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PubMed2001

[Daily life activities and multiple sclerosis].

The onset of Multiple Sclerosis usually concerns young adults who are making plans for their life. The personal, familial, professional plans must be adapted to the course of the disease. This adapted daily life must be as normal as possible to prevent the social loneliness which is the principal complication of Multiple Sclerosis. Three frequent situations of daily life have recently been studied in Multiple Sclerosis. Pregnancy is permitted. There is a dramatic decrease of the relapse rate during pregnancy but an obvious increase after delivery. Pregnancy has no influence on disability. Vaccinations do not favor the onset or the worsening of Multiple Sclerosis according to studies with large number of patients (in particular hepatitis B vaccination). Stress is not able to trigger the onset or relapses of Multiple Sclerosis. Stress could even protect against relapses. The Multiple Sclerosis daily life does not need to take specific precautions which would expose to the marginalization of patients.

Activities of Daily Living↗
PubMed2001

[Optical involvement in multiple sclerosis. Results of a cross-sectional study with 57 patients from Martinique].

INTRODUCTION: The optical disease observed concurrent with multiple sclerosis is poorly known in blacks because of the rare occurrence of this pathology in the black population. The few studies currently available suggest more severe problems in black subjects than in Caucasians. Martinique has subjects who are genetically close or even identical but who acquired multiple sclerosis in two very different endemic areas: some in Martinique and others in France. PATIENTS AND METHODS: We performed an ophthalmological transversal descriptive study in a population of 57 black multiple sclerosis patients living in Martinique, selected according to the Poser criteria. Patients were divided into two groups: an M group (26 cases) made up of patients who had never left Martinique or the West Indies and an FM group (31 patients) made up of patients who had lived at least one year in France between the ages of 5 and 15. RESULTS: At least one episode of retrobulbar optic neuritis was observed in 16 cases (61.5%) in the M group and in 11 cases (31.5%) in the FM group. The number of eyes with either one episode or more of retrobulbar optic neuritis or papillitis was higher in the M group, 26 cases (50%) than in the FM group, 14 cases (22.6%). Multiple sclerosis began by a disease of the optic nerve in 12 cases (46%) in the M group and in 7 cases (22.6%) in the FM group. The mean visual acuity is 20/30 in the M group and 20/20 in the FM group. The mean value of the p 100 wave was 131 ms in the M group and 113 ms in the FM group. DISCUSSION: Multiple sclerosis observed in the black population living in Martinique (M group) is characterized by frequent and severe visual problems. The visual phenotype of the FM group is quite similar to the visual phenotype of Caucasians. More than ethnic and genetic factors, the tropical area of acquisition should have an influence on the visual phenotype. For unknown reasons, the optical problems appear severe when multiple sclerosis is acquired in a low endemic area.

Adolescent↗
PubMedDate not supplied

[Matrix metalloproteinase-9 (MMP-9) activity in cerebrospinal fluid of amyotrophic lateral sclerosis patients].

Matrix metalloproteinase-9 (MMP-9) is a member of the family of zinc-dependent endopeptidases that degrade extracellular matrix proteins. It can be activated by serine proteinases or by superoxide radicals. The motor neurons in amyotrophic lateral sclerosis patients express significantly higher levels of MMP-9, suggesting a role in neurodegeneration. The aim of the study was to investigate MMP-9 in cerebrospinal fluid from amyotrophic lateral sclerosis patients. MMP-9 was measured by enzyme-linked immunosorbent assay ELISA in cerebrospinal fluid from 24 amyotrophic lateral sclerosis patients and 15 controls. The mean amyotrophic lateral sclerosis duration was 18 months. According to Munsat ALS Health State Scale, the patients were divided into four groups: mild, moderate, severe, terminal. The patients were also divided into groups with shorter (below 12 months) and longer (above 12 months) duration of the disease. MMP-9 level was insignificantly lower in the cerebrospinal fluid from amyotrophic lateral sclerosis patients compared with controls. MMP-9 level showed a tendency to decrease with clinical status worsening, however this correlation was not statistically significant. The difference between MMP-9 level in the cerebrospinal fluid between the groups of patients with shorter and longer duration of amyotrophic lateral sclerosis was not significant.

Aged↗
PubMedDate not supplied

[A control and case study of multiple sclerosis in the Alicante and Villajoyosa areas].

INTRODUCTION: Three studies have been carried out in the area of Alcoy (Spain) which show an association between contact with dogs and multiple sclerosis. We present a control and case study conducted in a different geographical area, the area of Alicante. AIMS. To examine environmental factors linked with multiple sclerosis in the health care district of Alicante, and to compare findings with those from the health care district of Alcoy. PATIENTS AND METHODS: A study of cases and controls was conducted with 47 patients, each of which was paired with four controls according to gender, age and place of residence. All the cases fulfilled criteria of defined multiple sclerosis. The controls were obtained from the Emergency and Casualty Services at different hospitals in the area. Each of the environmental factors studied was stratified by genders. RESULTS: A total of 47 patients and 188 controls were analysed. A statistically significant association was found between the disease and smoking, a low educational level, a social level 2 on the classification developed by Koch Henriksen, having had measles before the age of 15 and contact with dogs. The fact of being the third, or later, child in a family and a family history of cephalea were more frequent among controls than among cases. CONCLUSIONS: Multiple sclerosis in the Alicante area is related with contact with dogs, smoking, a low educational level, a high social level and measles before the age of 15. Since an association between contact with dogs and multiple sclerosis has been shown repeatedly in other previous studies conducted in the town of Alcoy, we are now in a position to state that this factor is indeed linked with the appearance of multiple sclerosis.

Adult↗
PubMed2003

Anterior temporal changes on MR images of children with hippocampal sclerosis: an effect of seizures on the immature brain?

BACKGROUND AND PURPOSE: Ipsilateral loss of anterior temporal gray-white matter definition, due mainly to white matter signal intensity abnormality, is frequently seen on MR images of patients with hippocampal sclerosis. Our aim was to determine the prevalence and clinical correlations of these anterior temporal changes in pediatric cases of hippocampal sclerosis and to determine whether cumulative damage from seizures is important for their development. METHODS: We reviewed the MR images and clinical details of 54 children (age range, 1.5-19 years) with typical hippocampal sclerosis. Specific imaging features noted included hippocampal sclerosis, anterior temporal changes, anterior temporal atrophy, and extra-hippocampal abnormality. RESULTS: Thirty-one (57%) of 54 children with hippocampal sclerosis had associated ipsilateral anterior temporal changes. Ipsilateral anterior temporal atrophy was associated with anterior temporal changes (P <.03). Children whose images showed anterior temporal changes were younger at onset of epilepsy (P <.01) and younger at antecedent cerebral insult (P <.03) than those with normal anterior temporal lobes. Most (84%) children whose images showed anterior temporal changes had experienced the onset of epilepsy or antecedent cerebral insult before the age of 2 years (P <.0009). Eighty-one percent of children with anterior temporal changes shown on their images experienced seizures at the time of antecedent insult. CONCLUSION: Ipsilateral anterior temporal changes identical to those observed in adult cases are seen on the MR images of young children with hippocampal sclerosis, with a similar prevalence, and are associated with either epilepsy onset or seizure-related cerebral insult before the age of 2 years. We suggest that the loss of gray-white matter definition may represent a persistent immature appearance, including an abnormality of myelin or myelination, possibly a result of seizures occurring during maturation of the temporal pole.

Adolescent↗
PubMed2003

Multiple sclerosis with uncommon cerebrospinal fluid findings.

AIM: To determine the frequency and clinical and laboratory features of patients with multiple sclerosis characterized by uncommon cerebrospinal findings, ie, negative oligoclonal band or increased number of mononuclear cells in cerebrospinal fluid. METHODS: The retrospective analysis included medical records of 233 patients (158 women and 75 men) admitted to the Department of Neurology, Ljubljana Medical Center, between January 1, 1990, and December 31, 1999 and discharged with the diagnosis of multiple sclerosis. We determined clinical features and cerebrospinal fluid parameters of patients with oligoclonal band-negative multiple sclerosis and > or =15 mononuclear cells/mm( 3) in cerebrospinal fluid and compared them with patients with oligoclonal band-positive multiple sclerosis and expected number of mononuclear cells in cerebrospinal fluid, respectively. There were 26 patients with oligoclonal band-negative finding and 26 with > or =15 mononuclear cells/mm(3) in cerebrospinal fluid. The two groups of patients did not overlap, except for one patient, who had 19 mononuclear cells/mm(3) and was oligoclonal band-negative. RESULTS: The diagnosis was delayed in oligoclonal band-negative multiple sclerosis patients, their cerebrospinal fluid contained less leukocytes, and lower concentration of IgG. The patients with > or =15 leukocytes/mm( 3) in cerebrospinal fluid were diagnosed earlier and had increased cerebrospinal fluid protein and IgG concentrations. CONCLUSION: Multiple sclerosis with negative oligoclonal band or increased count of leukocytes in cerebrospinal fluid were found in approximately 10% of patients with the disease. Because of the absence of oligoclonal band and less active cerebrospinal fluid, the diagnosis in these patients may be delayed.

Adult↗
PubMed1992

Diagnostic value of clinical features and supplementary investigations in tuberous sclerosis in children.

The author evaluates the usefulness of clinical features and some supplementary investigations in diagnosis of tuberous sclerosis in children. 52 children ranging in age from 1 month to 14 years took part in the study. Usually depigmented naevi were the first sign of tuberous sclerosis and were seen in 98% of affected children. Epileptic seizures occurred in 96% of patients, mostly during the first year of life. Axial computed tomography of brain seems to be very helpful in diagnosis of tuberous sclerosis in every age. Multiple periventricular calcifications were found in 98% of children. Two-dimensional echocardiography was especially useful in infants and children below 2 years of age. Retinal hamartomas were found in 25% of children with tuberous sclerosis. In some cases these changes were revealed during the first year of age. Abnormal EEGs were found in 90% of recordings. The EEGs tended to improve with increasing age. In 25% of children one of parents was affected by tuberous sclerosis. The careful skin examination of both parents can be especially helpful in children with doubtful diagnosis of tuberous sclerosis.

Abdomen↗
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↗
PubMed2005

Regional lobar atrophy predicts memory impairment in multiple sclerosis.

BACKGROUND AND PURPOSE: In recent studies, measures of whole brain atrophy were strongly correlated with neuropsychological testing, explaining more variance than measures of lesion burden in patients with multiple sclerosis. The relationship between regional lobar atrophy and cognitive impairment is yet to be examined. We endeavored to assess the clinical significance of regional lobar atrophy in multiple sclerosis. METHODS: In a cross-sectional study, we evaluated 31 patients with multiple sclerosis with brain MR imaging and neuropsychological testing. Impairment was determined by comparison with demographically matched healthy controls. MR imaging generated measures of lesion burden (fluid-attenuated inversion recovery hyperintense volume), general atrophy (brain parenchymal fraction), central atrophy (lateral ventricle volume), and lobar atrophy (regional brain parenchymal fraction of frontal, temporal, parietal, and occipital lobes in each hemisphere). Neuropsychological testing emphasized measures of processing speed and memory, because these are commonly affected in multiple sclerosis. RESULTS: Patients with multiple sclerosis showed significant atrophy and impairment on all neuropsychological tests. Regional atrophy accounted for the most variance in all regression models predicting memory performance. Left temporal atrophy was the primary predictor of auditory/verbal memory (partial r's = 0.55-0.61), and both left and right temporal atrophy predicted visual/spatial memory performance (partial r's = 0.51-0.67). Models predicting learning consistency retained frontal lobe atrophy measures (partial r's = 0.44-0.68). Central and general atrophy measures were the primary predictors in modeling processing speed (partial r's = 0.42-0.64). CONCLUSION: Regional atrophy accounts for more variance than lesion burden, whole brain atrophy, or lateral ventricle volume in predicting multiple sclerosis-associated memory dysfunction.

Adult↗
PubMed2005

The appearance of pars planitis in multiple sclerosis.

The aim of the study was to investigate the clinical association of multiple sclerosis and pars planitis (or intermediate uveitis), as well as to determine the incidence of pars planitis in multiple sclerosis patients. During the period of one year authors examined 42 patients with multiple sclerosis divided into two groups. First group consisted of 23 patients with history of optic neuritis and the second group consisted of 19 patients who have never had optic neuritis. The mean age of patients in the first group was 31.7 +/- 5.1 years and in the second group 29.1 +/- 8.1 years. Pars planitis was found in 12 patients with multiple sclerosis. Age, sex and degree of neurological disability had no influence on the appearance of pars planitis. Although optic neuritis is considered to be the most common ocular manifestation of multiple sclerosis, the significant number of patients with multiple sclerosis has pars planitis.

Adult↗
PubMedDate not supplied

[Use of magnetic resonance imaging in the diagnosis and prognosis of multiple sclerosis].

Multiple sclerosis is an autoimmune disease characterized by demyelination and axonal loss. Conventional magnetic resonance imaging allows the demonstration of spatial and temporal dissemination of multiple sclerosis lesions earlier than is possible from clinical assessments. A variety of conventional magnetic resonance imaging protocols, in conjunction with clinical assessment, are now routinely used to increase the accuracy of diagnosis and long-term prognosis of multiple sclerosis. T2-weighted hyperintense lesions are related primarily to increased water content and thus cannot distinguish between inflammation, edema, demyelination, Wallerian degeneration, and axonal loss, whereas the contrast gadolinium-enhanced lesions on T1-weighted images reflect increased blood-brain barrier permeability associated with active inflammatory activity. Conventional magnetic resonance imaging metrics are not sufficiently sensitive to detect invisible brain damage in the normal appearing brain tissue, and they do not show a reliable correlation with clinical measures of disability. However, numerous studies showed that they can improve accuracy in the diagnosis and prognosis of multiple sclerosis. Recently, non-conventional magnetic resonance imaging techniques have been introduced to increase the accuracy of diagnosis and prognosis of multiple sclerosis. Several studies have used brain atrophy, T1-hypointense lesion volume, magnetization transfer imaging, diffusion-weighted imaging and magnetic resonance spectroscopy to test whether the extent and severity of tissue loss in lesions and in normal appearing gray and white matter at the time of clinically isolated syndrome may have diagnostic and prognostic value. These magnetic resonance imaging techniques represent a powerful tool to non-invasively study different pathological substrates of lesions and microscopic tissue changes. Additional short- and long-term prospective studies are requested to establish their value in the diagnosis and prognosis of multiple sclerosis.

Brain↗
PubMed1991

Luminol-dependent chemiluminiscence of monocytes and granulocytes in multiple sclerosis: the effect of autologous thrombocytes.

The luminol-dependent chemiluminiscence of monocytes and granulocytes and the effect of autologous thrombocytes upon the chemiluminiscence activity were investigated in multiple sclerosis patients, patients with other neurological diseases and healthy controls. The spontaneous monocyte chemiluminiscence was found to be significantly higher in multiple sclerosis patients than in healthy controls. However, no differences were found between multiple sclerosis patients and the group of other neurological diseases. Addition of autologous thrombocytes did not substantially alter both the spontaneous and the zymozan-stimulated monocyte chemiluminiscence. No significant differences in granulocyte spontaneous and stimulated chemiluminiscence were found between the multiple sclerosis patients and both control groups. In all multiple sclerosis patients the addition of autologous thrombocytes markedly depressed the spontaneous and stimulated granulocyte chemiluminiscence and a similar effect was observed in most of the patients with other neurological diseases. In healthy controls, the effect of autologous thrombocytes was rather more heterogenous and both a thrombocyte-dependent increase and a decrease of the granulocyte chemiluminiscence were found. The results suggest that platelets are able to suppress the granulocyte oxidative burst and that this scavenger mechanism can be activated in multiple sclerosis and some other neurological diseases.

Blood Platelets↗
PubMed1990

Ammon's horn sclerosis: its pathogenesis and clinical significance.

Sclerosis of the cornu Ammonis or Ammon's horn sclerosis (AHS) is an "often-described, yet hitherto enigmatic phenomena" as Spielmyer put it in 1927. It has been found in cases with ischemia, anoxia or hypoglycemia and in more than half of the epileptic brains examined at autopsy. Various theories about its pathogenesis have been propounded. Among them, the "Pathoklise" theory of the Vogts and the vascular theory of Spielmeyer and his associates were prevailing until recently. In 1953, two articles were published to contribute to the pathogenesis of ictal automatism (a type of complex partial or temporal lobe seizures). One is the incisural sclerosis theory by Penfield and his associates and the other is the Ammon's horn sclerosis theory by Sano and Malamud. The former authors described a diffuse sclerosis of the infero-mesial temporal structures without, however, specifically relating it to AHS. They considered it was the result of localized anoxia of that portion of the brain caused by incisural herniation occurring during parturition. Sano and Malamud maintained that AHS is a result of convulsions, a distinct scar adjacent to which epileptogenic foci may develop in the course of time to cause ictal automatism. The latter theory was corroborated by Sano, Falconer and others. Falconer expanded the theory to the assertion that not only ictal automatism but other types of intractable epilepsy may be due to "mesial temporal (Ammon's horn) sclerosis". The most recent development in the pathogenesis of AHS is the excitotoxicity theory. Namely, AHS is caused by excessive excitation of neurons, probably by putative excitatory neurotransmitters, especially, glutamate. For this theory, there is a significant body of evidence. The problem of AHS, an old research subject and a matter of long-lasting controversy, has now been updated and become one of the newest topics in the field of experimental neurobiology.

Animals↗
PubMed1988

Effect of calcium ionophore A23187 and of leukotrienes B4 and C4 on the adherence of mononuclear leucocytes in multiple sclerosis.

The disturbances of the arachidonic acid metabolic cascade are supposed to play a significant part in some membrane alterations and in associated immunopathological changes in multiple sclerosis. Since the lipoxygenase derivatives of the arachidonic acid and the calcium ion influx were proved to participate in the mechanisms involved in the leucocyte adherence inhibition phenomenon, the effect of calcium ionophore A23187 and of leukotrienes B4 and C4 upon the adherence of mononuclear leucocytes of multiple sclerosis patients and of healthy controls was investigated in the present study using a modification of the leucocyte adherence inhibition assay. A23187, a potent stimulator of the arachidonic acid metabolism, induced the mononuclear leucocyte adherence inhibition in a dose-dependent manner. In multiple sclerosis patients without corticosteroid treatment and in those treated with lower prednison doses (up to 5 mg/day), the non-adherent response to A23187 stimulation was significantly lower than in the controls, whereas in multiple sclerosis patients treated with prednison doses varying from 20 to 90 mg/day the A23187-induced adherence inhibition reached non-significantly higher values compared to the controls. Leukotrienes B4 and C4 stimulated the adherence of the leucocytes in multiple sclerosis patients treated with higher prednison doses. Compared to controls, statistically significant differences were found using 1 nM and 100 nM LTC4. The findings obtained in this study with all probability reflect alterations of the membrane processes in multiple sclerosis leucocytes associated with calcium ion homeostasis and arachidonic acid metabolic cascade.

Adult↗
PubMed1986

[HLA and familial multiple sclerosis].

Some data suggest an environmental perhaps a viral factor but also of a genetic factor in the etiology of multiple sclerosis. Among the latter is the notably increased risk for a twin when the other twin has the disease, a risk further increased if they are monozygotic. There is also a greater than chance frequency of common HLA haplotypes in 2 affected siblings. The frequency of familial forms of multiple sclerosis is estimated at approximately 6 p. 100. We have studied 14 families of which 12 included 2 members with multiple sclerosis and 2 with 3 affected members. Parental relation between patients was parent to child (7 cases), brother to sister (5 cases), sister to sister including two pairs of twins (4 cases) and cousin to cousin on the mother's side (2 cases). When compared with non-familial multiple sclerosis there were no particular features in clinical disorders or course: 4 forms were progressive, the others evolving by episodes. In 26 patients in whom HLA antigens were determined, the DR2 antigen was present 19 times, the B7 antigen 9 times and the A3 antigen 7 times. In the 8 pairs of siblings with multiple sclerosis, 2 were HLA-identical and 5 semi-identical. One pair had no common haplotype. Grouping of HLA in 22 healthy members allowed 8 genealogic trees to be established. If a gene for susceptibility to multiple sclerosis exists, it is of low penetration, of dominant transmission and of limited frequency. It probably lies close to the region D of chromosome 6, because of the disequilibrium of crossed linking with A3, B7 and DR2 antigens.

Chromosome Mapping↗
PubMed1982

Colonic dysfunction in multiple sclerosis.

Multiple sclerosis is a central nervous system disease frequently accompanied by urinary symptoms and severe constipation. In order to investigate the pathophysiology of these symptoms, we studied colonic motor and myoelectrical activity, as well as colonic volume-pressure relationships (colonometrograms) and have correlated these data with cystometry and electrophysiologic studies of the central and peripheral somatosensory nervous system. The study group consisted of 7 patients with advanced multiple sclerosis marked by symptoms and signs of somatic and visceral nervous system dysfunction including severe constipation. Ten normal volunteers served as control subjects. The multiple sclerosis group demonstrated electrophysiologic evidence of lesions in the somatosensory neuroaxis central to the lumbosacral spinal cord. Abnormal cystometrograms suggested visceral central nervous system dysfunction. Colonometrograms in the multiple sclerosis group demonstrated a more rapid pressure rise than in the control group (p less than 0.01). The multiple sclerosis group failed to demonstrate the postprandial increase in colonic motor and myoelectrical activity observed in the control group (p less than 0.01). Abnormal colonometrograms and absent postprandial colonic motor and myoelectric responses may be features of visceral neuropathy in patients with advanced multiple sclerosis and severe constipation.

Colon↗
PubMed1978

Discogenic vertebral sclerosis.

Narrowing of a disc space, sclerosis of the adjacent vertebral bodies, and irregularity of the vertebral end plates constitute a roentgen complex classically associated with infectious spondylitis. However, narrowing of a disc space may be the result of a herniated nucleus pulposus, and in some individuals the reactive sclerosis is sufficiently intense to resemble infection. Roentgenographic recognition of discogenic vertebral sclerosis may obviate the need for further evaluation and biopsy. Forty-four cases of discogenic vertebral sclerosis, nine with surgical proof and four developing after disc surgery, are presented. Roentgen signs helping to distinguish it from infection include: (i) rounded sclerosis most frequently in the anterior vertebral body (100%), (ii) central lucency in the sclerosis (77%), (iii) associated degenerative changes at the intervertebral disc, e.g. vacuum phenomena (44%), (iv) absence of a para-spinal mass and (v) maintenance of vertebral body height.

Adult↗
PubMed1978

[Haptoglobin levels in the serum and the cerebrospinal fluid patients with multiple sclerosis].

In 47 patients with multiple sclerosis and 10 with other diseases of the nervous system determinations of haptoglobin were performed in the serum and cerebrospinal fluid by the method of Owen et al. The Hp level in the serum of multiple sclerosis patients was normal. Its level in the cerebrospinal fluid was higher in multiple sclerosis patients than in cases of other nervous system diseases (statistically significant difference, p less than 0.001). Raised value of the Hp/IgG index in the cerebrospinal fluid of multiple sclerosis patients points to increased permeability of the blood-brain barrier. The so called normal Hp/IgG index was found in multiple sclerosis patients with high Hp and IgG level. Low Hp/IgG index suggested the possibility of IgG synthesis in the brain of patients with this disease. The comparison of the protein level and protein indexes showed that raised IgG level in the cerebrospinal fluid was present in 80% of multiple sclerosis cases, raised Kabat index in 50%, and low Hp/IgG index in 48%.

Haptoglobins↗