Assessment Of Posterior Fossa Damage In MS Using MRI
Yousry TA, Grossman RI, Filippi M
J Neurol Sci 2000 Jan 15;172 Suppl 1:S50-S53
Klinikum Grosshadern Ludwig Maximilian UnivMunich, Dept of NeuroRadiology, Marchioninistr. 15. D-81377, Munich, Germany
In Multiple Sclerosis (MS), BrainStem and Cerebellum are frequent sites of damage in Clinically Isolated Syndromes at presentation and it is likely that lesions located in such structures can have an important impact on the development of disability in the definite forms of the disease.
In patients presented with isolated BrainStem syndromes, the symptomatic lesion was often not detected by Magnetic Resonance (MR) imaging. But patients with asymptomatic InfraTentorial lesions progressed to Clinically Definite MS in 65% of cases.
InfraTentorial lesions are included in various MR criteria designed to assist in the differential diagnosis of MS lesions from incidental lesions, to differentiate MS from SubCortical Encephalopathic Arteriopathy.
The preferred MR sequence to visualize InfraTentorial lesions is the Fast Spin Echo sequence. It is preferred to conventional Spin Echo and Fast Fluid Attenuated Inversion Recovery sequences because of its relatively short acquisition time and good sensitivity.
The correlation between disability and InfraTentorial lesion load on T2 weighted sequences is controversial.
However, it was recently shown that the correlations between clinical measures and T1 lesion load, Histogram Magnetization Transfer Ratio and peak positions, and InfraTentorial volume measurements are strong.
These findings suggest that one of the major factors in the development of disability in patients with MS is the pathological damage in clinically eloquent sites such as the BrainStem and Cerebellum.
A Comparison Of Continuous Thalamic Stimulation And Thalamotomy For Suppression Of Severe Tremor
Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, Merkus MP, Speelman JD
N Engl J Med 2000 Feb 17;342(7):461-468
Academic Medical Center, Dept of Neurology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
Deep-Brain stimulation through an electrode implanted in the Thalamus was developed as an alternative to Thalamotomy for the treatment of drug-resistant Tremor. Stimulation is thought to be as effective as Thalamotomy but to have fewer complications.
We examined the effects of these two procedures on the functional abilities of patients with drug-resistant Tremor due to Parkinson's Disease, Essential Tremor, or Multiple Sclerosis.
Sixty-eight patients (45 with Parkinson's Disease, 13 with Essential Tremor, and 10 with Multiple Sclerosis) were randomly assigned to undergo Thalamotomy or Thalamic stimulation.
The primary outcome measure was the change in functional abilities six months after surgery, as measured by the Frenchay Activities Index. Scores for this index can range from 0 to 60, with higher scores indicating better function.
Secondary outcome measures were the severity of Tremor, the number of adverse effects, and patients' assessment of the outcome.
Functional status improved more in the Thalamic-Stimulation group than in the Thalamotomy group, as indicated by increases in the score for the Frenchay Activities Index (from 31.4 to 36.3 and from 32.0 to 32.5, respectively; difference between groups, 4.4 points; 95 percent confidence interval, 2.0 to 6.9).
After adjustment for base-line characteristics, multivariate analysis also showed that the Thalamic-Stimulation group had greater improvement (difference between groups, 5.1 points; 95 percent confidence interval, 2.3 to 7.9).
Tremor was suppressed completely or almost completely in 27 of 34 patients in the Thalamotomy group and in 30 of 33 patients in the Thalamic-Stimulation group.
One patient in the Thalamic-Stimulation group died perioperatively after an IntraCerebral Hemorrhage. With the exception of this incident, Thalamic Stimulation was associated with significantly fewer adverse effects than Thalamotomy.
Functional status was reported as improved by 8 patients in the Thalamotomy group, as compared with 18 patients in the Thalamic-Stimulation group (P=0.01).
Thalamic stimulation and Thalamotomy are equally effective for the suppression of drug-resistant Tremor, but Thalamic Stimulation has fewer adverse effects and results in a greater improvement in function.
Cryoelectron Microscopy Of Protein-Lipid Complexes Of Human Myelin Basic Protein Charge Isomers Differing In Degree Of Citrullination
Beniac DR, Wood DD, Palaniyar N, Ottensmeyer FP, Moscarello MA, Harauz G
J Struct Biol 2000 Feb;129(1):80-95
Univ of Guelph, Guelph, Dept of Molecular Biology and Genetics, Ontario, N1G 2W1, Canada
Myelin Basic Protein (MBP) is considered to be essential for the maintenance of stability of the Myelin Sheath.
Reduction in cationicity of MBP, especially due to conversion of positively charged Arginine residues to uncharged Citrulline (Cit), has been found to be associated with Multiple Sclerosis (MS).
The interactions of an anionic Phosphatidylserine/Monosialoganglioside-G (M1) (4:1, w:w) Lipid monolayer with 18.5-kDa MBP preparations from age-matched adult humans without MS (no Cit residues), with Chronic MS (6 Cit), and with Acute Marburg-type MS (18 Cit) were studied by transmission and ultralow dose scanning transmission electron microscopy under cryogenic conditions.
Immunogold labeling and single particle electron crystallography were used to define the nature of the complexes visualized.
These electron microscopical analyzes showed that the three different MBP charge Isomers all formed uniformly sized and regularly shaped Protein-Lipid complexes with G(M1), probably as hexamers, but exhibited differential association with and organization of the Lipid.
The least cationic Marburg MBP-Cit(18) formed the most open Protein-Lipid complex.
The data show a disturbance in lipid-MBP interactions at the ultrastructural level that is related to degree of Citrullination, and which may be involved in Myelin degeneration in Multiple Sclerosis.
Copyright 2000 Academic Press.
Canadian Collaborative Study Group
Steckley JL, Dyment DA, Sadovnick AD, Risch N, Hayes C, Ebers GC
Neurology 2000 Feb 8;54(3):729-32
Univ of Oxford, Wellcome Trust Centre for Human Genetics, England
PMID# 10680811; UI# 20143004
The objective of this study was to investigate Genes involved in the metabolism and function of Vitamin D as candidate Genes for Genetic susceptibility to MS.
Restriction fragment length polymorphisms and highly polymorphic microsatellite markers within or very close to the 1,25(OH)2D3 receptor (VDR) [12q14], the Vitamin D binding protein (DBP) [4q12], and the 25(OH)D2 1alpha-hydroxylase [12q13] loci were analyzed for linkage or association with MS.
We found no evidence for linkage or association of these candidate Genes with MS in the Canadian population.
Identification Of HLA-Class-II-Restricted Epitopes Of AutoAntigens In Transgenic Mice
Abraham RS, David CS
Curr Opin Immunol 2000 Feb;12(1):122-129
Mayo Medical School, Dept of Immunology, Rochester, MN-55905, USA
The past year has seen a spate of research in the use of HLA transgenic mice in the identification of Self Antigens associated with AutoImmunity.
Dominant T-Cell determinants - and, in a few cases, B-Cell determinants - have been characterized in the context of disease-predisposing HLA DR and DQ Genes for at least three prominent and devastating AutoImmune Diseases: Rheumatoid Arthritis, Multiple Sclerosis and Insulin-dependent Diabetes Mellitus.