Prevalence Survey Of Multiple Sclerosis In The Australian Capital Territory
Simmons RD, Hall CA, Gleeson P, Everard G, Casse RF, O'Brien ED
Intern Med J 2001 Apr;31(3):161-7
Australian National Register of MS Families, Canberra Hospital, Woden, Australia
PMID# 11478345; UI# 21370621
This study sought to obtain an estimate of the prevalence of Multiple Sclerosis (MS) in the Australian Capital Territory (ACT).
A largely urban region that differs climatically and SocioEconomically from other Australian cities examined in previous MS surveys.
Prevalence day was chosen to coincide with the 1996 National Census.
All ACT Neurologists' records for the previous 5 years were examined and cases of MS were classified according to the published diagnostic criteria of Rose et al. and Poser et al.
By the criteria of Rose et al., as used in previous Australian surveys of MS, prevalence was 79.9/100,000 (95% confidence interval (CI) = 63.4-99.2) for females, 32.8 (22.7-46.2) for males and 56.7 (43.1-74.1) for all people, standardized to the 1996 population.
Standardized to the 1981 population for direct comparison with 1981 surveys in New South Wales, the prevalence of MS in the ACT was still unexpectedly high, particularly for females.
Using the criteria of Poser et al., the prevalence of MS standardized to the 1996 population was 70.6/ 100,000 (95% CI = 58.4-85.3) for females, 28.0 (20.3-37.8) for males and 49.5 (42.2-58.2) for all people.
There was evidence from a relatively short duration of disease in the ACT sample that some persons with long-standing MS had been missed in the survey and therefore that the prevalence of MS observed in the ACT was an underestimate.
The survey found an unexpectedly high prevalence of MS in the ACT. Possible reasons for this are discussed.
There was no evidence that the advent of Magnetic Resonance Imaging had increased the numbers of persons diagnosed with MS in the present survey.
Clinical Study Of Vestibular-Evoked Myogenic Potentials And Auditory BrainStem Responses In BrainStem Lesions
Itoh A, Kim YS, Yoshioka K, Kanaya M, Enomoto H, Hiraiwa F, Mizuno M
Acta Otolaryngol Suppl 2001;545:116-9
Saitama Medical School, Division of Neuro-otology, Dept of Otolaryngology, Saitama, Japan
PMID# 11677723; UI# 21533653
A total of 13 patients, who were diagnosed with localized BrainStem lesions using MRI, were investigated.
The diagnoses were Multiple Sclerosis in five patients, BrainStem hemorrhage in three patients, PontoMedullary infarction in one patient and Wallenberg's Syndrome in four patients.
In addition, 42 ears of 21 normal adult volunteers were also examined.
In a patient with upper BrainStem lesions mainly affecting the MidBrain, the Auditory BrainStem Response (ABR) was abnormal but the Vestibular-Evoked Myogenic Potential (VEMP) was normal.
In four patients with middle BrainStem lesions which mainly affected the Pons, both ABR and VEMP were abnormal.
In five patients with lower BrainStem lesions which mainly affected the Medulla, the ABR was normal but the VEMP was abnormal
In those patients with middle-to-lower BrainStem lesions, a disappearance of VEMP reactions, delay of the positive-negative (PN) wave, increase in PN interpeak latency and decrease in PN amplitude on the affected side were confirmed.
In conclusion, the VEMP test comprises a useful new diagnostic method for identifying lower BrainStem lesions.
Amato MP, Ponziani G, Siracusa G, Sorbi S
Arch Neurol 2001 Oct;58(10):1602-6
University of Florence, Dept of Neurology,Viale Morgagni, 85, Florence, Italy 50134
PMID# 11594918; UI# 21478894
To reassess, in a cohort of patients with early-onset Multiple Sclerosis, the long-term evolution of Cognitive deficits, their relationship to the disease's clinical progression, and their effects on daily life.
Ten years after our baseline assessment, we again compared the Cognitive performance of patients and control subjects on a NeuroPsychological test battery.
Clinical and demographic correlates of Cognitive Impairment and their effects on everyday functioning were determined by multiple linear regression analysis.
Setting & Participants
The research clinic of a Univ Dept of Neurology. Forty-five inpatients and outpatients with Multiple Sclerosis and 65 demographically matched healthy controls from the original sample.
Main Outcome Measures
Mean scores of both groups on the NeuroPsychological test battery in initial and 2 follow-up evaluations (about 4 and 10 years, respectively).
Number of Cognitively impaired subjects, defined by the number of subtests failed.
Regression coefficients measuring the relationship between clinical variables and Cognitive outcome and between mental decline and everyday functioning assessed by the Environmental and the Incapacity Status Scales.
Previously detected Cognitive Defects in Verbal Memory, Abstract Reasoning, and Linguistic Processes were confirmed on the third testing, at which time deficits in Attention/Short-Term Spatial Memory also emerged.
Only 20 of 37 patients who were Cognitively unimpaired on initial testing remained so by the end of the follow-up, when the proportion of subjects who were Cognitively impaired reached 56%.
Degree of physical Disability, Progressive Disease course, and increasing age predicted the extent of Cognitive decline.
Disability level and degree of Cognitive Impairment were independent predictors of a patient's handicap in the workplace and in social settings.
In the course of a sufficiently long follow-up, Cognitive Dysfunction is likely to emerge and progress in a sizable proportion of patients.
As Multiple Sclerosis advances, Neurological and Cognitive involvement tend to converge.
Limitations in a patient's work and social activities are correlated with the extent of Cognitive decline, independent of degree of physical disability.
Berry I, Cassol E, Ibarrola D, Manelfe C, Clanet M
Rev Neurol (Paris) 2001 Sep;157(8-9):769-776
NeuroRadiologie et Neurologie, Biophysique, CHU Toulouse
Early imaging investigations in Multiple Sclerosis (MS) described focal signs. Technological progress now suggests this concept should be revisited.
As more diffuse anomalies of the Central Nervous System are described, sometimes involving regions that appear normal with conventional imaging techniques.
This integrative concept results largely from the contribution of Magnetic Resonance Imaging techniques recently broadened to in vivo investigations.
Technical developments in MRI now provide new contrast images: Magnetization Transfer, Diffusion, Anisotropic Diffusion, or Functional MRI.
As well as new variants of conventional sequences designed to demonstrate specific aspects of the MS lesions:
- FLAIR sequence - a T1-weighted sequence
- Black Holes - a particular aspect on T1-weighted images
- Cord Atrophy - quantification of the Axonal section of the Cord on T1-weighted sequences
Together these new methods should improve diagnostic sensitivity (FLAIR) or provide prognosis information not provided by conventional sequences (T1 or T1 weighted images with or without Gadolinium injection).