Cognitive Impairment In Different MS Subtypes And Clinically Isolated Syndromes
Potagas C, Giogkaraki E, Koutsis G, Mandellos D, Tsirempolou E, Sfagos C, Vassilopoulos D
J Neurol Sci 2008 Apr 15;267(1-2):100-6
Eginition Hospital, Department of Neurology, School of Medicine, University of Athens, Greece
To investigate the pattern of Cognitive Impairment in patients with Relapsing/Remitting (RR), Secondary/Progressive (SP), Primary/Progressive (PP) Multiple Sclerosis, and patients with Clinically Isolated Syndrome (CIS) suggestive of MS, relative to control participants in the Greek population.
RR patients (N=75), SP patients (N=29), PP patients (N=23), CIS patients (N=33), and healthy control participants (N=43) were assessed by the Brief Repeatable Battery of NeuroPsychological Tests (BRBN).
The overall prevalence of Cognitive Dysfunction in our patients was 52.8% with CIS patients excluded and 47.5% with CIS patients included.
All MS patients differed significantly from controls in all BRBN measures.
Similar was the pattern of Cognitive Dysfunction in patients with CIS suggestive of MS, although Verbal Learning/Memory Capacity (as measured by the Selective Reminding Test) remained relatively spared.
The comparisons between patient groups revealed some differences in the performance mainly in favor of CIS and RRMS patients. These differences largely disappeared after controlling for physical disability (EDSS).
All MS subtypes patients exhibit a pattern of Cognitive Impairment running across the studied Cognitive domains.
The pattern of Cognitive Dysfunction in patients with CIS is similar with relative sparing of Verbal Learning.
Pluriformity Of Inflammation In Multiple Sclerosis Shown By Ultra-Small Iron Oxide Particle Enhancement
Vellinga MM, Oude Engberink RD, Seewann A, Pouwels PJ, Wattjes MP, van der Pol SM, Pering C, Polman CH, de Vries HE, Geurts JJ, Barkhof F
Brain 2008 Mar;131(Pt 3):800-7
University Medical Centre, Department of Neurology, Amsterdam, The Netherlands
Gadolinium-DTPA (Gd-DTPA) is routinely used as a marker for inflammation in MRI to visualize breakdown of the Blood-Brain Barrier (BBB) in Multiple Sclerosis.
Recent data suggest that Ultra-Small Superparamagnetic Particles of Iron Oxide (USPIO) can be used to visualize cellular infiltration, another aspect of inflammation.
This project aimed to compare the novel USPIO particle SHU555C to the longitudinal pattern of Gd-DTPA enhancement in Multiple Sclerosis. Nineteen Relapsing/Remitting patients were screened monthly using Gd-enhanced MRI.
In case of new enhancing lesions, USPIO were injected and 24 h later, MRI was performed and blood was collected to confirm USPIO loading of circulating Monocytes.
Lesion development was monitored by 3 monthly Gd-DTPA-enhanced scans and a final scan 7-11 months after injection.
USPIO-enhancement was observed as HyperIntensity on T1-weighted images, whereas no signal changes were observed on T2-weighted-gradient-echo images.
In 14 patients with disease activity, 188 USPIO-positive lesions were seen, 144 of which were Gd-negative. By contrast, there were a total of 59 Gd-positive lesions, 15 of which were USPIO negative.
Three patterns of USPIO-enhancement were seen:
- Focal enhancement
- Ring-like enhancement and
- Return to IsoIntensity of a previously HypoIntense lesion
The latter pattern was most frequently observed for lesions that turned out to be transiently HypoIntense on follow-up scans.
And ring-enhancing lesions were less likely to evolve into black holes at follow-up than lesions without ring-like USPIO-enhancement; we speculate this to be associated with repair.
In 4% of the USPIO-positive/Gd negative lesions, USPIO-enhancement preceded Gd-enhancement by 1 month.
USPIO-enhancement remained visible for up to 3 months in 1.5% of all USPIO-positive lesions. In 29% of the lesions enhancing with both contrast agents, USPIO-enhancement persisted whereas Gd-enhancement had already resolved.
In conclusion, the new nano-particle SHU555C provides complementary information to Gd-enhanced MRI, probably related to Monocyte infiltration.
The use of USPIO-enhanced MRI is likely to lead to more insight in the pluriformity of inflammation in Multiple Sclerosis.
Variation Of Serum Uric Acid Levels In Multiple Sclerosis During Relapses And Immunomodulatory Treatment
Guerrero AL, Martín-Polo J, Laherrán E, Gutiérrez F, Iglesias F, Tejero MA, Rodríguez-Gallego M, Alcázar C
Eur J Neurol 2008 Apr;15(4):394-7
Hospital Río Carrión, Neurology Unit, Palencia, Spain
Uric Acid (UA), a product of purine metabolism, may be an antioxidant, perhaps acting as a scavenger of Peroxynitrite. Patients with Gout have a reduced incidence of Multiple Sclerosis (MS).
A number of studies found that patients with MS have low serum levels of UA, although it has not been established whether this represents a primary deficit or a secondary effect.
UA has also been proposed as a marker of disease activity and response to ImmunoSuppressive or ImmunoModulatory treatment.
We retrospectively reviewed 83 Relapsing/Remitting or Secondary/Progressive MS patients (64 females and 19 males) followed in our Neurology Unit.
We collected data concerning demographic variables as age and sex, and clinical variables as age of onset, clinical type, disease duration, EDSS score and total number of relapses.
We considered UA levels in three different situations: during a relapse, during remission period and during remission period under ImmunoModulatory treatment Interferon-beta-1a im (Avonex; Biogen Idec Inc., Cambridge, MA, USA).
Interferon-beta-1a sc (Rebif; Serono Europe Limited, London, UK), Interferon-beta-1b (Betaferon; Bayer Schering Pharma AG, Berlin, Germany) or Glatiramer Acetate (Copaxone; TEVA Neuroscience LLC, Kansas City, MO, USA).
A Wilcoxon matched pairs test was carried out to determine differences between groups. A P-value less than 0.05 was considered statistically significant.
In 33 patients, we were able to compare at least one UA value obtained during a relapse with at least one when remission without treatment. Mean serum UA levels were significantly lower when measured during a relapse (r: 0.39, P: 0.024).
In 27 cases, we compared at least one remission value without treatment with at least one obtained during remission and ImmunoModulatory treatment.
Mean serum UA levels significantly increased when determined during Interferon-beta or Glatiramer Acetate therapy (r: 0.84, P < 0.001).
Although we do not know exactly whether and how UA is involved in MS pathogenesis, our data suggest that UA might reflect disease activity or treatment response in MS.
Comparison Of The Effect Of Two Types Of Acupuncture On Quality Of Life In Secondary/Progressive Multiple Sclerosis: A Preliminary Single-Blind Randomized Controlled Trial
Donnellan CP, Shanley J
Clin Rehabil 2008 Mar;22(3):195-205
Nottingham University Hospitals NHS Trust, Neuro-Rehabilitation Unit, Nottingham. UK
To compare the effect of two types of Acupuncture on the quality of life of individuals with Secondary/Progressive Multiple Sclerosis and provide preliminary evidence regarding the safety of this intervention for this population.
Design & Setting
Preliminary single-blind randomized controlled trial. Outpatient attendance at rehabilitation unit.
Fourteen participants with Secondary/Progressive Multiple Sclerosis.
Chinese medical Acupuncture or minimal Acupuncture. Participants received 10 treatments over five weeks.
Multiple Sclerosis Impact Scale 29, Fatigue Severity Scale and General Health Questionnaire 12 were measured pre and post intervention. Adverse events and other responses during treatment were recorded prospectively.
Participants receiving minimal Acupuncture demonstrated statistically significant greater improvement in the Multiple Sclerosis Impact Scale.
29 psychological subscale compared with those receiving Chinese medical Acupuncture in an intention-to-treat analysis (P=0.04), with mean change in Chinese Acupuncture group of 6.0 (SD 13.9).
And in minimal Acupuncture group of 23.0 (SD 21.0). No other statistically significant difference between the groups was found.
No major adverse events were noted. Minor adverse events such as lower limb muscle spasms or pain were noted in some participants in both intervention groups.
Minimal Acupuncture resulted in greater improvement of Multiple Sclerosis Impact Scale 29 psychological subscale compared with Chinese medical acupuncture.
No other differences between the groups were found. In view of the small sample these results are not conclusive.
This study provides preliminary evidence to suggest that Acupuncture is safe for people with Secondary/Progressive Multiple Sclerosis. A large-scale trial is required to provide more definitive evidence.
Canadian Pediatric DeMyelinating Disease Study Group
Ghassemi R, Antel SB, Narayanan S, Francis SJ, Bar-Or A, Sadovnick AD, Banwell B, Arnold DL
Ann Neurol 2008 Mar;63(3):401-5.
McGill University, Montreal Neurological Institute, Montreal, Quebec
We evaluated the incidence, volume, and spatial distribution of T2-weighted Magnetic Resonance Imaging lesions in 58 children.
With Clinically Isolated Syndromes at risk for Multiple Sclerosis compared with 58 adults with Relapsing/Remitting Multiple Sclerosis.
Pediatric patients with Clinically Isolated Syndromes who had Brain lesions had SupraTentorial lesion volumes similar to adult Multiple Sclerosis patients, but greater InfraTentorial lesion volumes (p < 0.009), particularly in the Pons of male patients.
The predilection for InfraTentorial lesions the pediatric patients with Clinically Isolated Syndromes may reflect Immunological differences or differences in Myelin, possibly related to the CaudoRostral temporal gradient in Myelin maturation.
Ann Neurol 2008.
Voxel-Based Assessment Of Differences In Damage And Distribution Of White Matter Lesions Between Patients With Primary/Progressive And Relapsing/Remitting Multiple Sclerosis
Di Perri C, Battaglini M, Stromillo ML, Bartolozzi ML, Guidi L, Federico A, De Stefano N
Arch Neurol 2008 Feb;65(2):236-43
University of Siena, Department of Neurological and Behavioral Sciences, Neurology and NeuroMetabolic Unit, Viale Bracci 2, 53100 Siena, Italy
Several studies have reported lower focal DeMyelination and inflammatory activity in Primary/Progressive Multiple Sclerosis (PPMS) than in Relapsing/Remitting MS (RRMS).
However, very little is known about possible differences in damage and distribution that may occur within lesions visible on Magnetic Resonance Imaging in the 2 forms of the disease.
To evaluate differences in spatial distribution and structural damage of focal DeMyelinating lesions in patients with PPMS and RRMS.
We acquired conventional Magnetic Resonance and Magnetization Transfer images in 24 PPMS and 36 RRMS patients (matched for sex, age, and disease duration) and 23 healthy sex- and age-matched controls.
In each participant, we measured T2- and T1-weighted lesion volumes and Magnetization Transfer Ratios in lesional and nonlesional Brain Tissues.
The spatial distribution of focal DeMyelination was assessed using T2- and T1-weighted lesion probability maps in each patient group. Voxel-based procedures were performed.
Patients with PPMS had greater disability than those with RRMS, with 70% of PPMS patients and 11% of RRMS patients having relevant motor symptoms.
The T1- and T2-weighted lesion volumes were higher in PPMS than in RRMS patients (P < .001).
T1- and T2-weighted lesion probability maps showed that the maximum probability for lesions was higher in PPMS (peak probability, 45% and 29%, respectively) than in RRMS (peak probability, 33% and 19%, respectively).
Patients and was localized in the Corona Radiata. Voxelwise analysis of lesional Magnetization Transfer Ratios gave overlapping results.
Differences in Cerebral pathologic involvement exist between RRMS and PPMS and contribute to variations in clinical disability.
Effects Of Interferon-ß On Co-Signaling Molecules: Upregulation Of CD40, CD86 And PD-L2 On Monocytes In Relation To Clinical Response To Interferon-beta Treatment In Patients With Multiple Sclerosis
Wiesemann E, Deb M, Trebst C, Hemmer B, Stangel M, Windhagen A
Mult Scler 2008 Mar;14(2):166-76
Medical School Hannover, Department of Neurology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Interferon-beta (IFN-ß) reduces disease activity in a subgroup of patients with Relapsing/Remitting Multiple Sclerosis (MS). The mechanism of action as well as the PathoPhysiological basis of responsiveness to IFN-ß is not well understood.
Since T-Cell activation plays an important part in the pathophysiology of MS, we here investigated the effect of IFN-ß on the expression of co-signaling pathways (CD28-CD80/CD86, CD154-CD40, ICOS-ICOSL, PD-1-PD-L1/2).
In MS patients and correlated the results with the clinical response to IFN-ß in individual patients.
Expression of co-signaling molecules was measured by flow cytometry in vitro on Peripheral Blood MonoNuclear Cells after incubation with IFN-ß, and in vivo in whole blood samples of 32 untreated and 24 IFN-ß treated MS patients, including 13 patients longitudinal.
IFN-ß treatment induced upregulation of CD40, CD80, CD86, PD-L1 and PD-L2 on Monocytes as well as PD-L1 on CD4(1)-T-Cells in vitro and in vivo.
IFN-ß treated MS patients were grouped into responders and non-responders on the basis of Kurtzke's EDSS (Expanded Disability Status Scale) progression and relapse rate.
Upregulation of CD40, CD86 and PD-L2 on Monocytes was associated with treatment response to IFN-ß (P < 0.001, P = 0.028 and P = 0.028, respectively).
Our results show that IFN-ß upregulates co-stimulatory as well as co-inhibitory molecules in vitro and in vivo implicating that modulation of the balance between positive and negative co-stimulatory signals might be an important part of the mechanism of action of IFN-ß in MS.
Upregulation of the expression of CD40, CD86 and PD-L2 may be useful as a predictive marker for clinical response to IFN-ß treatment at early timepoints during IFN-ß therapy.