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PubMed2005

Familial recurrence rates and genetic models of multiple sclerosis.

Susceptibility to multiple sclerosis (MS) is determined by both inherited and non-inherited factors. The importance of genetic factors is demonstrated by the increased risk of disease in relatives of MS patients. Our objective was to determine the implications of the observed familial recurrence risks for the genetic basis of MS. We developed a computer program which calculates recurrence risks for monozygotic (MZ) twins, siblings, and second degree relatives, and used it to calculate recurrence risks for a wide variety of genetic models. We investigated models with different numbers of genes, different patterns of interaction between the genes, and dominant or recessive inheritance. The models that best reproduced the observed values had multiple loci with strongly synergistic interaction and autosomal dominant (AD) inheritance. At least six loci were required, and we found no upper limit on the number of loci. Models with genetic heterogeneity, where only a fraction of the risk loci are required for disease, are possible. In models with large numbers of loci the "abnormal" alleles conferring risk of disease are the most common allele. We conclude that a variety of genetic models with multiple genes, dominant inheritance, and synergistic interaction between risk genes are consistent with the observed familial recurrence rates in MS.

Algorithms↗
PubMed2003

Remyelination in multiple sclerosis.

Remyelination in multiple sclerosis (MS) lesions has been described in several studies. It depends on the presence of myelinating oligodendrocytes and a functional interaction between these myelinating cells and axons. The imaging signal of remyelination in magnetic resonance imaging or spectroscopy is not yet defined. The present review will focus on the morphological appearance of remyelinating MS lesions, their correlation with oligodendrocyte pathology, and possible markers for remyelination in imaging.

Animals↗
PubMed1986

Multiple sclerosis and vision.

Multiple sclerosis (MS) is a demyelinating disease that can result in numerous eye signs and symptoms. This paper reviews the changes that can occur in the visual system of those afflicted, as well as causes and treatment. Current diagnostic tests and therapeutic procedures of importance to the optometrist are also highlighted. Two case reports illustrate how seeking optometric care early in the course of the disease may lead to its diagnosis.

Adolescent↗
PubMed1999

[Diagnosis of multiple sclerosis].

Diagnosis of multiple sclerosis is based on detection of a disseminated demyelinating inflammatory disorder of the central nervous system with a progressive course and(or) exacerbations. Essential data is obtained by study of the cerebrospinal fluid and magnetic resonance imaging. Other causes of white matter disorders (vascular, compressive or tumoral) are less important in differential diagnosis than are other monophasic demyelinating inflammatory disorders, such as acute disseminated encephalomyelitis, idiopathic optic neuritis and idiopathic myelitis.

Central Nervous System↗
PubMed1981

Urodynamic studies in female patients with multiple sclerosis.

Patients with multiple sclerosis may have two fundamental, related problems in the lower urinary tract, i.e., urinary retention and/or urinary incontinence. Forty-six patients were assessed by urodynamic testing. Evidence of detrusor overactivity was seen in 40 patients (86.9%), elevated resting urethral pressures in 39 patients (84.8%), a positive bethanechol chloride (Urecholine) stress test in 24 patients (63.2%), and a significant residual urine in 26 patients (56.5%). Data were analyzed in an attempt to explain retention and incontinence in these patients.

Female↗
PubMedDate not supplied

Benchmarking best practice in relapse management of multiple sclerosis.

The Midlands multiple sclerosis (MS) nurse group developed a benchmark for relapse management in MS, using the framework outlined in the DoH document Essence of Care (DoH 2001). The authors discuss the benchmarking process and demonstrate how specialist nurses can collaboratively establish best practice and influence the quality of care. The potential benefits of applying the benchmarking process to relapse management are discussed. Good practice for management of patients with relapsing MS has been developed.

Anti-Inflammatory Agents↗
PubMed1998

Improving health care delivery for persons with multiple sclerosis.

Persons with multiple sclerosis (MS) have a close-to-normal life span and can look forward to a high level of consumption of health care services for an average of 40 to 50 years. As expensive new treatments for MS are developed and better rehabilitation techniques are implemented, lifetime health care costs for MS patients can be very great. This article discusses ways in which these costs can be managed.

Cost Control↗
PubMed1983

[The role of evoked potentials in the diagnosis of multiple sclerosis].

Diagnosis of multiple sclerosis is based mainly upon evidence of inflammation in the cerebrospinal fluid and of diffuse neurological involvement. The second feature is often lacking at onset. It is important to establish the diagnosis as early as possible. In this respect, evoked potentials (visual, auditive or somatosensory) in the brainstem are useful to demonstrate asymptomatic lesions. Our recordings taken in 43 patients are conclusive. The diagnostic reliability of simultaneous recordings of all three types of evoked potentials is similar to that of the study of cerebrospinal fluid.

Evoked Potentials↗
PubMed2004

[The formation and significance of antibodies to interferon beta during immunomodulating treatment of multiple sclerosis].

Patients with multiple sclerosis receiving interferon beta (IFN) may develop neutralizing anti-interferon beta antibodies (NABs). The importance of NABs has not been completely explained, however it is generally reckoned that they might be one of the factors diminishing treatment efficacy. This paper presents the consequences of NABs formation during IFN therapy. Differences of immunogenicity between the interferon beta products with regard to their structure, formulation, dose, route of administration were presented and the influence of NABs on the biological and clinical activity of IFN beta therapy was shown.

Adjuvants, Immunologic↗
PubMed2000

The pathophysiology of demyelination and the ionic basis of nerve conduction in multiple sclerosis: an overview.

Multiple sclerosis (MS) affects young adults during the prime of life, complicating child-rearing and work-related activities, often resulting in significant disability. New treatment options are rapidly becoming available. Persons with MS and their families rely on nurses to provide current and accurate information. Neuroscience nurses are increasingly challenged to keep abreast of new treatments and research and the scientific bases for them. In response to this need, nurses must develop a basic understanding of the proposed etiology of MS as well as of the pathophysiology of demyelination and the ionic basis of nerve conduction.

Adult↗
PubMedDate not supplied

Beliefs, perceptions, and practices related to osteoporosis risk reduction among women with multiple sclerosis.

Women with multiple sclerosis (MS) are at increased risk for osteoporosis and fracture; in turn, osteoporosis has the potential to exacerbate the physical limitations imposed by MS. This qualitative study explored the understanding of osteoporosis risk and risk reduction, strategies being used to reduce risk, and related beliefs among 27 women with MS. Participants were recruited at a regional MS Society meeting. The women completed personal data forms, and responded to open-ended questions during taped interviews, which were transcribed and subjected to comparative content analysis. Five themes emerged from the data: knowledge about osteoporosis, sense of vulnerability, interactions with healthcare providers, preventive actions, and sense of control. All of the women had some knowledge about osteoporosis risk reduction, and most of the women were actively attempting to reduce their risk. However, few of the women had full knowledge, or were doing all that they might do, to minimize their risk. Few of their healthcare providers had discussed the issue or responded to their concerns, even when women had histories of multiple fractures. The women did comprehened their increased risk and most attempted to manage it, although input was lacking from healthcare providers about osteoporosis risk reduction.

Adult↗
PubMed1992

Strategies for intervention and research with children or adolescents who have a parent with multiple sclerosis.

Parents with multiple sclerosis worry about effects their illness may have on their children. This stress can be a factor in exacerbating parental illness, yet little conclusive research exists about this population of children. In most instances their existence is not even recorded within the medical records of their parents. Children with chronically ill parents have been described by some as constrained, depressed and antisocial. In contrast, other authors, including this researcher, have concluded that these children are more empathetic and are advanced in friendship concept development compared to the general population. Implications for nursing research and nursing care are presented.

Adolescent↗
PubMed1985

[Immunologic multiple sclerosis research].

In multiple sclerosis (MS) different autoimmunological phenomena can be held responsible for the inflammatory demyelinating process. A cytotoxic reaction of lymphocytes against the encephalitogenic peptide of the myelin basic protein is assumed to be the primary factor; furthermore, demyelinating antibodies play an important part in the destruction of the myelin sheath. As can be identified at the acute stage of the disease, anomalies in the immunoregulation and the suppression of the control mechanism give additional indications towards the immunopathogenesis of MS. The cause of the demyelinating autoimmune process is unknown. According to epidemiological studies, a virus infection is the most likely etiology for MS.

Antibodies, Viral↗
PubMed2005

MRI in multiple sclerosis.

MRI provides multiple uses and applications in multiple sclerosis(MS). The basic features of the MRI-detected lesions, including the underlying pathology, are discussed. MRI allows assessment of the normal-appearing white and gray matter, and neuronal tract and functional system disturbances. An overview of the clinical significance of these MRI measures is included, as a basis for understanding their role as outcome measures in clinical trials. MRI recently assumed greater importance in its role in establishing an earlier diagnosis of MS after a first clinical event, and in monitoring subclinical disease before or subsequent to the formal diagnosis. The background to these applications and practical issues are discussed.

Brain↗
PubMed2003

Practical consultations: multiple sclerosis.

People with multiple sclerosis (MS) are increasingly referred for specialty care to tertiary centers, particularly for advice regarding initiation and monitoring of immunomodulatory therapies. However, the generalist must still be able to apply appropriate skills and technology to diagnose the disease and its complications, provide basic counseling of patients, and be aware of potential treatment options at the time of diagnosis and when therapeutic regimens fail. A general approach, supported by evidence where possible, to common and contemporary clinical issues in MS care is provided in a case-based narrative.

Adjuvants, Immunologic↗
PubMed2001

Improving mobility and functional independence in persons with multiple sclerosis.

Persons with multiple sclerosis (MS) commonly experience restrictions in mobility and everyday functional activities. A wide range of factors including physical, psychological, environmental and economic issues may contribute to these difficulties. This is particularly the case as the disease evolves, and the impairments and disabilities become more numerous, inter-related and hence more complex. Effective management of these complex problems requires assessment and intervention from a variety of different perspectives by using a coordinated, goal-oriented, multi-disciplinary management approach. Crucially, it requires management to be considered from a long-term perspective rather than as a fragmented series of isolated "quick-fixes".

Activities of Daily Living↗
PubMed2003

A controlled trial of natalizumab for relapsing multiple sclerosis.

BACKGROUND: In patients with multiple sclerosis, inflammatory brain lesions appear to arise from autoimmune responses involving activated lymphocytes and monocytes. The glycoprotein alpha4 integrin is expressed on the surface of these cells and plays a critical part in their adhesion to the vascular endothelium and migration into the parenchyma. Natalizumab is an alpha4 integrin antagonist that reduced the development of brain lesions in experimental models and in a preliminary study of patients with multiple sclerosis. METHODS: In a randomized, double-blind trial, we randomly assigned a total of 213 patients with relapsing-remitting or relapsing secondary progressive multiple sclerosis to receive 3 mg of intravenous natalizumab per kilogram of body weight (68 patients), 6 mg per kilogram (74 patients), or placebo (71 patients) every 28 days for 6 months. The primary end point was the number of new brain lesions on monthly gadolinium-enhanced magnetic resonance imaging during the six-month treatment period. Clinical outcomes included relapses and self-reported well-being. RESULTS: There were marked reductions in the mean number of new lesions in both natalizumab groups: 9.6 per patient in the placebo group, as compared with 0.7 in the group given 3 mg of natalizumab per kilogram (P<0.001) and 1.1 in the group given 6 mg of natalizumab per kilogram (P<0.001). Twenty-seven patients in the placebo group had relapses, as compared with 13 in the group given 3 mg of natalizumab per kilogram (P=0.02) and 14 in the group given 6 mg of natalizumab per kilogram (P=0.02). The placebo group reported a slight worsening in well-being (a mean decrease of 1.38 mm on a 100-mm visual-analogue scale), whereas the natalizumab groups reported an improvement (mean increase of 9.49 mm in the group given 3 mg of natalizumab per kilogram and 6.21 mm in the group given 6 mg of natalizumab per kilogram). CONCLUSIONS: In a placebo-controlled trial, treatment with natalizumab led to fewer inflammatory brain lesions and fewer relapses over a six-month period in patients with relapsing multiple sclerosis.

Adult↗
PubMed1995

Cytokine-producing cells in experimental autoimmune encephalomyelitis and multiple sclerosis.

In both multiple sclerosis (MS) and experimental autoimmune encephalomyelitis, the regulation of the cytokine spectrum and production is likely to have a decisive influence on disease outcome. Studies of cytokines, however, are hampered by the autocrine or paracrine nature of cytokines. Studies of cellular production by messenger RNA detection or cellular secretion are therefore necessary. Collective data suggest that certain cytokines associated with the TH1 phenotype or lymphocytes, such as tumor necrosis factor alpha, lymphotoxin, interleukin-12, and interferon gamma, may promote disease, while cytokines produced by the TH2 subset, such as interleukin-10, may limit disease. In addition, transforming growth factor beta is a putative disease downregulator. Increased knowledge in this field will likely lead to improved therapy for MS patients.

Cytokines↗