Influence Of Infection On Exacerbations Of MS
Ann Neurol 1994;36 Suppl:S25-8
VA Medical Center, Research Service, Baltimore, MD
IS# 0364-5134; UI# 94288568
Exacerbations of Multiple Sclerosis (MS) are triggered by exogenous events, the best documented being Viral Upper Respiratory Infections (URIs), which can stimulate secretion of Cytokines such as Interferon-gamma (IFN-) by Immune Cells.
In conjunction with a recent clinical trial of systemic Interferon-beta (IFN-ß) in Relapsing/Remitting MS, we studied the occurrence of Viral Infections and their correlation with MS attacks.
Thirty patients kept daily logs, noting URI symptoms in themselves, family members, and co-workers. Patients were examined every 3 months, or whenever an attack of MS occurred, and were tested for AntiBodies to common Upper Respiratory Pathogens.
A strong correlation was found between MS attacks and URIs. There were 168 URIs in 2,792 patient-weeks, including 996 weeks at risk (the interval beginning 1 week before and ending 5 weeks after onset of URI symptoms) and 1,796 weeks not at risk.
Nearly two-thirds of attacks occurred in periods at risk. Attack rates were 2.92 per year in weeks at risk compared to 1.16 per year in weeks not at risk, a significant difference (p 0.001). High-dose Interferon reduced the frequency of MS attacks, but had no effect on the number of URIs.
Although a specific Virus could not be incriminated, we concluded that URIs of presumed Viral origin are an important trigger of MS attacks, and that treatment with IFN-ß reduces the attack rate, but not by preventing URIs.
Rather, it may modulate responses to Viral Infection that would otherwise lead to Immune activation and clinical symptoms.
Hypoxemia During Oral Feedings In Adults With Dysphagia And Severe Neurological Disabilities
Rogers B; Msall M; Shucard D
State Univ of New York, Dept of Pediatrics, Buffalo
IS# 0179-051X; UI# 93169994
Signs of Respiratory distress including coughing, choking, and gagging are not uncommon during oral feedings in patients with severe Dysphagia. Aspiration Pneumonia and Chronic Lung Disease are recognized complications.
Pulse Oximetry, Respiratory Inductance Plethysmography, and Nasal Airflow measurement by thermistors are accurate noninvasive methods of monitoring CardioPulmonary adaptation during oral feedings in patients with severe Dysphagia.
We report significant, previously unrecognized, acquired Hypoxemia during oral feedings in two patients with severe Cerebral Palsy and one with Multiple Sclerosis. The episodes of Hypoxemia occurred only while swallowing specific food textures.
Periods of Hypoxemia most probably resulted from aspiration during oral feedings. CardioPulmonary adaptation may prove to be an important consideration in decisions
regarding the method and advisability of continued oral feedings in patients with severe Dysphagia.
The Effects Of The Gaba Agonist, Baclofen, On Sleep And Breathing
Finnimore AJ; Roebuck M; Sajkov D; McEvoy RD
Eur Respir J 1995 Feb;8(2):230-4
Repatriation General Hospital, Sleep Disorders Unit, Daw Park, Australia
IS# 0903-1936; UI# 95278313
The Gamma AminoButyric Acid (GABA)-B agonist, Baclofen, is a centrally-acting, Anti-Spasmodic agent and muscle relaxant used in Spinal Cord lesions, Multiple Sclerosis and other Neurological Disorders.
In a previous pilot study of quadriplegic patients, 75% of whom were treated with Baclofen, we found a high prevalence of sleep-disordered breathing.
Because of the depressant effects of GABA on the Central Nervous System, we hypothesized that Baclofen might aggravate sleep-disordered breathing in susceptible individuals by depressing Central Ventilatory Drive, increasing Upper Airway Obstruction and/or increasing the Arousal Threshold to Apnoea.
We therefore conducted a double-blind, placebo-controlled, cross-over study of Baclofen 25 mg, administered before sleep in 10 snorers with mild sleep-disordered breathing (Respiratory disturbance index 30 events per sleep hour).
Each subject underwent two standard PolysoMnographic assessments, one week apart. Total sleep time was significantly prolonged by Baclofen (placebo 356 +/- 9.9 SEM min;
Baclofen 386 +/- 9.9 min).
Both NonRapid Eye Movement (REM) and REM sleep duration were increased (nonREM: placebo 295 +/- 6.8 min; Baclofen 311 +/- 8.9 min; REM: placebo 61 +/- 7.5 min; Baclofen 76 +/- 9.0 min). Time spent awake after sleep onset was reduced after Baclofen (placebo 71 +/- 10.3 min; Baclofen 51 +/- 9.7 min).
There was a slight reduction in mean overnight Oxygen saturation (placebo 95.2 +/- 0.5%; Baclofen 94.4 +/- 0.7%). The frequency of Apnoeas plus Hypopnoeas (Respiratory disturbance index (RDI)) did not change significantly (placebo 9 +/- 1.8 events.h-1; Baclofen 13 +/- 3.4 events.h-1)
(Abstract Truncated At 250 Words).
Dysphagia In Multiple Sclerosis
De Pauw A, Dejaeger E, D'hooghe B, Carton H
Clin Neurol NeuroSurg 2002 Sep;104(4):345-51
University Hospital, Secretariaat Neurologie, Department of Neurology, Herestraat 9, 3000, Leuven, Belgium
PMID# 12140103; UI# 22135535
- To determine the prevalence of Swallowing problems in MS patients
- And its relation to the overall disability
- To define the most frequent symptoms suggestive of Dysphagia
- To describe the abnormalities on ManoFluoroScopy (MFS)
Three hundred and eight consecutive MS patients were asked whether they ever had Swallowing problems.
If so the questionnaire of the Johns Hopkins Swallowing Centre was applied to qualify the Dysphagia.
A MFS was performed in 30 patients with Dysphagia covering the entire spectrum of MS. Overall disability was assessed using the Expanded Disability Status Scale (EDSS).
Seventy-three of our 309 patients had permanent Dysphagia (24%). Another 5% had a history of transitory Swallowing problems only.
Permanent Dysphagia started to be a problem in mildly impaired patients (EDSS 2-3). Prevalence increased together with rising disability to reach 65% in the most severely disabled subjects (EDSS 8-9).
Two alarming symptoms of patients with Swallowing problems, Coughing or Choking during the meal and a history of Pneumonia were present in 59%, respectively, 12% of these patients.
MFS showed deficiency of the Oral Phase in all patients, while only the patients with an EDSS higher than 7.5 showed abnormalities of the Pharyngeal Phase.
Permanent Dysphagia may already develop in mildly impaired MS patients but becomes a rather frequent finding in MS patients with moderate or severe disability.
MFS is a sensitive and useful ancillary examination. Important qualitative changes of the Pharyngeal Phase on MFS are seen in patients with an EDSS higher than 7.5.