Gray matter brain structures, including deep nuclei and the cerebral cortex, are affected significantly and early in the course of multiple sclerosis and these changes may not be directly related to ...demyelinating white matter lesions. The hippocampus is an archicortical structure that is critical for memory functions and is especially sensitive to multiple insults including inflammation. We used high-resolution MR imaging at 3.0 T to measure hippocampal volumes in relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) patients and controls. We found that both groups of MS patients had hippocampal atrophy and that this volume loss was in excess of global brain atrophy. Subregional analysis revealed selective volume loss in the cornu ammonis (CA) 1 region of the hippocampus in RRMS with further worsening of CA1 loss and extension into other CA regions in SPMS. Hippocampal atrophy was not correlated with T2-lesion volumes, and right and left hippocampi were affected equally. Volume loss in the hippocampus and subregions was correlated with worsening performance on word-list learning, a task requiring memory encoding, but not with performance on the Paced Auditory Serial Addition Task (PASAT), a test of information processing speed. Our findings provide evidence for selective and progressive hippocampal atrophy in MS localized initially to the CA1 subregion that is associated with deficits in memory encoding and retrieval. The underlying histopathological substrate for this selective, symmetric and disproportionate regional hippocampal vulnerability remains speculative at this time. Further understanding of this process could provide targets for therapeutic interventions including neuroprotective treatments.
The paced auditory serial addition task (PASAT) is a test of working memory and attention that is frequently abnormal in MS and is used serially to assess cognitive dysfunction as part of the MS ...Functional Composite in clinical trials. Previous studies using functional MRI (fMRI) during PASAT performance have shown significant differences in activation patterns between healthy controls and MS patients matched for performance, but serial fMRI measures have not been reported. A confound is that learning effects are common with repeated PASAT testing, diminishing over successive trials. After measuring PASAT performance weekly for four weeks in 10 healthy controls to eliminate practice effects, we assessed brain activity using fMRI at baseline and after six months to determine the reproducibility of activation patterns in healthy controls during PASAT performance. Results showed that scores improved during the first three testing trials and stabilized subsequently. Brain activation during PASAT performance was seen in left frontal and parietal regions consistent with previous reports. After a six-month interval, PASAT performance and fMRI activity were stable, suggesting that serial fMRI during PASAT performance could be used as an outcome measure in trials assessing cognitive decline in clinical populations once practice effects are eliminated. Multiple Sclerosis 2008; 14: 465—471. http://msj.sagepub.com
PURPOSEWhile there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of ...evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.
RECENT FINDINGSStudies across multiple specialties report noninferiority of evaluations by telemedicine compared with traditional, in-person evaluations in terms of patient and caregiver satisfaction. Evidence reports benefits in expediting care, increasing access, reducing cost, and improving diagnostic accuracy and health outcomes. However, many studies are limited, and gaps in knowledge remain.
SUMMARYTelemedicine use is expanding across the vast array of neurologic disorders. More studies are needed to validate and support its use.
Editorial: Diet and multiple sclerosis Titcomb, Tyler J; Giesser, Barbara S; Plafker, Scott M ...
Frontiers in neurology,
12/2023, Letnik:
14
Journal Article
Gender Issues in Multiple Sclerosis Giesser, Barbara S.
The Neurologist (Baltimore, Md.),
2002-November, Letnik:
8, Številka:
6
Journal Article
Recenzirano
BACKGROUND-Multiple sclerosis (MS) is primarily a disease of premenopausal women. Interactions between the disease and the reproductive cycle are important to consider for optimal patient management.
...REVIEW SUMMARY-Sex hormones are potent immunomodulators, and their actions may help explain the gender distribution seen in MS and other immune-mediated diseases. Preliminary data suggest that immune function may vary cyclically as a function of hormonal milieu. MS does not affect fertility or the ability to bear children, and pregnancy generally has a salutary effect on the disease. Possible teratogenic actions of drugs used for symptom management and prophylactic treatment must be reviewed when managing patients.
CONCLUSIONS-Additional studies are needed to delineate the roles of sex hormones as etiologic (and possibly therapeutic) agents in MS. Pharmacologic treatment of MS may impact reproductive function. Neurologists need to be familiar with these issues to assist their patients in choosing therapies and family planning.
We reviewed a 10% random sample of charts from an outpatient clinic for multiple sclerosis to determine the frequency with which baclofen was prescribed for spasticity in high doses (greater than 80 ...mg/d). About 20% of patients had taken high-dose baclofen, and 15% were still receiving a high dose. Taking a high dose was not associated with discontinuing treatment.
Background: Hippocampal atrophy preferentially affects the CA1 region in early multiple sclerosis (MS). Volume loss, especially in the left hippocampus, is correlated with deficits in verbal ...learning. The spatial localization and extent of hippocampal volume change in MS in association with clinical variables has not been characterized. Objective: To localize hippocampal atrophy in MS patients compared with controls using a three-dimensional surface displacement mapping technique, and to determine if these changes are correlated with clinical measures. Methods: The right and left hippocampi (CA1-3, dentate gyrus and subiculum) were manually segmented from a standard T1-weighted scan obtained at 1.5 T (resolution 1 mm3) by a single trained researcher. A total of 23 relapsing- remitting MS (RRMS) patients and 18 controls were studied. Using a previously described high resolution surface mesh algorithm, average surface maps were generated for controls and RRMS patients. Differences in surface landmarks between the groups were determined over the entire left and right hippocampus. Significance of detected displacements was determined using the Wilcoxon ranked-sum test adjusted for multiple comparisons with the permutation test. The relationship of clinical variables (performance on an unrelated word list learning task, PASAT performance and T2 lesion volume measures) was assessed using linear regression. Results: Surface displacements in the RRMS patients were greater in the anterior hippocampal region and statistically significant displacement was detectable in the left anterior subiculum. Surface displacement was greater for the left versus the right hippocampus. Worsening verbal learning performance was correlated with greater displacement in the left anterior CA regions, while PASAT performance and T2 lesion volumes were not correlated with regional hippocampal changes. Conclusions: Changes in hippocampal volumes in RRMS are localized to anterior regions as revealed by three-dimensional surface mapping. Left anterior hippocampal changes are associated with deficits in verbal learning but not T2 lesion volumes. The hippocampus is vulnerable to clinically relevant changes in MS.
Background:
People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. ...the Society).
Objective:
The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda.
Method:
The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness.
Results:
That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society’s Wellness Research Working Group.
Conclusion:
The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences.
Background: Multiple sclerosis (MS) patients experience a wide spectrum of cognitive deficits, and verbal memory deficits are common. Verbal encoding is dependent on the medial temporal lobe (MTL) ...and the hippocampus. Previous functional magnetic resonance imaging (fMRI) studies show that in normal learning, encoding activates the anterior CA1-3 and dentate gyrus (antCADG) regions of the hippocampus. We recently demonstrated reductions in hippocampal gray matter volume localized to the CA1 subregion in early MS patients and significant loss in all hippocampal regions in secondary progressive patients. Objective: To assess whether alterations in hippocampal functional activity are present in MS, and if they contribute to verbal memory deficits, fMRI and a novel cortical unfolding technique were used to investigate BOLD signal differences in specific subregions of the hippocampus and MTL during a verbal memory task. Methods: High-resolution structural and functional MRls were acquired for each subject at 3.0T. An unrelated word-pairs test was used to determine verbal memory performance. Cortical unfolding of the hippocampus and nearby MTL was performed using a previously described technique. After interpolation, flattened templates had an isotropic resolution of 0.4 mm and demarcated 10 specific subregions. Significant group activations, corrected for multiple comparisons, were then overlaid on combined group templates to show subreglon-specific activity during encoding and recall. Results: During the task, patients required more trials than controls to learn all word pairs. Controls showed activations specific to the antCADG during encoding, consistent with previous literature. Patients did not show this same pattern, but instead showed extra-hippocampal activity localized to the perirhinal cortex. Conclusions: While MS affects hippocampal volume, it is unknown how these structural changes contribute to verbal memory deficits. Using fMRI, we find that MS patients deviate from normal activation patterns in the antCADG region during encoding. Patients instead demonstrate greater activity in the perirhinal cortex, a region that inputs into the hippocampus via the entorhinal cortex. These differences may account for verbal memory deficits.
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