Multiple Sclerosis And Age At Infection With Common Viruses
Hernan MA, Zhang SM, Lipworth L, Olek MJ, Ascherio A
Epidemiology 2001 May;12(3):301-6
Harvard School of Public Health, Dept of Epidemiology, 677 Huntington Avenue, Boston, MA 02115, USA
PMID# 11337603; UI# 21236977
Increased risk of Multiple Sclerosis has been reported among individuals with a history of Measles and other common childhood diseases during adolescence, infectious Mononucleosis, or exposure to the Canine Distemper Virus.
We investigated these associations in a case-control study nested within the Nurses' Health Study (121,700 women traced since 1976) and the Nurses' Health Study II (116,671 women traced since 1989).
Age at diagnosis of common Viral diseases and birth order were obtained through a questionnaire. Our results include 301 cases with Multiple Sclerosis and their (up to six) matched controls.
Except for infectious Mononucleosis, which was a moderate risk factor (odds ratio = 2.1, 95% confidence interval = 1.5-2.9).
We found little association between history of common Viral diseases or exposure to Canine Distemper Virus and risk of Multiple Sclerosis.
We did find a relation between Mumps after 15 years of age (odds ratio = 2.3, 95% confidence interval = 1.2-4.3) or Measles after age 15 years of age (odds ratio = 2.8, 95% confidence interval = 0.8-9.1) and Multiple Sclerosis.
Birth order was not materially related to Multiple Sclerosis.
Our findings support the hypothesis that individuals who suffered from infectious Mononucleosis, a marker of late infection with the Epstein-Barr Virus, have an increased risk of Multiple Sclerosis.
Late infection with other common Viruses may also be associated with increased risk.
The ParaCentral Visual Field In Multiple Sclerosis: Evidence For A Deficit In InterNeuronal Spatial Summation?
Antal A, Aita JF, Bodis-Wollner I
Vision Res 2001 Jun;41(13):1735-42
Univ of Szeged, Dept of Physiology, P.O. Box 427, 6720, Szeged, Hungary
PMID# 11348654; UI# 21247233
A Visual complaint such as blurred or 'washed-out vision' can be one of the early signs of Multiple Sclerosis (MS).
Although Visual deficits are commonly attributed to Optic Nerve DeMyelination even with preserved Visual Acuity.
The results of a considerable number of Visual studies are inconsistent with this interpretation: [Camisa, Mylin, & Bodis-Wollner, Annals of Neurology 10 (1981) 532-539; Regan & Neima, British Journal of Ophthalmology 68 (1984) 310-315].
However, a Retinal Axonal (Nerve Fiber Layer) defect can be detected in some Eyes, this is not the rule.
Routine Visual Field (VF) tests, with a low sampling rate may also be non-informative in MS and Optic Neuritis, possibly because the VF abnormalities may be small and spotty or they can be found between tested points.
The present study combined the advantages of VF and Contrast Sensitivity (CS) testing by applying Contrast Perimetry (CP), to the central 16 degrees of the VF.
Four ParaCentral VF quadrants were tested in clinically affected and unaffected eyes of 31 MS patients and 26 controls.
The stimuli were vertical Gaussian apertured sinusoidal gratings (Gabors) of 1 cpd. CS was obtained as a function of the diameter of the Gabor ranging from 1 to 7.4 degrees.
The CP data of controls and Definite and Probable MS groups were significantly different for each pattern size, but the largest difference was found at diameters 2.5-3.7 degrees.
Our study adds to previous evidence showing that Optic Nerve pathology does not explain 'subclinical' and manifest Visual dysfunction in MS. Given previous studies revealing orientation dependent MonOcular Visual deficits and our study results.
Parsimony suggests that MS affects a network relying on Myelinated Lateral Axonal branches of the Visual Cortex, binding MonOcular columns of Neurons with-like specificity.
Clinico-Laboratory Study Of MethylPrednisolone And Cyclophosphamide Treatment In Multiple Sclerosis Relapse
Manova MG, Kostadinova II, Rangelov AA
Folia Med (Plovdiv) 2000;42(3):20-5
Higher Medical Institute, Dept of Neurology, 15A Vassil Aprilov St., 4000 Plovdiv, Bulgaria
PMID# 11347331; UI# 21245898
The effect of combined treatment (MethylPrednisolone and Cyclophosphamide) of Multiple Sclerosis relapse within one year was investigated in an open clinical trial study of 70 patients.
The sample comprised subjects shown to have clinically proven Multiple Sclerosis according to the criteria of C Poser and degree of Neurological deficit according to EDSS rating from 2.5 to 6.0 points.
Material And Methods
MethylPrednisolone (200 mg, i.v., every other day, 10 doses, total course dose 2 g) was administered to 35 patients (mean age 31.34 +/- 1.53 years).
MethylPrednisolone using the same schedule and Cyclophosphamide (200 mg, i.v.) given in the MethylPrednisolone-free day, 10 doses plus 200 mg i.v. once a month in the first three consecutive months (total course dose 2.6 g) were applied in another 35 patients (mean age 33.22 +/- 1.32 years).
Results And Discussion
The changes of EDSS ratings at the end of months 1 and 12, of the CD8+ T-Lymphocytes subpopulations and B-Lymphocytes from peripheral blood - prior to treatment and between the 5th and 9th week of treatment were compared.
The Neurological deficit degree according to EDSS dropped significantly (P < 0.01; P < 0.001) after one month of treatment in both groups.
At the end of month 12 this indicator reached its baseline value in the group treated only with MethylPrednisolone while remaining significantly lower in the combined therapy group (P < 0.01).
After MethylPrednisolone and Cyclophosphamide application the Suppressor/Inducer CD8+ T-Cells increased significantly in percentage (P < 0.05).
While the values of B-Lymphocytes decrease significantly (P < 0.05), in contrast to the results from the MethylPrednisolone-only treatment.
The results clearly indicate the greater efficaciousness of treatment by combining two ImmunoSuppressive drugs.
Acute Disseminated EncephaloMyelitis In Childhood
Report of 10 cases
Campistol Plana J, Cambra FJ, Guitet Julia M
Rev Neurol 2001 Mar 16;32(5):409-413
Unid. Integr. Pediatr, Servei de Neurologia, Hospital Universitario Sant Joan de Deu, Esplugues de Llobregat, 08950, Espana
Acute Disseminated EncephaloMyelitis (ADEM) is a postinfectious Encephalitis that is usually preceded by an infectious disease or vaccination.
The clinical presentation has a wide spectrum and complementary exams are none specific, except Magnetic Resonance Imaging (MRI) findings showing multifocal White Matter lesions similar to those seen in Multiple Sclerosis.
Patients And Methods
We report 10 children with the diagnosis of ADEM. We describe the clinical course and response to treatment.
The prodroms were fever in all cases except one. The most common Neurological symptoms were Consciousness Impairment, Headache and Seizures.
The CerebroSpinal Fluid examination was abnormal in 9 patients with positive serologic test to EnteroVirus in one of them. MRI showed HyperIntense multifocal SubCortical White Matter lesions on T2-weighted images.
Treatment with Steroids was given to 5 patients, Steroids and ImmunoGlobulins to one patient and symptomatic treatment to the rest. From the last group one patient relapsed and then received CorticoSteroid treatment.
The follow up revealed a complete recovery in 6/7 patients that received steroids. Three patients have sequelae and of these, 2 received only symptomatic treatment.
The diagnosis of ADEM is based on clinical and radiologic features, once other entities have been excluded.
At the moment of suspicious of ADEM a Brain-Spinal Chord MRI should be done, seeing that TAC brings not much information at the beginning.
The treatment with Steroids seems to be the most effective and the prognosis good, specially in cases that respond rapidly to it.