Objective:
To evaluate the impact of age on recovery from multiple sclerosis relapses.
Background:
Increasing disability in multiple sclerosis is a consequence of progressive disease and incomplete ...relapse recovery.
Methods:
The first and last-ever relapse data (357 relapses in 193 patients) from the Olmsted County population-based multiple sclerosis cohort were systematically reviewed for age, fulminance, location (optic nerve, brainstem/cerebellar, spinal cord), peak deficit, and maximum recovery. Three different relapse-outcome measures were studied both as paired analyses and as an overall group effect: change from peak deficit to maximum recovery in raw functional system score related to the relapse (ΔFSS), a previously published FSS-based relapse-impact model, and change from peak deficit to maximum recovery in Extended Disability Status Scale (ΔEDSS) score.
Results:
Older age was linearly associated with worse recovery in the ΔFSS outcome (p = 0.002), ΔEDSS outcome (p < 0.001), and the FSS-based relapse-impact model (p < 0.001). A multivariate analysis of ΔFSS outcome linked poor recovery to older age (p = 0.015), relapse location (transverse myelitis or brainstem/cerebellar syndrome; p < 0.001), and relapse fulminance (p = 0.004).
Conclusion:
Multiple sclerosis-relapse recovery declines in a linear fashion with increased age, which should be considered when making treatment decisions.
Most of the published data relate to classical forms of rheumatic diseases (RD) and information on rare inflammatory disorders such as Behçet’s syndrome (BS) and familial Mediterranean fever (FMF) is ...limited. We studied the frequency of side effects and disease flares after COVID-19 vaccination with either Pfizer/BioNTech or Sinovac/CoronaVac in 256 patients with BS, 247 with FMF, and 601 with RD. Telephone interviews were conducted using a questionnaire survey in a cross-sectional design in patients with BS, FMF, and RD followed by a single university hospital. Study participants were vaccinated either with CoronaVac (BS:109, FMF: 90, and RD: 343,) or BioNTech (BS: 147, FMF: 157 and RD: 258). The majority have received double dose (BS: 94.9%, FMF 92.3% and RD: 86.2%). BioNTech ensured a significantly better efficacy than CoronaVac against COVID-19 in all patient groups (BS: 1.4% vs 10.1%; FMF: 3.2% vs 12.2%, RD:2.7% vs 6.4%). Those with at least one adverse event (AE) were significantly more frequent among those vaccinated with BioNTech than those with CoronaVac (BS: 86.4% vs 45%; FMF: 83.4% vs 53.3%; and RD: 83.3% vs 45.5%). The majority of AEs were mild to moderate and transient and this was true for either vaccine. There were also AEs that required medical attention in all study groups following CoronaVac (BS: 5.5%, FMF: 3.3%, and RD:2.9%) or BioNTech (BS: 5.4%, FMF: 1.9%, and RD: 4.7%). The main causes for medical assistance were disease flare and cardiovascular events. Patients with BS (16.0%) and FMF (17.4%) were found to flare significantly more frequently when compared to those with RD (6.0%) (
p
< 0.001). This was true for either vaccine. BS patients reported mainly skin-mucosa lesions; there were however, 11 (4.3%) who developed major organ attack such as uveitis, thrombosis or stroke. Flare in FMF patients were associated mainly with acute serositis with or without fever. Arthralgia/arthritis or inflammatory back pain were observed mainly in the RD group. Our study demonstrates that BS and FMF patients vaccinated with either CoronaVac or BioNTech demonstrated similar AE profile and frequency compared to RD patients. AEs that required physician consultation or hospitalization occurred in all study groups after either CoronaVac or BioNTech. Increased frequency of flares in BS and FMF compared to that seen in RD might reflect defects in innate immunity and deserves further investigation. Caution should be required when monitoring these patients after vaccination.
Background and Purpose This study aimed to investigate the potential contribution of quantitative measurements of dural venous sinuses to the diagnosis of idiopathic intracranial hypertension (IIH) ...and the relationship between IIH and dural venous sinus dimensions on 3D post-gadolinium T1-weighted magnetic resonance (MR) images. Material and Methods A total of 129 individuals (57 IIH patients and 72 controls) who complained of headache and underwent both magnetic resonance venography (MRV) and precontrast/postcontrast 3D T1-weighted MR imaging between 2018 and 2021 were included in this retrospective study. Dural venous sinus and jugular vein diameters were measured in all cases using post-gadolinium 3D T1 TFE images. The presence of transverse sinus (TS) hypoplasia and occipital sinus variation, the number and size of arachnoid granulations in the TS, and the presence of brain parenchymal herniation were also evaluated. Cut-off values that maximized accurate diagnosis of IIH were established on the receiver operating characteristic curve. The sensitivity and specificity of the diagnosis of IIH based on quantitative measurements of the dural sinus were calculated. Results The ratios of the maximum to minimum TS diameters and the minimum TS diameters to minimum sigmoid sinus (SS) diameters were significantly higher in IIH patients than in the control group (pâ¯< 0.001). The diagnostic sensitivity and specificity values of TS.sub.max/TS.sub.min and TS.sub.min sum/SS.sub.min sum parameters for the detection of IIH were 84.2%, 84.7% and 83.3%, 84.2%, respectively. Conclusion Practical measurements from multiplanar T1 sequences can be useful for both quantitative assessment and overcoming misinterpretation due to anatomical variation.
Multiple sclerosis (MS) is an immune-mediated, neuro-inflammatory, demyelinating and neurodegenerative disease of the central nervous system (CNS) with a heterogeneous clinical presentation and ...course. There is a remarkable phenotypic heterogeneity in MS, and the molecular mechanisms underlying it remain unknown. We aimed to investigate further the etiopathogenesis related molecular pathways in subclinical types of MS using proteomic and bioinformatics approaches in cerebrospinal fluids of patients with clinically isolated syndrome, relapsing remitting MS and progressive MS (n=179). Comparison of disease groups with controls revealed a total of 151 proteins that are differentially expressed in clinically different MS subtypes. KEGG analysis using PANOGA tool revealed the disease related pathways including aldosterone-regulated sodium reabsorption (p=8.02x10-5) which is important in the immune cell migration, renin-angiotensin (p=6.88x10-5) system that induces Th17 dependent immunity, notch signaling (p=1.83x10-10) pathway indicating the activated remyelination and vitamin digestion and absorption pathways (p=1.73x10-5). An emerging theme from our studies is that whilst all MS clinical forms share common biological pathways, there are also clinical subtypes specific and pathophysiology related pathways which may have further therapeutic implications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ABSTRACT
Background:
Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological ...comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS.
Objective:
To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey.
Methods:
Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D).
Results:
Out of the 1,068 participants, 173 (16.2%) were found to have RLS RLS(+) and 895 (83.8%) did not RLS(-). The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p<0.001 for all variables).
Conclusions:
According to our data, the presence of RLS in PwMS may increase the occurrence of both anxiety and depression symptoms. Awareness and treatment of RLS in PwMS could possibly reduce the symptoms of psychiatric comorbidities originating from RLS.
Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of migraine headache. In the ...International Classification of Headache Disorders, CM is defined as a separate entity and the presence of drug overuse headache is removed from being an exclusion criterion. CM accounts for more than 10% of all migraine patients and includes the group with the most prominent disease-related disability. Diagnosis is often overlooked and most patients do not receive appropriate treatment. CM is associated with social and economic burdens such as frequent use of health services, drug overuse, and significant disruption to work and school life. Compared with episodic migraine, more frequent comorbid disorders are important in migraine chronicity, treatment, and course. With appropriate treatment in CM, it is possible to increase the quality of life of the patient and to reduce the social economic burden associated with migraine. In this review, the disease burden of CM, accompanying comorbid diseases, and current treatment options are reviewed.
Amaç: Bu çalışmada parenkimal tutulumu olan Nöro-Behçet hastalarında kognitif bozukluk sıklığını ve paternini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya Cerrahpaşa Tıp Fakültesi Nöroloji ...Anabilim dalından takipli ve Cerrahpaşa Nörobehçet tanı kriterlerini dolduran 40 hasta dahil edildi. Olguların nörokognitif fonksiyonları seçici hatırlama testi, PASAT, görsel bellek testi, sembol sayı modaliteleri testi ve kelime akıcılığı testlerinden oluşan Brief Repeatable Battery of Neuropsychological Tests (BRB-N) ile değerlendirildi. Elde edilen sonuçlar daha önce normatif data oluşturulmak üzere kullanılan sağlıklı grup ile kıyaslandı.
Bulgular: Hasta grubun ortalama hastalık yaşı 39.48±10.66 idi ve Behçet tanısından ortalama 3.3 yıl sonra Nöro-Behçet hastalığı tanısı almışlardı. Erkek hakimiyeti mevcuttu. Hasta grubun tüm nöropsikolojik test sonuçları sağlıklılara kıyasla bozulmuştu. %60 hastada dikkati sürdürmede bozulma, %55 hastada görsel hafızada etkilenme, %45 hastada yürütücü işlevlerde etkilenme, %23.5 hastada sözel hafızada etkilenme saptandı.
Sonuç: Her iki hastadan birinde kognitif bozukluk tespit edildi. Gözlenen bu etkilenme sıklık sırasına göre dikkat, görsel hafıza ve yürütücü işlevlerdeydi. Bu yüksek prevelanstan dolayı Nörobehçet hastalarının klinik takibinde kognitif fonksiyonlar göz önünde bulundurulmalıdır.
Purpose of Review
Although Behçet’s syndrome (BS) is classified as a rare disease in European countries and the USA, its neurologic involvement “neuro-Behçet’s syndrome (NBS)” is commonly included in ...the differential diagnosis of many inflammatory and vascular central nervous system (CNS) disorders. Clinical and neuroimaging findings support two major forms of NBS: parenchymal NBS (p-NBS) and an extra-parenchymal form that presents with cerebral venous sinus thrombosis (CVST). The present review summarizes recent findings on the etiopathogenesis and clinico-radiological features of this disorder as well as its treatment options.
Recent Findings
Recent laboratory and clinical findings include the discovery of antibodies to human and mouse neuro-fibrils showing cross-reactivity with
Streptococcus
spp. and
Mycobacterium tuberculosis
heat shock proteins (HSP) in NBS. Diagnostically, two distinct magnetic resonance imaging (MRI) patterns of spinal cord involvement have been observed: (a) “Bagel sign” and (b) “motor neuron” patterns. Therapeutic studies have shown that infliximab effectively prevents further relapses and stabilizes the symptoms of patients experiencing ongoing clinical relapses while being treated with single or multiple immunosuppressant drugs.
Summary
Primary neurological involvement referred to as NBS. The majority of patients with NBS present with parenchymal involvement that commonly affects the brain stem-diencephalic region. Headache, dysarthria, ataxia, and hemiparesis are the main clinical features of NBS.
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