Shabas D, Weinreb H
J Womens Health Gend Based Med 2000 May;9(4):389-95
Initiative for Women with Disabilities, Multiple Sclerosis Care Center, Hospital for Joint Diseases/Mount Sinai NYU Health, New York, New York, USA
PMID# 10868611; UI# 20324463
The health maintenance of women with diverse disabilities and chronic disabling conditions has been neglected by medical professionals.
Interest in their basic health promotion has been eclipsed by the narrowed focus on their underlying conditions. We surveyed preventive medical practices of 220 women with Multiple Sclerosis (MS).
The objectives of this study were to evaluate the adequacy of preventive healthcare delivery for women with MS and to explore the adequacy of the detection, prevention, and treatment of Osteoporosis in this high-risk population.
Our survey revealed that 50% of the women do not get regular medical preventive checkups.
Twenty-five percent do not have regular pelvic examinations, and 11% have not had a Pap Smear within 3-5 years. In women over 40 years old, 52% do not have yearly Mammograms.
Risk factors for premature Osteoporosis in our sample included impaired mobility (53%), CorticoSteroid use (82%), and Vitamin D deficiency as a result of avoidance of sunlight.
Despite these risks, 85% have never had Bone Density Testing, 50% are not taking Calcium supplements, and 71% are not taking Vitamin D.
Among the postmenopausal sample, 81% have never had bone density testing, 50% are not taking Calcium supplements, and 70% are not receiving Hormone Replacement Therapy (HRT). Only 1% are taking Bone Resorption Inhibitors.
The benefits of preventive healthcare and Cancer prevention screening should be stressed to women with MS.
Referrals should be facilitated by Neurologists for dignified, knowledgeable examinations in fully accessible facilities. Osteoporosis prevention, screening, and treatment protocols must be part of the medical plan for all women with MS.
InterLeukin Genes Evaluation Fails To Identify Clear Multiple Sclerosis Susceptibility Loci
McDonnell1 GV, Kirk1 CW, Hawkins SA, Graham CA
J Neurol Sci 2000 May 1;176(1):4-12
Royal Victoria Hospital, Northern Ireland Neurology Service, Northern Ireland, Belfast, UK
Differential expression of InterLeukins may influence susceptibility to Inflammatory Diseases such as MS.
IL-1a production is increased in MS patients during acute relapse, IL-2 receptor (IL-2R) secretion correlates with disease activity in several inflammatory disorders and is variable in MS.
Both IL-4and IL-10 expression vary significantly with relapse/remission in MS and IL-9 is postulated to inhibit Steroid-induced Apoptosis.
To examine the influence of InterLeukin (IL) Genes on MS susceptibility and clinical course, Gene association studies using separate polymorphic microsatellite markers for IL-1alpha, IL-2, IL-2rß, IL-4 IL-9 and IL-10 were performed.
Incorporating 150-177 Relapsing/Remitting or Secondary/Progressive MS (RR/SPMS) patients, 100-110 Primary/Progressive (PPMS) patients and 152-210 controls.
No significant differences existed in Allele frequencies between either MS group and controls for any of the InterLeukin microsatellite markers studied, nor were statistically significant differences observed in PPMS vs. RR/SPMS for any marker.
These data indicate that the IL-1alpha, IL-2, IL-2Rß, IL-4, IL-9 and IL-10 Genes are unlikely to be susceptibility loci for MS in this population.
ApolipoProtein E Genotype Related Differences In Brain Lesions Of Multiple Sclerosis
Fazekas F, Strasser-Fuchs S, Schmidt H, Enzinger C, Ropele S, Lechner A, Flooh E, Schmidt R, Hartung HP
J Neurol NeuroSurg Psychiatry 2000 Jul;69(1):25-28
Karl-Franzens University, Dept of Neurology, Auenbruggerplatz 22, A-8036 Graz, Austria
Clinical reports have speculated on a more severe course of Multiple Sclerosis in patients with the ApolipoProtein E (ApoE) Epsilon4 Allele.
As this could be reflected by differences in the severity of tissue damage MRI was used to obtain further support for a disease modifying effect of the ApoE Genotype.
Brain MR scans of 83 patients (mean age 35.5 (SD 9.5 years) who participated in a cross sectional study on the distribution of Genotype patterns in Multiple Sclerosis.
The total lesion load (TLA) on Proton Density weighted (T2-LL) and T1 weighted scans (T1-LL) obtained with conventional Spin Echo sequences at 1.5 T was measured.
A "Black Hole" ratio ((T1-LL/T2-LL)x100) was also calculated. This indicates the proportion of Multiple Sclerosis lesions with more severe tissue damage and may reflect disease aggressiveness or quality of repair.
Patients with the ApoE-Epsilon3/Epsilon4 Genotype (n=19) showed a non-significantly greater T2-LL (16.0 (SD 14.0) cm(3)) than patients with the Epsilon2/Epsilon3 (n=11; 13.3 (9.5) cm(3)) or the Epsilon3/Epsilon3 Genotype (n=49; 9.4 (SD 9.2) cm(3)).
Both the T1-LL (2.6 (SD 3.3) v 1.6 (SD 2.4) and 1.2 (SD 3.0) cm(3); p=0.04) and the black hole ratio (14.3 SD 11.9) v 7.4 (SD 9.3) and 8.4 (SD 13.3)%; p=0.02), however, were significantly higher in Epsilon3/Epsilon4 patients.
Similar differences were seen when comparing patients with at least one Epsilon4 Allele with the remainder of the group.
These data support speculations on a modulation of Multiple Sclerosis severity by the ApoE Genotype which can be attributed to more extensive tissue destruction or less efficient repair in carriers of the Epsilon4 Allele.
The Social Impact Of Multiple Sclerosis - A Study Of 305 Patients And Their Relatives
Hakim EA, Bakheit AM, Bryant TN, Roberts MW, McIntosh-Michaelis SA, Spackman AJ, Martin JP, McLellan DL
Disabil Rehabil 2000 Apr 15;22(6):288-93
Southampton General Hospital, Rehabilitation Research Unit, Southampton, UK
PMID# 10864132; UI# 20320128
To assess the effects of Multiple Sclerosis (MS) on the patients' ability to fulfil their chosen family and social roles and to examine the impact of the disease on their relatives.
A population-based survey of all known patients with MS and their relatives in Hampshire County, England, between 1986 and 1989.
Seventy-four% of the total study population of 411 completed the study.
The patients' mean age was 48.3 years (range 19-82) and the mean disease duration was 15.8 years. About 16% of patients were Depressed on a Mood Rating Scale and a similar number also exhibited symptoms of Anxiety.
The marital status of most patients had not changed since the onset of MS but 53% of those who were employed at the time of diagnosis gave up their jobs and the standards of living of 37% of patients and their families had declined as a direct result of the disease.
The ability to continue in gainful employment or to maintain social contacts and leisure activities correlated with the course and severity of the disease and Cognitive function.
Most carers reported symptoms that clearly related to organic pathologies, Anxiety and symptoms of Depression.
The occurrence of these symptoms was associated with disease severity. The professional career of 57% of relatives was also adversely affected by the patient's illness.
MS has a profound impact on the patients' social roles and their relatives' well-being. In contrast to previous studies, a high divorce/separation rate among patients with MS was not observed.
Severe Disability and Cognitive Impairment are predictors of loss of employment, decline in the standards of living and withdrawal from social and leisure activities among patients and are strong indicators of stress among relatives.
Murine Macrophages Stimulated With Central And Peripheral Nervous System Myelin Or Purified Myelin Proteins Release Inflammatory Products
Constantinescu CS, Goodman DB, Hilliard B, Wysocka M, Cohen JA
NeuroSci Lett 2000 Jun 30;287(3):171-174
Univ of Leicester, Dept of Microbiology and Immunology, Maurice Shock Medical Sciences Building, UnivRoad, LE1 9HN, Leicester, UK
Macrophage inflammatory products including Tumor Necrosis Factor (TNF) and InterLeukin-12/p40 are implicated in DeMyelinating Diseases such as Multiple Sclerosis (MS), Guillain-Barre Syndrome, and animal models Experimental AutoImmune EncephaloMyelitis and Neuritis.
The Macrophage product Angiotensin Converting Enzyme (ACE) is released during Inflammation. ACE can also be elevated in MS.
We investigated the ability of central (CNS) and Peripheral Nervous System (PNS) Myelin to stimulate TNF, InterLeukin-12, and ACE production by murine Macrophages.
Both CNS and PNS Myelin and purified Myelin Basic Protein and P2 protein induced release of these products.
Direct stimulation by Myelin may represent a mechanism of inducing release of Macrophage products in inflammatory DeMyelination or Neural injury.
Gabapentin Is Effective In Treating Nocturnal Painful Spasms In Multiple Sclerosis
Solaro C, Uccelli MM, Guglieri P, Uccelli A, Mancardi GL
Mult Scler 2000 Jun;6(3):192-3
Italian M.S. Society, Dept of Social and Health Services and Research, Italy
PMID# 10871832; UI# 20332499
In patients with MS Nocturnal Spasms (NPS) occur frequently, primarily during the night and may influence the ability to and/or quality of sleep. We enrolled in an open label trial with Gabapentin (GBP) (up to 600 mg/day) 24 MS patients with NPS.
We obtained patient reports of subjective discomfort at pre-treatment and following 2- (T1) and 8 weeks (T2), utilizing a 3-point analogue scale.
Twenty of the 22 patients who completed the study reported resolution or amelioration of discomfort. Clinical improvement occurred 1 - 5 days following initial treatment.
Three patients experienced adverse effects but completed the minimal follow-up period (2 weeks). Two patient dropped out of the study due to no compliance or adverse effects.
A very low dose of GBP may be effective treatment for MS patients with NPS who may benefit from rapid improvement of discomfort with minimal risk of adverse effects.