A Randomized Trial Of Plasma Exchange In Acute Central Nervous System Inflammatory DeMyelinating Disease
Weinshenker BG, O'Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW, Pineda AA, Stevens LN, Rodriguez M
Ann Neurol 1999 Dec;46(6):878-86
Mayo Clinic and Mayo Foundation, Dept of Neurology, Rochester, MN 55902, USA
PMID# 10589540; UI# 20055457
There are no established treatments for patients with acute, severe Neurological deficits caused by Multiple Sclerosis or Other inflammatory DeMyelinating Diseases of the Central Nervous System who fail to recover after treatment with high-dose CorticoSteroids.
We conducted a randomized, sham-controlled, double-masked study of Plasma Exchange without concomitant ImmunoSuppressive treatment in patients with recently acquired, severe Neurological deficits.
Resulting from attacks of inflammatory DeMyelinating disease, who failed to recover after treatment with IntraVenous CorticoSteroids.
Patients who did not achieve moderate or greater improvement after the first treatment phase crossed over to the opposite treatment.
Moderate or greater improvement in Neurological Disability occurred during 8 of 19 (42.1%) courses of active treatment compared with 1 of 17 (5.9%) courses of sham treatment. The primary analysis was positive.
Improvement occurred early in the course of treatment, and was sustained on follow-up. However, 4 of the patients who responded to the active treatment experienced new attacks of DeMyelinating Disease during 6 months of follow-up.
Moderate or greater improvement occurred during follow-up in only 2 of 13 patients who failed to improve during the treatment phase.
Plasma Exchange leads to functionally important Neurological recovery in an important proportion of severely disabled patients with acute attacks of idiopathic inflammatory DeMyelinating Disease.
The Development Of A Scale Of The Guttman Type For The Assessment Of Mobility Disability In Multiple Sclerosis
De Souza LH
Clin Rehabil 1999 Dec;13(6):476-81
Centre for Research in Rehabilitation, Dept of Health Studies, Brunel University, Isleworth, Middlesex, UK
PMID# 10588533; UI# 20053754
To develop a valid and reliable scale of the Guttman type for the assessment of mobility disability in Multiple Sclerosis (MS).
Sixty-eight subjects with a definite diagnosis of MS participated. They were living in the community and attending as outpatients at a MS unit at a District General Hospital.
Thirty had the Primary/Progressive pattern of disease, and 38 had the Relapsing/Remitting pattern.
Formal assessments used for Neurological Disability were inspected, and 14 test items of gross motor function were extracted and ordered according to criteria.
These were that tests required trunk control and did not require isolated movement at a single limb or body segment.
That actions progressed from lying, to sitting, to standing and walking tasks, proceeding from broader to narrower bases of support. All subjects carried out all test items which were scored as 'pass' or 'fail'.
Data were tested for internal consistency, reliability, inter-item correlation, reproducibility and scalability. On the basis of the results, the items were reordered in rank, and reduced to 11 tests. The 11-item scale was reanalyzed.
Results showed that the scale had an internal consistency of 0.88 (alpha coefficient) and a coefficient of reproducibility (CR) of 0.95 and above for both MS subject groups.
The coefficient of scalability (CS) for items was 0.78 for Primary/Progressive subjects and 0.74 for the Relapsing/Remitting group. Reliability ranged from moderate (kappa = 0.49) for one item, to perfect for six items.
The scale was demonstrated to be a hierarchical scale of the Guttman type exhibiting homogeneity and good reliability.
The high CR indicated that scores may be summed, and the very acceptable levels of CS indicated that the cumulative scores are meaningful within the defined concept of hierarchy used in this study.
Role Of MicroVascular Decompression In Trigeminal Neuralgia And Multiple Sclerosis
Broggi G, Ferroli P, Franzini A, Pluderi M, La Mantia L, Milanese C
Lancet 1999 Nov 27;354(9193):1878-9
PMID# 10584731; UI# 20049426
An excellent outcome after MicroVascular decompression for medically intractable Trigeminal Neuralgia in patients with Multiple Sclerosis is reported in seven of 15 cases.
A dual cause could be hypothesised in some patients with Multiple Sclerosis and Trigeminal Neuralgia
Frontal Lobe Dementia In Multiple Sclerosis
A MultiParametric MRI Study
Comi G, Rovaris M, Falautano M, Santuccio G, Martinelli V, Rocca MA, Possa F, Leocani L, Paulesu E, Filippi M
J Neurol Sci 1999 Dec 15;171(2):135-144
Scientific Institute H San Raffaele, Dept of NeuroScience, Clinical Trials Unit, Via Olgettina 60, 20132, Milan, Italy
Previous studies achieved conflicting results when correlating Magnetic Resonance Imaging (MRI) abnormalities and Cognitive Impairment in Multiple Sclerosis (MS) patients.
Recently, the estimation of MS lesion load on T1-weighted images and the analysis of Magnetization Transfer Ratio (MTR) Histograms, increased the degree of the correlation between physical disability and MRI findings in MS.
We assessed the relationship of conventional and non-conventional MRI-derived measures with Frontal Lobe Dementia in MS.
Dual echo, T1-weighted and MT MRI scans of the Brain were obtained in 11 MS patients with and in 11 without Frontal Lobe Dementia, matched for age, sex, education and disability. Total (TLL) and Frontal (FLL) lesion loads were assessed from T2- and T1-weighted scans.
MTR Histogram analysis was performed for the whole Brain, the Frontal Lobe and the Cerebellum. Median TLL and FLL were significantly higher in Cognitively impaired patients on both T2- and T1-weighted scans.
The MRI measure that better discriminated the two groups of patients was T1-weighted TLL (median values were 19.1 ml for demented and 1.9 ml for non-demented patients, P=0.006).
Average MTR, peak height and location of overall Brain and Frontal Lobe Histograms were significantly lower for Cognitively impaired than for Cognitively intact patients (P values ranged from 0.0001 to 0.001).
Cerebellar MTR Histogram metrics did not significantly differ in patients with and without Cognitive decline.
The presence of Cognitive decline in MS is associated with the extent and pathological severity of Brain MRI abnormalities.