Clinical Tests Of Standing Balance
In Multiple Sclerosis
Frzovic D, Morris ME, Vowels L
Arch Phys Med Rehabil 2000 Feb;81(2):215-21
LaTrobe University, School of Physiotherapy, Faculty of Health Sciences, Bundoora, Victoria, Australia
PMID# 10668778; UI# 20132212
To investigate differences in performance between people with Multiple Sclerosis (MS) and control subjects on clinical tests of balance, and to assess performance consistency on balance tests in people with MS from morning to afternoon.
Study Design & Setting
Two factor repeated measures design with a two group sample of convenience.
Kingston Centre and the Camberwell Centre of the MS Society of Victoria, Australia.
Fourteen people with MS and 14 control subjects matched for age, height, and sex.
Main Outcome Measures
Subjects were measured on their ability to maintain standing balance in steady stance, (feet apart, feet together, stride stance, tandem stance, and single leg stance), during self-generated perturbations (functional reach, arm raise, and step tests) and in response to an external perturbation.
Participants with MS were also asked to rate their Fatigue level in the morning and afternoon.
There were no differences between MS and control groups on the ability to maintain standing balance with feet apart, feet together, or in stride stance.
Participants with MS performed more poorly than control subjects in tandem stance and single leg stance and in the functional reach test, arm raise test, step test, and in response to an external perturbation.
There was little change in balance from morning to afternoon in participants with MS (ICCs (2,1) .70 to .94), despite an increase in self-rated Fatigue (t(14) = -3.14, p = .008).
The ability to maintain balance in standing is a marked problem in people with MS despite the consistency of their performance from morning to afternoon.
Increased Numbers Of CCR5+ Interferon-- And Tumor Necrosis Factor--Secreting T-Lymphocytes In Multiple Sclerosis
Strunk T, Bubel S, Mascher B, Schlenke P, Kirchner H, Wandinger KP
Ann Neurol 2000 Feb;47(2):269-73
Univ of Lubeck School of Medicine, Institute of Immunology and Transfusion Medicine, Germany
PMID# 10665504; UI# 20127270
To determine the frequency of in vivo activated T(H)1 Lymphocytes, T-Cell subsets of 9 Multiple Sclerosis patients with active disease and 17 healthy controls were analyzed by Immunostaining for CCR5, CD26.
And their expression of InterLeukin-2, Interferon-, and Tumor Necrosis Factor-.
The numbers of CCR5+ Interferon-- and Tumor Necrosis Factor--producing T-Cells were significantly increased in the peripheral blood of Multiple Sclerosis patients.
CCR5 expression may be a useful marker to identify effector cells in Multiple Sclerosis and could be used as a tool for monitoring disease activity.
Heterogeneity Of T-Lymphocyte Function In Primary/Progressive Multiple Sclerosis: Relation To Magnetic Resonance Imaging Lesion Volume
Prat A, Pelletier D, Duquette P, Arnold DL, Antel JP
Ann Neurol 2000 Feb;47(2):234-7
Montreal Neurological Institute, McGill University, NeuroImmunology Unit, Quebec, Canada
PMID# 10665495; UI# 20127261
We found that in vitro migration and Interferon- production by Lymphocytes derived from Primary/Progressive Multiple Sclerosis patients preselected on the basis of a high T2-weighted lesion volume (>10 cm3) on Magnetic Resonance Imaging, were increased compared with that in Primary/Progressive Multiple Sclerosis patients with a low T2-weighted lesion volume (<3 cm3) and controls.
Whether the Heterogeneity of Immune function within the Primary/Progressive population will correlate with response to therapy remains to be established.
Lycklama a Nijeholt GJ, Uitdehaag BM, Bergers E, Castelijns JA, Polman CH, Barkhof F
Eur Radiol 2000 Jan 27;10(2):368-376
Dutch MS-MRI Center, Dept of Radiology, Vrije Universiteit Hospital, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
We examined the value of Spinal Cord Magnetic Resonance Imaging (MRI) in the diagnostic work-up of Multiple Sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms.
Disability was assessed, and symptoms were categorized as either Brain or Spinal Cord. Work-up further included CerebroSpinal Fluid analysis and standard proton-density, T2-, and T1-weighted Gadolinium-enhanced Brain and Spinal Cord MRI.
Patients were categorized as either Clinically Definite MS (n = 13), laboratory-supported definite MS (n = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected.
Spinal Cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic Spinal Cord lesions occurred in six patients.
All patients with diffuse Spinal Cord abnormality had clear Spinal Cord symptoms and a Primary/Progressive disease course.
In Clinically Definite MS, the inclusion of Spinal imaging increased the sensitivity of MRI to 100 %. Seven patients without a definite diagnosis had Clinically Isolated Syndromes involving the Spinal Cord.
Brain MRI was inconclusive, while all had focal Spinal Cord lesions which explained symptoms and ruled out other causes. Two other patients had atypical Brain abnormalities suggesting Ischemic/Vascular Disease.
No Spinal Cord abnormalities were found, and during follow-up MS was ruled out. Spinal Cord abnormalities are common in suspected MS, and may occur asymptomatic.
Although diagnostic classification is seldom changed, Spinal Cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS.
In addition, patients with Primary/Progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved.