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PubMedDate not supplied

[Experimental allergic encephalomyelitis as an animal model for multiple sclerosis].

Experimental allergic encephalomyelitis is an animal model for demyelinating autoimmune disease of central nervous system, whose clinical and pathological characteristics resemble those in human disease multiple sclerosis. Multiple sclerosis is a chronic inflammatory disease followed by central nervous system demyelination, which is the result of an autoimmune process followed by central nervous system infiltration with autoreactive lymphocytes, activated macrophages and by local production of proinflammatory cytokines. Finally, the destruction of oligodendrocytes and myelin sheath occurs, caused by immunologic effector mechanisms. In this paper we reviewed fundamental and new facts about the most used models, induction, clinical and immunological characteristics of the experimental allergic encephalomyelitis in comparison with multiple sclerosis. Aethology and pathogenesis of multiple sclerosis are still unknown, but experiments on its animal models have improved our knowledge, not only about multiple sclerosis, but autoimmune diseases in general.

Animals↗
PubMed2001

[Peritoneal sclerosis in children under treatment with peritoneal dialysis].

Peritoneal dialysis(PD) is an established method of dialysis for children at the end stage of renal failure. Among several problems associated with PD, peritoneal sclerosis is one of the most serious complications. We examined four children on PD who were diagnosed as having peritoneal sclerosis in 1997 and 1998. Three of these cases were switched to hemodialysis(HD) and one is now undergoing a switch from PD to HD. Although all of the four patients had a history of bacterial peritonitis, they had been maintained in a fairly good condition on PD. The mean duration of PD was 9 years(4-14 years). All cases were anuric and had been maintained on PD without any problems of peritoneal function. From these observations, we should consider peritoneal sclerosis even in patients with a good clinical condition during the long-term period of PD. We recommend serial peritoneal biopsies, at least at the time of peritoneal catheter changes, to check for peritoneal sclerosis. The patients who are diagnosed as having sclerotic thickening of the peritoneal membrane should be switched from PD to HD to prevent the occurrence of life-threatening peritoneal sclerosis.

Adolescent↗
PubMed2001

[Early multiple sclerosis therapy in the effects of public health economics].

BACKGROUND: Meanwhile, a number of drugs are available for the course-modifying therapy of multiple sclerosis. Their use depends on the individual indication as well as on the patient's compliance, but also increasingly on the economic considerations of the public health system. For years, the costs of multiple sclerosis and the critically evaluated cost-benefit analyses were based on estimated figures. PATIENTS AND METHODS: For better transparency of the actual costs of the disease, a cross-sectional study of multiple sclerosis patients was performed for the first time in Germany, where the patients answered questionnaires as to their financial resources and quality of life. Within this representative framework of questionnaires, data of 737 patients were evaluated. RESULTS: This study came up with a total cost of DM 65,400.-per patient and year. The complete costs of multiple sclerosis, based on an estimated number of 120,000 patients, thus run up to 7.85 bio. DM a year. Only a small percentage is caused by medication (7%), including the use of new extremely expensive drugs. There is a positive correlation between the severity of the disease and the underlying costs of treatment. CONCLUSION: Due to these results, concrete health-economic goals in the treatment of patients with multiple sclerosis should aim at stabilization on a low disability level at an early stage of the disease.

Cost of Illness↗
PubMedDate not supplied

[Neuropsychiatric disorders in multiple sclerosis].

OBJECTIVE: Neuropsychological investigations over the past 20 years have shown the high prevalence of cognitive dysfunction in multiple sclerosis, although there are still large gaps. In this article we review current concepts regarding the different types of neuropsychiatric disorders, their physiopathology, diagnosis and treatment. DEVELOPMENT: We present a classification of the most important types of cognitive and psychiatric alterations in multiple sclerosis, and their physiopathology. We review the methods used in diagnosis, follow up and assessment of these patients. Finally, we analyze the current treatment available for each of these disorders. CONCLUSIONS: Although considerable advances have been made in understanding the neuropsychological disorders occurring in multiple sclerosis, there are still many questions to be answered. There is a need for a unified, agreed, validated battery of neuropsychological tests for the study of specific cognitive deficits in multiple sclerosis so that results may be compared. There is also a lack of biological markers which would help in diagnosis and prognosis. Finally the design and carrying out of clinical trials in the search for specific, effective drugs for the treatment of neuroconductual disorders of multiple sclerosis is necessary.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Intercellular communication in the astrocyte culture as a measure of therapeutic efficacy in multiple sclerosis treated by interferon].

INTRODUCTION: Measurement of therapeutic efficacy in multiple sclerosis depends on the clinical and magnetic resonance findings on follow up. There are no biological markers. Measurement of interleukins and other markers of inflammation has not proved useful in the follow up of these patients. The response of astrocytes to mediators of inflammation gives rise to modification in their capacity for intercellular communication. OBJECTIVE: To find whether culture of astrocytes in serum from patients with multiple sclerosis at different clinical stages and on different treatments gives rise to modification in intercellular communication. PATIENTS AND METHODS: Astrocytes were cultured in serum from three patients with an untreated acute clinical episode of multiple sclerosis, and the results compared with those obtained after serum culture when the patients had been treated with interferon for a year. RESULTS. In astrocyte culture using serum from patients with an acute episode of multiple sclerosis, but not on treatment with interferon, there was a statistically significant reduction in intercellular communication as compared to astrocytes cultured with serum from these same patients treated with interferon for one year (*p< 0.05; **p< 0.01). CONCLUSION: Measurement of the modifications in intercellular communication on astrocyte culture may be used as a marker for inflammatory activity in the serum of patients with multiple sclerosis, and therefore as an index of therapeutic efficacy.

Adjuvants, Immunologic↗
PubMedDate not supplied

Morphological aspects of peritoneal sclerosis.

The term peritoneal sclerosis simply means the presence of sclerotic tissue in the peritoneum. Qualitative and quantitative morphological aspects indicate that there are two nosological entities: simple sclerosis and sclerosing peritonitis. Simple sclerosis is a thin (<40-50 microm) layer of submesothelial sclerotic tissue often limited to certain peritoneal areas, with monotonous histology. It is a component of the slight anatomical alterations constantly detectable in peritoneal dialysis patients. Sclerosing peritonitis is characterized by very thick (1,0004,000 microm) sclerotic tissue involving the whole peritoneal wall, often with inflammatory infiltrates, microabscesses, giant cells of macrophagic origin, calcifications and severe vascular alterations. Intermediate stages between simple sclerosis and sclerosing peritonitis have rarely been detected. Simple sclerosis and sclerosing peritonitis also seem to be distinct with respect to frequency, etiology, reproducibility in animal models and clinical manifestations.

Animals↗
PubMed2002

Apparent diffusion coefficient value of the hippocampus in patients with hippocampal sclerosis and in healthy volunteers.

BACKGROUND AND PURPOSE: MR diffusion-weighted (DW) imaging with apparent diffusion coefficient (ADC) has had widespread use clinically in a variety of intracranial diseases; however, only a few studies report ADC changes in patients with hippocampal sclerosis. We sought to determine the ability of ADC to lateralize the epileptogenic lesion in patients with hippocampal sclerosis. METHODS: Nineteen healthy volunteers and 18 patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis were examined prospectively with DW imaging and ADC mapping. DW images were obtained at 1.5 T with a spin-echo echo-planar sequence (6500/103 [TR/TE]) with variable diffusion gradients. ADCs were calculated from bilateral hippocampi. The ability of DW imaging and ADC to lateralize the lesion was evaluated visually and by comparing ADC values between healthy volunteers and patients with hippocampal sclerosis. RESULTS: In all patients, visual assessment of DW images failed to lateralize the lesion. However, the mean ADC value measured at the hippocampal area was significantly higher on the lesion side than on the contralateral side (P <.001). The overall correct lateralization rate of ADC was 100% (18 of 18 patients). Mean ADC in sclerotic hippocampi was also significantly higher than that in healthy volunteers. The normal-appearing hippocampus of the contralateral side in the patients had higher ADC values compared with those of healthy volunteers (P =.045). CONCLUSION: ADC can be used as a complementary tool in lateralizing the epileptogenic lesion in patients with hippocampal sclerosis, although the practical role of ADC value is yet to be determined in patients with inconclusive MR imaging findings.

Adolescent↗
PubMed2003

Mechanisms of unexpected death in tuberous sclerosis.

Tuberous sclerosis complex is a protean autosomal dominant disorder characterized by multifocal tissue lesions arising from defects in cellular migration, proliferation, and differentiation. It has an association with sudden death. In the current study, review of all cases of sudden death due to tuberous sclerosis was undertaken at the Forensic Science Centre in Adelaide, Australia from 1991 to 2001, in addition to an analysis of cases from the literature. There were two local cases where unexpected death had occurred in individuals with known tuberous sclerosis, involving a 31-year-old male (epilepsy), and a 24-year-old female (massive hemorrhage into a renal angiomyolipoma). Fatal mechanisms in cases of tuberous sclerosis may be associated with underlying cardiovascular, renal and cerebral abnormalities. Sudden death may be due to cardiac arrhythmia, epilepsy, and intra-tumoral hemorrhage with additional complications including cardiac outflow obstruction, obstructive hydrocephalus, aneurysm rupture, and spontaneous pneumothorax. An awareness of the highly variable tissue manifestations of tuberous sclerosis and the mechanisms that may be responsible for death is necessary to establish correctly the diagnosis in occult cases (possibly with molecular confirmation), and to chart accurately organ changes in individuals with established disease.

Adult↗
PubMed2003

Multiple sclerosis presenting as neurological decompression sickness in a U.S. navy diver.

A case of clinically definite multiple sclerosis presenting as neurological decompression sickness is presented. A 23-yr-old U.S. Navy diver experienced onset of hypesthesia of the left upper trunk approximately 19 h after making two SCUBA dives. She did not seek medical attention until 3 wk later, at which time she was diagnosed with possible neurological decompression sickness. She was treated with hyperbaric oxygen, but demonstrated no improvement. Further evaluation led to the diagnosis of multiple sclerosis. This case underscores the potential similarity in neurological presentation between multiple sclerosis and decompression sickness. The differential diagnosis of neurological decompression sickness, particularly in atypical cases, should include multiple sclerosis. The appropriateness of medically clearing multiple sclerosis patients for diving is discussed.

Adult↗
PubMed2003

[Microscopic disorders of cortical development of the brain and its etiopathogenic importance for detection in patients with temporal epilepsy associated with hippocampal sclerosis].

Hippocampal sclerosis represents a common structural basis of temporal lobe epilepsy. However, the etiological factors and mechanisms leading to its development still remain unexplained. In our study, we present neuropathological findings in the resected hippocampus and the pole of the temporal lobe in 15 patients with hippocampal sclerosis. "Initial precipitating injuries" that are thought to cause the development of hippocampal sclerosis (febrile seizures in early childhood, head injury or meningoencephalitis) were present in the history of 12 patients. In the remaining 3 cases, no predisposing factors were found. Attention was paid to the histopathological identification of disturbed neuronal migration and differentiation in the temporal lobe. These defects were observed in 7 cases; in three of these, no predisposing factors were stated in the patients' histories. We suggest that in these cases, hippocampal sclerosis arises due to previously undetected disorders of cortical development. A latent neocortical malformation may also contribute to the development of hippocampal sclerosis in patients with an initial precipitating injury in anamnensis. Histopathological examination of resected epileptic brain tissue can provide insights into the individual pathogenesis of epileptic disorders, especially by the detection of microscopic disorders of cortical development.

Adolescent↗
PubMed2004

Chlamydophila pneumoniae infection of the central nervous system in patients with multiple sclerosis.

BACKGROUND: Chlamydophila pneumoniae has been postulated as an aetiological agent in the pathophysiology of multiple sclerosis. Previous studies show conflicting results. OBJECTIVE: To investigate patients with multiple sclerosis and other neurological diseases for evidence of past or present infection with C pneumoniae. METHODS: 19 patients with multiple sclerosis and 29 with other neurological diseases were studied. Evidence was sought for past or present infection with C pneumoniae using polymerase chain reaction (PCR) and cell culture of cerebrospinal fluid (CSF), and enzyme linked immunosorbent assay and microimmunofluorescence of serum. RESULTS: C pneumoniae was grown from the CSF of one patient with multiple sclerosis. PCR was negative in all cases. Anti-chlamydial antibodies were detected in the same proportion in each group. CONCLUSIONS: This study does not support the theory of an association between C pneumoniae and multiple sclerosis.

Adult↗
PubMed2004

Multiple sclerosis initially presenting as facial palsy.

A case of multiple sclerosis initially presenting as a facial palsy is presented. A 35-yr-old U.S. Air Force aviator developed a purely right-sided facial palsy with no sensory abnormalities. She had no other neurologic findings except for a barely perceptible loss of coordination in her right upper extremity. Subsequent brain MRI revealed multiple white matter lesions. Further history and laboratory analysis confirmed multiple sclerosis. This case underscores the potential for multiple sclerosis to mimic other more benign conditions and the need for clinicians to carefully examine patients presenting with new neurologic abnormalities. The diagnosis and treatment of multiple sclerosis as well as military aviation policy regarding multiple sclerosis patients is discussed.

Adult↗
PubMed2005

[Application of the Multiple Sclerosis Functional Composite in Debrecen].

INTRODUCTION: The Multiple Sclerosis Functional Composite (MSFC) has been recommended by the National Multiple Sclerosis Society as a new clinical outcome measure. It is based on measurements in three clinical dimensions: leg function/ambulation (timed 25-foot walk), arm function (9-hole peg test), and cognitive function (paced auditory serial addition test). Scores on component measures are converted to standard scores (Z-scores) that reflect patient performance. This method has not yet been introduced into routine clinical practice. PATIENTS AND METHOD: MSFC calculation was applied to 17 patients with relapsing-remitting multiple sclerosis (age mean: 37.4+/-10.8 years; duration of the disease: 5.5+/-4.9 years, EDSS: 2.7+/-1.4) seen at the neuroimmunological outpatient clinic to evaluate its usefulness and its correlation with the traditionally applied Expanded Disability Status Scale (EDSS) and with patient-reported quality of life. Fifteen patients received immunomodulatory treatment (interferon beta and glatiramer acetate). MSFC and EDSS were measured at 0, 3, 6, 9, 12, 18 months, and questionnaires on quality of life were filled in by the patients at 0, 6, 12, 18 months of follow-up. RESULTS: The prospective study confirmed a strong correlation between EDSS and MSFC (Spearman correlation test, p=0.03, 0.004, 0.002, 0.004, 0.0008, 0.002; R=-0.54, -0.66, 0.68, -0.65, -0.73, -0.69) in multiple sclerosis. The MSFC was more sensitive to clinical changes than EDSS. The extent of changes on the two scales correlated only after 18 months (p<0.005, R=-0.65). The arm/hand function was the most sensitive measure for disease progression. There was no correlation between the quality of life and either of the two other clinical parameters. CONCLUSION: MSFC is a simple method, suitable for follow-up of multiple sclerosis patients in everyday clinical practice.

Adult↗
PubMed2005

The correlation of changes of the optic nerve diameter in the acute retrobulbar neuritis with the brain changes in multiple sclerosis.

The aim of this paper is to compare diameter of healthy and affected optic nerve determined by ultrasound with brain lesions in acute retrobulbar neuritis in patients with multiple sclerosis. In this prospective study 20 patients with multiple sclerosis and acute retrobulbar neuritis were examined. Optic nerve diameter was measured by ultrasound. Brain lesions were detected by magnetic resonance. Correlation between demyelinating lesions of the brain in multiple sclerosis and optic nerve diameter was tested by Kruskal-Wallis test. Significant difference in diameter between healthy and affected optic nerve in acute retrobulbar neuritis was found. Demyelinating brain changes examined by magnetic resonance revealed periventricular lesions, subcortical lesions and lesions in corpus callosum. There is statistically significant correlation between optic nerve diameter and number of brain lesions in multiple sclerosis, p < 0.05. Diameter of optic nerve in retrobulbar neuritis measured by ultrasound correlates with brain lesions detected by magnetic resonance in multiple sclerosis.

Acute Disease↗
PubMed2006

[A case of a pediatric patient with tuberous sclerosis (Bourneville-Pringle disease) and frequent epileptic seizure for intensive dental treatment under general anesthesia].

Tuberous sclerosis (Bourneville-Pringle disease) is a rare disease with a triad of mental retardation, epilepsy, and facial spot. Management of the patients with tuberous sclerosis under general anesthesia has been previously reported. However, there are few case reports about management under general anesthesia of a pediatric patient with tuberous sclerosis with frequent epileptic seizure. Here, we report a case of a pediatric patient with tuberous sclerosis and frequent epileptic seizure who underwent intensive dental treatment under general anesthesia with careful management of epilepsy. The patient was discharged on the day of surgery without any complications. In this case report, we discussed the appropriate assessment of the complications of tuberous sclerosis; such as, of central nervous, circulatory, respiratory, endocrine, and urinary systems including the management of general anesthesia.

Anesthesia, General↗
PubMed2006

[Long-term application of the multiple sclerosis functional composite test in Debrecen, Hungary].

INTRODUCTION: The multiple sclerosis functional composite (MSFC) has been recommended by the National Multiple Sclerosis Society as a new clinical outcome measure. It is based on measurements in three clinical dimensions: leg function/ambulation (timed 25-foot walk), arm function (9 hole peg test) and cognitive function (paced auditory serial addition test). Scores on component measures are converted to standard scores (Z-scores), that reflect patient performance. This method has not yet been introduced into routine clinical practice. PATIENTS AND METHODS: Since March 2000 over the five years period the MSFC calculation was applied to 17 patients with relapsing-remitting multiple sclerosis (age mean: 37.4 +/- 10.8 years, duration of the disease: 5.5 +/- 4.9 years, EDSS: 2.7 +/- 1.4) seen at the neuroimmunological outpatient clinic to evaluate its usefulness and its correlation with the traditionally applied expanded disability status scale (EDSS). Thirteen patients received immunomodulatory treatment (interferon beta and glatiramer acetate), one patient received immunosuppressant therapy (azathioprine), and there was one patient, who developed secondary-progressive phase and we changed the interferon treatment to mitoxantrone. MSFC and EDSS were measured at 3., 6., 9, 12., 18 and 60 months of follow-up. RESULTS: The prospective study confirmed a strong correlation between EDSS and MSFC in multiple sclerosis. The MSFC was more sensitive to clinical changes than EDSS. Our results after 18 months of follow up are already published. After five years arm/hand function and leg function/ambulation were the most sensitive measures for disease progression. In contrast with the literature we did not experience correlation with cognitive changes. CONSEQUENCES: We demonstrated strong correlation between MSFC and EDSS after a longer period. MSFC is a simple method, suitable for follow-up of multiple sclerosis patients in everyday clinical practice.

Adult↗
PubMedDate not supplied

Imaging findings in hippocampal sclerosis: correlation with pathology.

We evaluated the ability of preoperative radiologic imaging to detect hippocampal sclerosis in 31 patients who underwent surgery for intractable epilepsy. Hippocampal sclerosis is commonly associated with surgically treatable temporal lobe epilepsy. It is pathologically described as neuronal cell loss with associated gliosis in the hippocampus. While previous reports have correlated imaging results with clinical or qualitative histologic findings, this study used quantitative pathologic criteria (neuronal cell density) to diagnosis hippocampal sclerosis. We focused our study on the 11 patients with cryptogenic temporal lobe epilepsy. Of these, nine had hippocampal sclerosis by pathologic criteria. MR findings included unilateral hippocampal atrophy, an increased signal in the hippocampus on long TR scans, and atrophy in the adjacent white matter and temporal lobe. Hippocampal atrophy was most frequently seen in the red nucleus plane on coronal scans, corresponding to the body of the hippocampus. We also compared hippocampal size on MR with neuronal density in surgical specimens of the 11 patients with cryptogenic temporal lobe epilepsy. A statistically significant correlation was found between MR size and neuronal density in CA3 and CA4 of the cornu ammonis and the granular cell layer of the hippocampus. Since temporal lobectomy eliminated seizures in seven of nine patients with hippocampal sclerosis, preoperative diagnosis by MR has important therapeutic consequences.

Adolescent↗
PubMed1991

[A clinical study of voiding status in multiple sclerosis patients].

During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.

Adult↗