fulfill most of the criteria identified for an optimal multiple sclerosis clinical outcome measure. Major drawbacks to their current use in assessing clinical trial outcomes are the heterogeneity inherent in neuropsychological test performance(both cross-sectionally and longitudinally), and limitations in our knowledge about the evolution of multiple sclerosis- related cognitive impairment and the psychometric properties of specific measures over time. At this point in time, we cannot identify the single "best" measure for assessing neuropsychologic change in multiple sclerosis patients, and we cannot specify what constitutes clinically significant change. Analyses of neuropsychologic data from recently completed trial will soon provide an empirical basis for selecting measures to use in future multiple sclerosis clinical trials and specifying criteria for clinically significant change on these measures.

Cognition Disorders↗
PubMed2003

[Proliferative retinal vasculitis and multiple sclerosis: a case report].

INTRODUCTION: Retinal periphlebitis can precede the neurological effects of multiple sclerosis and reveal the disease. Although these occurrences of vasculitis are noted in 10% - 35% of multiple sclerosis patients, proliferative retinopathy is, on the contrary, an exceptional complication. CASE REPORT: We report the case of a 28-year-old woman who presented bilateral, proliferative, retinal vasculitis complicated with recurrent vitreous hemorrhages occurring with multiple sclerosis. Initially, there was a unilateral, central venous thrombosis in a particularly ischemic and proliferative form. After a neurological, biological and radiological check-up, the diagnosis of multiple sclerosis was pronounced and treatment with Interferon was started. A pan-retinal laser photocoagulation and vitrectomy with proliferative membrane peeling were performed. After a follow-up of 2.5 years, a bilateral epiretinal membrane on the macula with a chronic macular edema persisted, with visual acuity limited to 0.2 Parinaud 4 in the right eye and 0.5 Parinaud 2 in the left eye. DISCUSSION: This case shows that the diagnosis of multiple sclerosis must be established in cases of ischemic retinal vasculitis, especially as the literature does not seem to report a correlation between the retinal vascular affect and how far multiple sclerosis has progressed. Moreover, the visual prognosis of these proliferative lesions remains uncertain. CONCLUSION: Multiple sclerosis can be revealed initially, although exceptionally, by bilateral, proliferative and severe retinal vasculitis complicated with recurrent vitreous hemorrhages and tractional retinal detachment.

Adrenal Cortex Hormones↗
PubMed2005

The ependymal "Dot-Dash" sign: an MR imaging finding of early multiple sclerosis.

BACKGROUND AND PURPOSE: Corpus callosum lesions are of specific interest in the evaluation of suspected multiple sclerosis in brain MR imaging. Using thin-section sagittal fluid-attenuated inversion recovery images, researchers have shown that the finding of "subcallosal striations" correlates significantly with the diagnosis of multiple sclerosis. Using the same MR imaging technique, we describe a finding of ependymal irregularity that we call the "Dot-Dash" sign, which we believe to be associated with early multiple sclerosis. METHODS: Sagittal 2-mm fast fluid-attenuated inversion recovery images were obtained in 70 patients. Thirty-five patients had multiple sclerosis according to the Poser criteria, and 35 were age-matched controls. The images were reviewed in a blinded fashion by an experienced neuroradiologist for the presence or absence of the Dot-Dash sign. RESULTS: The correlation between the Dot-Dash sign and definite clinical multiple sclerosis is highly significant (P < .001), with a sensitivity of 91.4% and a specificity of 65.7%. In the age group of < or =50 years, the sensitivity was 95.7% and the specificity, 71.9%. CONCLUSION: The Dot-Dash sign of ependymal irregularity on thin-section sagittal fluid-attenuated inversion recovery images is an early marker for multiple sclerosis, which is particularly useful in the younger patient. This finding appears to be more sensitive for early lesion detection than any other multiple sclerosis imaging finding yet described in the literature.

Adolescent↗
PubMed2006

[Infection by Epstein-Barr virus and multiple sclerosis].

INTRODUCTION: Multiple sclerosis is the most important disabling neurological disease in young adulthood in our environment. However, its etiology remains unknown. It has been proposed that multiple sclerosis is caused by an interaction of genetic and environmental factors. In particular, Epstein-Barr virus infection could play a fundamental role in the pathophysiology of multiple sclerosis. METHODS: We have reviewed the most recent and important bibliography, both from epidemiologic and basic research studies, dealing with the possible association between Epstein-Barr virus infection and multiple sclerosis. RESULTS: Retrospective and prospective epidemiologic studies suggest a direct association between Epstein-Barr virus infection and the risk of multiple sclerosis. Several physiopathologic mechanisms, including molecular mimicry and bystander activation, could be responsible for this association. CONCLUSIONS: Based on the published evidence, Epstein-Barr virus infection can be considered to have a causal role in the etiology of multiple sclerosis. Further research should be conducted to elucidate the mechanisms underlying this association and to assess its potential for multiple sclerosis prevention and treatment.

Epidemiologic Studies↗
PubMedDate not supplied

[Erythrocyte complement receptor (C3b) expression in multiple sclerosis].

The study was carried out in 121 patients with multiple sclerosis and a control group of 519 healthy individuals. In 13 cases of multiple sclerosis and 12 controls family studies were carried out. Complement receptors (C3bR) on the erythrocytes were demonstrated by the haemagglutination test using human IgG heat-aggregated and guinea pig serum which served as a source of complement. On the basis of haemagglutination intensity and results of radioimmunoassay three phenotypes of complement receptor were isolated: high HH(C3bRh/C3bRh) producing strong agglutination, medium HL (C3bRh/Cbl) producing weak agglutination, and low phenotype LL (C3bR1/Cbl) in which no visible agglutination of erythrocytes was noted. Considerable differences were observed in the distribution of these phenotypes between controls and multiple sclerosis patients in whom the low phenotype (C3bR1/C3bR1) was more frequent. Family studies of controls suggested presence of two codominant alleles C3bRh and C3bR1 with Mendelian inheritance while similar studies of multiple sclerosis patients it was found that e.g. a child with multiple sclerosis whose parents had high C3bR phenotypes, that it were homozygotes for the C3bRh gene, had low phenotype. On the other hand, the high phenotype was found in a child of a female multiple sclerosis patient with the low phenotype (C3bR1/C3bR1). These observations suggest that reduced expression of the complement receptor on the erythrocytes depends in multiple sclerosis on the disease process in the first place, and not on genetic factors.

Adult↗
PubMed1981

Relative value of three laboratory methods in the diagnosis of multiple sclerosis.

We compared three methods of analysis for IgG in cerebrospinal fluid, using samples from 158 patients with clinically suspected multiple sclerosis and from 200 neurological controls. The tests were: search for oligoclonal bands, calculation of rate of synthesis of IgG in the cerebrospinal fluid, and determination of the IgG/albumin ratio. Paired cerebrospinal fluid and serum samples were collected and their IgG and albumin concentrations measured. Oligoclonal bands were detected by electrophoresis on agarose. Positive results were obtained in 94, 75, and 67% of patients with probable or definite multiple sclerosis by the three respective methods. In contrast, for patients for whom the clinical diagnosis of multiple sclerosis was considered possible, positive results were obtained in 10, 43, and 13%, respectively. Evidently, detection of oligoclonal bands remains the best single test for the presence of abnormal IgG in suspected multiple sclerosis patients. A combination of the first two tests is most sensitive for both probable and definite multiple sclerosis (97%) and possible multiple sclerosis (50%). Some infectious or immunologic disorders can also produce these IgG abnormalities, but they can usually be distinguished from multiple sclerosis by other clinical and laboratory data.

Diagnosis, Differential↗
PubMed1980

Role of intrarenal vascular sclerosis in progression of poststreptococcal glomerulonephritis.

A comparison has been made of the percentage of sclerotic glomeruli found in normal subjects and in 31 patients 6 months to 15 years after an episode of acute poststreptococcal glomerulonephritis (PSGN). The findings establish that a greater than expected incidence of glomerular sclerosis occurs in the course of PSGN. The pattern of glomerular sclerosis frequently was that of contracted collapsed tufts, one known to result from ischemia. In the majority of specimens with significant glomerular sclerosis, there was co-existent vascular sclerosis (arterioles and/or prearterioles), and the incidence of both glomerular and vascular sclerosis increased with time from onset of PSGN. Intrarenal vascular sclerosis may thus be of major importance in the genesis and progression of glomerular sclerosis in PSGN.

Adolescent↗
PubMed1975

Multiple sclerosis: some epidemiological clues to etiology.

The diagnosis of multiple sclerosis is frequently made with undue haste and without a firm basis. A false positive diagnosis is made in about 20 to 30% of the cases originally labeled as multiple sclerosis. The proportion of false positive diagnosis is probably still higher in countries where this disease is less frequent. An exhaustive investigation (neurological, clinical, neurorradiological, isotopic, etc.) is necessary before accepting such a diagnosis. This is particularly important because many of the lesions which can masquerade as multiple sclerosis are amenable to medical or surgical treatment. The prevalence of multiple sclerosis varies widely throughout the world, with a very definite preference for the white race. This difference seems to be caused, at least in part, by dietary habits. Lack of breastfeeding and excessive consumption of cow's milk during infancy is postulated as an important factor in the appearance of multiple sclerosis later in life. A lack of essential fatty acids (and may be of certain minerals and vitamins) in such a diet during pregnancy and childhood may result in the synthesis of abnormally unstable myelin. This underlying deficiency in myelin composition may be the substrate on which immunological factors act to produce the disease. The breakdown of this unstable myelin may be initiated by a variety of factors; natural decay of abnormally weak bonds in proteolipids, viral infection, immune reactions or even trauma. Immune reactions can explain, at least in part, the onset and the course of the disease, and probably immunodeficiency is the most important factor. Demyelination, once it starts, may continue until all abnormally formed myelin is destroyed, or until the building up of immunological defenses can stop the process. It follows from this that prevention of multiple sclerosis should be based mainly on dietic measures which ensure a sufficient supply of essential fatty acids, minerals and vitamins, during pregnancy and childhood. Breast feeding is probably the most important preventive factor. Skin pigmentation, either natural or from exposition to sunshine also seems to act as a preventive factor, and its mode of action deserves further investigation. Treatment of multiple sclerosis should be based on the improvement of immunological defenses, the elimination of possible allergens and saturated fats from the diet, and on the administration of sufficient amounts of essential fatty acids and of other various elements.

Adolescent↗
PubMed1996

Chronic renal failure and its treatment in tuberous sclerosis.

BACKGROUND: Chronic renal failure is rare in tuberous sclerosis, but its precise frequency is not known and treatment modalities have not been evaluated. METHODS: A questionnaire was addressed to the 260 French dialysis centres and the characteristics of 65 patients with tuberous sclerosis and chronic renal failure were analysed. RESULTS: In France the approximate prevalence of tuberous sclerosis with end-stage renal failure is 0.7 cases per million and that of end-stage renal failure in tuberous sclerosis 1 per 100. Tuberous sclerosis with chronic renal failure was more frequent in females (63.1%) and was diagnosed at a mean age of 29 years. Renal impairment was the first manifestation of tuberous sclerosis in about half the cases. Renal tumours were frequent, with angiomyolipomas in 15 cases (23.1%), cysts in 12 cases (18.5%), and both in 35 cases (53.8%). Malignancies were associated in nine cases (13.8%). Nephrectomy was done before dialysis in 21 cases (32.3%), and after the start of dialysis in six cases (9.2%). All but one of the 48 patients with end-stage renal failure were treated by dialysis; 20 were transplanted, with good results. CONCLUSIONS: Tuberous sclerosis with end-stage renal failure is rare. These patients require dialysis and renal transplantation, but we recommend binephrectomy after starting dialysis and before transplantation, given the risk of cancer and bleeding related to angiomyolipomas.

Adult↗