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Multiple Sclerosis Abstracts



Additional Abstracts:



Psychosocial Issues

Economic Status of Families Living with Multiple Sclerosis
A nation-wide survey of 604 families living with Multiple Sclerosis was conducted.

The sample was recruited through local chapters of the National Multiple Sclerosis Society and the public press.

This paper describes the economic impact of the disease on families. There were 427 families in which the woman had Multiple Sclerosis and 177 families in which the man had the disease.

The average duration of the disease was 10 years. Family income was well above the national median income.

Thirty-nine per cent of the men and 19% of the women with Multiple Sclerosis retired because of disability.

Income was adequate to pay for medical expenses in 21% of the families and 25% had inadequate funds to meet basic living expenses.

While 80% of the families had health care insurance, for 28% of the families the insurance was inadequate to cover the costs of their illness.

The number of children living at home and the amount of health care bills paid out of pocket failed to explain why families in the high income groups had difficulty meeting their expenses.

Factor other than income and proportion of medical expenses covered by insurance determine the economic impact on the family.

If health care providers are going to meet all the needs of the family with Multiple Sclerosis, a more comprehensive assessment of their economic status is needed.

Catanzaro, M; Weinert, C
International Journal of Rehabilitation research 1992; 15(3): 209-18



Multiple Sclerosis: Role of Social Support & Disability
This descriptive study explores the types and sources of social support and examines the relationship between types and sources of social support and physical disability and the length of illness of 101 individuals with Multiple Sclerosis.

The Norbeck Social Support questionnaire was used to examine functional support (affect, affirmation, and aid) and structural support (size of network, duration of relationships, and frequency of contact).

Findings reveal that subjects perceived "moderate" to quite a bit" of affect (love, respect, and admiration) but only "moderate" to "little" amounts of affirmation (support of one's thoughts or actions) and tangible aid.

Results of multivariate analysis of variance carried out on 44 subjects perceived less overall support from spouse/partner and family.

Findings also indicate that subjects with a longer period of illness perceived less amount of affect and affirmation and had less contact with network members.

O'Brien, MT
Clinical Nursing Research 1993 Feb; 2(1): 67-85





Chronic Sorrow in Multiple Sclerosis: A Case Study

Multiple Sclerosis, one of the most common chronic disabilities among young adults, may potentiate the occurrence of chronic sorrow.

Chronic sorrow differs from acute grief because it is permanent, periodic, and progressive in nature; it may be a normal component of chronic illness and disability.

This study describes one woman's experience with Multiple Sclerosis, her chronic sorrow, about the trajectory of her disability, her progressive loss of bodily function, and the stigma of chronic illness. It also reports some of the feelings experienced by her husband, the primary caregiver.

Hainsworth, MA; Burke, ML; Lindgren, CL; Eakes, GG
Home healthcare Nurse 1993 Mar-Apr; 11(2): 9-13



Cognitive-Linguistic Assessment in Multiple Sclerosis

Four individuals diagnosed as having Multiple Sclerosis (MS) and four matched controls were assessed with the Arizona Battery for Communication Disorders (SABCD), a standardized battery of memory and cognitive-linguistic tasks.

Subjects with MS and controls performed in an equivalent fashion for nine of the ABCD subtests. For five of the subjects (Object description, generative Naming, concept definition, generative Writing, and Picture Description), subjects with MS performed substantially lower than the control subjects.

Results of this pilot study suggest that portions of the ABCD may be useful in identifying profiles of memory, and cognitive-linguistic impairment among individuals with Multiple Sclerosis.

Further research using a larger sampling of individuals with MS is needed to more fully assess the usefulness of the ABCD with this population.

Wallace, GL; Holmes, S
Archives of Physical Medicine and Rehabilitation 1993; 74(6): 637-43


Physiopathology

Seizures due to Multiple Sclerosis:
Seven Patients with MRI Correlations

The MRI data of seven patients with clinically definite Multiple Sclerosis who developed Epileptic Seizures are present.

Six of these cases demonstrated new of enhancing lesions. Cerebral biopsy in one of these lesions confirmed inflammation with Myelin breakdown products.

Lesions implicated in the causation of Seizures involved the Cortex or SubCortical area. In one patient, a new lesion was associated with EEG abnormalities which resolved as the lesion reduced in size.

In three patients Epileptic activity was the only clinical manifestation of disease. Large, unresolving lesions tended to be associated with continuing Seizures.

Thompson, AJ; Kermode, AG; Mosely, IF; MacManus, DG; McDonald, WI
Journal of Neurology, NeuroSurgery and Psychiatry 1993; 56:1317-1320




Limiting and Repairing the Damage in Multiple Sclerosis

Inflammation of the Brain depends upon migration of activated Lymphocytes across the Blood-Brain Barrier bringing to the Abluminal surface of Cerebral Blood vessels a variety of cellular and soluble immune mediators.

Treatments which reduce the availability of circulating Lymphocytes or limit their entry into the Nervous System influence human and experimental inflammatory Brain Disease.

The knowledge that inflammatory processes in the Brain culminate in contact between Microglia and Oligodenrocyte-Myelin unit, which is damaged by local release of Tumor Necrosis Factor, provides additional opportunities for treatment.

In this disease, disability results both from the inflammatory process and the failure of precursor cells to enter the lesions, differentiate and ReMyelinate the naked Axons.

The probability for the future is that a combination of manoeuvres involving limitation of the inflammatory process, increased availability of Glial progenitors and re-establishment of their developmental growth factor environment will be needed to repair DeMyelinated lesions

Compston, A
Schweiziche Medizinsche Wochenschrift.
Journal Suisse de Medicine 1993 Jun 5; 123(22): 1145-52


Urinary Symptoms and the Neurological Features of Bladder Dysfunction in Multiple Sclerosis

One hundred and seventy patients with Multiple Sclerosis and Bladder Dysfunction were evaluated. Emphasis was placed on the relationship between their neurologic features and Urinary symptoms.

The severity of the Urinary symptoms was related to the degree of Pyramidal impairment in the lower limbs, so that both problems are though to reflect the extent of Spinal involvement. No other neurological features correlated with Bladder Dysfunction.

Detrusor hyperreflexia was the commonest finding on Cystometry and no patient had areflexia. More than half of the patients had a significantly raised post-micturition residual volume but symptoms were largely unreliable in predicting poor bladder emptying.

In this series only two patients had evidence of upper tract disease: both men with severe, long-standing neurological disease who had Indwelling Catheters. Detrusor HyperReflexia can be anticipated in patients with MS who have irritative Urinary symptoms and Pyramidal Signs in their lower limbs. After measurement of the residual volume appropriate treatment can be instituted.

Betts, CD; D'Mellow, MT; Fowler, CJ
Journal of Neurology, NeuroSurgery and Psychiatry 1993 Mar; 56(3): 245-50



A Serial Study of Psychometric and Magnetic Resonance Imaging Changes in Multiple Sclerosis

Over a 6-month period, five patients with early Relapsing/Remitting Multiple Sclerosis and five with long-standing, Benign Multiple Sclerosis underwent serial psychometric testing and contrast enhanced Magnetic Resonance Imaging of the Brain at 2-weekly or monthly intervals, respectively.

All patients were individually matched with healthy controls who completed the same psychometric battery at the same time intervals.

As a group, Multiple Sclerosis patients either made more errors or performed slower on all psychometric tasks than controls.

In the control subjects and those patients with a stable Brain lesion score, no consistent deterioration occurred in any test and the overall pattern was one of improvement over time commensurate with practice effects.

However, patients with a deteriorating lesion score either showed a fall-off in performance on some psychometric tasks (patients 2,3) or else an impaired ability to improve with practice on certain tests of Attention and Information-Processing Speed (patient 10).

Feinstein, A; Ron, M; Thompson A:
Brain (1993) 116:569-602



Pregnancy and Multiple Sclerosis:
A Longitudinal Study of 125 Remittent Patients

The relationship between pregnancy and Multiple Sclerosis (MS) was assessed in a clinic-based, prospectively followed, population of 125 patients with a remittent onset of MS who had been followed for a mean (SD) of 10.3 (0.3) years.

Thirty three women had a total of 49 pregnancies of which 32 had been full term and 17 terminated.

There was a threefold increase in the relapse rate per year during the first three months following delivery, compared with the baseline period of the same patients [1.62 (0.38) vs 0.51 (0.08) p=0.05]. during pregnancy itself, the relapse-rate was not different from baseline.

The overall relapse rate of the pregnancy group was lower than that of a control group without pregnancies after MS onset, but similar to that of patients who had children after MS onset, but no pregnancy during follow up.

Pregnancy did not lead to increased disability. These results confirm that post partum increase in relapse rate is the main event related to pregnancy in MS and underline the difficulties of undertaking prospective studies in this field.

Roullet, E; Verdier-Taillefer, MH; Amarenco, P; Gharbi, G; Alperovitch, A; Marteau, R;
Journal of Neurology. NeuroSurgery and Psychiatry. 1993;56:1062-1065


Epidemology

The Geographic Distribution of MS: A Review (Editorial)

The decisive conclusions to be drawn from the geography and prevalence of MS are:
(1) a north-south (as well as west-east in the United States) gradient exists independent from Genetic/racial factors;
(2) major differences in prevalence occur in the absence of difference in latitude
(3) individuals from the same ethnic derivation have either the similar prevalence or have very different prevalence rates in widely separated geographical areas, and (4) specific resistance isolates are shown to exist regardless of latitude.

Existing prevalence information leads to the almost inescapable conclusion that the geography of MS cannot be explained by any single known environmental or Genetic factor(s) in isolation.

A combination of a heterogeneous distribution of both Genetic and environmental factors appears to be required to explain the available data on MS and geography.

Ebers, GC; Sadovnick, AD
Neuroepidemiology 1993; 12(1): 1-5


Prognostic Factors in a Multiple Sclerosis Incidence Cohort with Twenty-five Years of follow-up

An incidence cohort consisting of 308 Multiple Sclerosis patients was followed up repeatedly during at least 25 years of disease. A number of clinical factors were analyzed with respect to their validity in assessing the long-term prognosis.

Of the onset characteristics: the type of course was the most important, with Primary/Progressive patients experiencing a much more severe course.

In patients with an acute onset, low onset age, high degree of remission at first exacerbation, symptoms from Afferent Nerve fibers and onset symptoms from only one region (as compared with polyregional symptoms) of the Central Nervous Symptom, were factors significantly associated with a favorable long-term prognosis.

Of all factors known 5 years after onset, a low number of affected neurological systems, a low neurological deficit score and a high degree of remission from the last bout were the most important favorable prognostic factors.

Runmarker B; Anderson, O
Brain 1993 Feb; 116(Pt 1): 117-34


Prevalence of MS in South Estonia

Evidence of a New Border of Fennoscandian focus: A population-based study of MS was carried out in South Estonia in 1988-1989.

Cases were identified from the Tartu Univ Hospital archives where all MS cases in South Estonia are diagnosed, from all Neurologists and nursing homes of the region, and from the local Multiple Sclerosis Society. The revalence in South Estonia is 51 per 100,000.

The prevalence rate in different counties was demonstrated as low as 31 per 100,000. The prevalence rate in different counties was demonstrated as low as 31 per 100,000 in the County of Tartu, to 72 per 100,000 in Polva county.

55% of patients have retired because of their handicap and only 2 patients (1%) were living in nursing homes.

Gross, K; Kokk, A; Kaasik, A-E
Acta Neurol Schand 1993: 88: 241-46


Oral Contraceptives and Reproductive Factors in Multiple Sclerosis Incidence

Data from the Oxford FPA prospective study show that oral contraceptive use and pregnancy have no discernible effect on the risk of developing Multiple Sclerosis (MS).

Women of parity 0-2 developed MS twice as often as women of parity 3 or more but the difference did not reach statistical significance.

Smoking may be a risk factor for developing MS. A nested test-control analysis did not identify any associations between MS onset and preceding illnesses.

Villard Mackintosh, L; Vessey, MP
Contraception 1993 Feb; 47(2): 161-8


Treatment

Intrathecal Baclofen for Intractable Spasticity of Spinal Origin: Results of a Long-term Multicenter Study

A total of 93 patients with Intractable Spasticity due to either Spinal Cord Injury (59 cases), Multiple Sclerosis (31 cases) or other spinal pathology (3 cases) were entered into a randomized double-blind placebo controlled screening on Intrathecal Baclofen test injections.

Of the 88 patients who responded to an Intrathecal bolus of 50,75 or 100 mg of Baclofen, 75 underwent implantation of a programmable pump system for chronic therapy.

Patients were followed for 5 to 41 months after surgery (mean 19 months). No deaths or new permanent neurological deficits occurred as a result of surgery or chronic Intrathecal Baclofen administration.

Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7.

Muscle spasms were reduced from a mean preoperative score of 3.1 (on a four-point to a mean postoperative score of 1.0. Although the dose of Intrathecal required to control Spasticity increased with time, drug tolerance was not a limiting factor in this study.

Only one patient withdrew from the study because of a late surgical complication (pump pocket infection). Another patient received an Intrathecal Baclofen overdose because of a human error in programming the pump.

The results of this study indicate that Intrathecal Baclofen infusion can be safe and effective for the long-treatment of intractable Spasticity in patients with Spinal Cord Injury or Multiple Sclerosis.

Coffey, JR; Cahill, D; Steers, W; Park, TS; Ordia, J; Meythaler, J; Herman, R; Shetter, AG; Levy, R; Gill, B
Journal of NeuroSurgery 1993 Feb; 78(2): 226-32


Interferon-ß-1b is Effective in Relapsing/Remitting Multiple Sclerosis
I. Clinical Results of a Multicenter, Randomized, Double-blind, Placebo-controlled Trial

We report a multicenter, randomized, double-blind, placebo-controlled trial of Interferon-ß- 1b (IFNB) in 372 ambulatory patients with Relapsing/Remitting Multiple Sclerosis (MS).

Entry criteria included an Expanded disability Status Scale (EDSS) score of 0 to 5.5 and at least two exacerbations in the previous 2 years.

One-third of the patients received placebo, one-third 1.6 million international units (MIU) of IFNB, and one-third 8 MIU of IFNB, self-administered by subcutaneous injections every other day.

The primary end points were differences in exacerbation rates and proportion of patients remaining exacerbation-free.

The annual exacerbation rate for patients receiving placebo was 1.27; for 1.6 MIU IFNB, 1.7; and for 8 MIU UFNB, 0.84 after 2 years.

Exacerbation rates were significantly lower on both treatment groups compared with the placebo group (8 MIU versus placebo, p=0.0001; 1.6 MIU versus placebo, p=00101; and 8 MIU versus 1.6MIU, p=0.0086), suggesting a dosage effect.

The reduction in exacerbation severity in the 8 MIU group was attributable to a twofold reduction in the frequency of moderate and severe attacks.

More patients in the 8 MIU groups (n=36) were exacerbation-free at least 2 years compared with the placebo group (n=18; p0.007).

EDSS scores changed little from baseline in both the placebo and treatment arms. Accordingly, a significant change in disability could not be discerned in this trial.

Finally, in serial MRIs, MS activity was significantly less in the highdose IFNB group.

IFNB Multiple Sclerosis Study Group
Neurology 1993 Apr; 43(4): 655-61


Interferon-ß-1b Effective in Relapsing/Remitting MS: MRI Results of a Multicenter, Randomized, Double-blind, Placebo-controlled Trial

We performed yearly MRI analyzes on 327 of the total 372 patients in a multicenter, randomized, double-blind, placebo-controlled trial of Interferon-ß- 1b (IFNB).

Clinical results are presented in the preceding companion paper. Baseline MRI characteristics were the same in all treatment groups.

Fifty-two patients at one center formed a cohort for frequent MRIs (one every six weeks) for analysis of disease activity.

The MRI results support the clinical results in showing a significant reduction in disease activity as measured by numbers of active scans (median 80% reduction, p=0.0082) and appearance of new lesions.

In addition, there was an equally significant reduction in MRI detected burden of disease in the treatment as compared with placebo groups (mean group difference of 23%, p=0.001).

These results demonstrate that IFNB has made a significant impact on the natural history in these patients.

UBC MS/MRI Study Group and IFNB Multiple Sclerosis Study Group
Paty, DW; Li, DK
Neurology 1993 Apr; 43(4): 655-61




Editor's Note:
The ultimate status of Beta Interferon in the therapeutic management of MS is yet to be determined.

This study has provided strong indicators that Betaseron "alters the natural course of MS" in the decreased lesion load on MRI and the reduced severity and rate of exacerbations.

Nevertheless, the lack of significant alteration in disability progression has clouded the interpretation of the results.

Ongoing assessment of this patient group (and those in initial pilot trials) plus further similarly well-conducted trials will help to clarify the role of Beta Interferon in this fundamental parameter.

The study focused on Relapsing/Remitting patients and thus the effects of Beta Interferon on the Progressive course of MS will be separately determined in a number of forth-coming trials.

The justifiable enthusiasm and hope generated from these results must be tempered by necessary caution and scientific vigilance.



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