CerebroSpinal Fluid In The diagnosis Of Multiple Sclerosis: A Consensus Report
Andersson M; Alvarez-Cermeno J; Bernardi G; Cogato I; Fredman P; Frederiksen J; Fredrikson S; Gallo P; Grimaldi LM; Gronning M; et al
J Neurol NeuroSurg Psychiatry 1994 Aug;57(8):897-902
Sahlgrenska Hospital, Gothenburg, Sweden
PMID# 8057110; UI# 94334685
The Committee of the European Concerted Action for Multiple Sclerosis (Charcot Foundation) organized five workshops to discuss CSF analytical standards in the diagnosis of Multiple Sclerosis.
This consensus report from 12 European countries summarises the results of those workshops. It is hoped that Neurologists will confer with their colleagues in clinical chemistry to arrange the best possible local practice.
The most sensitive method for the detection of OligoClonal ImmunoGlobulin Bands is IsoElectric focusing.
The same amounts of IgG in parallel CSF and Serum samples are used and OligoClonal Bands are revealed with IgG specific AntiBody staining.
All laboratories performing Isoelectric focusing should check their technique at least annually using "blind" standards for the five different CSF and Serum patterns.
Quantitative measurements of IgG production in the CNS are less sensitive than Isoelectric focusing.
The preferred method for detection of Blood-Brain Barrier Dysfunction is the Albumin quotient. The CSF Albumin or total protein concentrations are less satisfactory.
These results must be interpreted with reference to the age of the patient and the local method of determination. Cells should be counted. The normal value is no more than 4 cells/microliters.
Among evolving optional tests, measurement of the combined local synthesis of AntiBodies against Measles, Rubella, and/or Varicella Zoster could represent a significant advance if it offers higher specificity (not sensitivity) for identifying chronic rather than acute inflammation.
Other tests that may have useful correlations with clinical indices include those for OligoClonal free light chains, IgM, IgA, or Myelin Basic Protein concentrations.
Multiple Sclerosis: The Impact Of MR Imaging
Wallace CJ; Seland TP; Fong TC
AJR Am J RoentGenol 1992 Apr;158(4):849-57
Foothills Hospital, Dept of Radiological Sciences & Diagnostic Imaging, Calgary, Alberta, Canada
PMID# 1546605; UI# 92188863
MR imaging has had a significant impact on the understanding of Multiple Sclerosis.
The procedure now plays an important role in initial diagnostic workup, replacing some other radiologic and paraclinical tests and often confirming clinically suggested locations of lesions.
It also has contributed greatly to the understanding of the natural history of this disease, allowing objective assessment of disease load, detection of asymptomatic lesions (Clinically Silent MS lesions), and differentiation between acute and chronic Lesions.
MR imaging is highly sensitive to inflammation and DeMyelination caused by Multiple Sclerosis
And, although there is a long differential diagnosis for some of the MR findings, increasing experience has defined a number of relatively specific criteria for Multiple Sclerosis.
Recent advances may allow faster imaging and highly objective Lesion quantification, which will aid in therapeutic trials.
An Outcomes-Based Model For Directing Decisions In Women's Health Care
Clin Obstet Gynecol 1994 Mar;37(1):192-206
Univ of California at San Diego, Dept of Family & Preventive Medicine, La Jolla 92093-0622
PMID# 8194209; UI# 94251942
Physicians have recognized for a long time that disease categories provide minimal information about the impact of illness on patient experiences.
A diagnosis is important, because it can identify a course of treatment. However, there are considerable differences in how patients with similar diagnoses are affected.
Multiple Sclerosis, for example, may have essentially no impact on behavioral dysfunction or it could have devastating implications.
The impact of the disease on the daily life of the patient may be more important than the diagnosis of the condition. Physicians need to learn to treat the patient, not the disease. There are only two health outcomes that are of importance.
First, there is life expectancy. Second, there is function or quality of life. Biologic and physical events are mediators of these behavioral outcomes.
We are concerned about Cancer, high blood pressure, high cholesterol, and other problems because they may shorten a patient's life expectancy or make his or her life less desirable before death.
There is a growing consensus that these behavioral outcomes are central in studies of health care and medicine.
However, these outcomes, which can be obtained from standardized questionnaires, rarely are obtained in medical research and practice. A behavioral concept of health outcomes can suggest important new directions for research and practice.
Spatial Frequency Evoked VisuoGrams In Multiple Sclerosis
Celesia GG; Brigell M; Gunnink R; Dang H
Neurology 1992 May;42(5):1067-70
Loyola Univ of Chicago, Dept of Neurology, Maywood, IL
PMID# 1579231; UI# 92253024
We obtained steady-state Visual Evoked Potentials (VEPs) to Sinusoidal gratings alternating at 4 Hz with spatial frequencies varying from 0.5 to 8 cpd in 21 normal controls and 21 patients with Multiple Sclerosis (MS), and analyzed responses by fast Fourier transform.
Amplitude- and phase-spatial frequency functions were obtained and referred to as amplitude and phase "VisuoGrams."
We observed two types of abnormalities in the phase VisuoGrams of MS patients:
- Abnormal responses at all spatial frequencies tested (37%), and
- Abnormal responses only at selective spatial frequencies (52%).
Some patients had phase lag limited to low, middle, or high spatial frequencies. Steady-state and transient VEPs to 2 and 4 cpd showed a similar percent of abnormalities.
The use of more than one spatial frequency stimulus increased the diagnostic yield by 17%. Our data confirm that MS may selectively affect specific Neuronal channels within the Visual pathways.
Clinical Evaluation Of Fast Spin Echo Sequences For Cranial Magnetic Resonance Imaging At 0.5 Tesla
Hawnaur JM; Hutchinson CE; Isherwood I
Br J Radiol 1994 May;67(797):423-8
Univ of Manchester, Dept of Diagnostic Radiology, Manchester, UK
PMID# 8193885; UI# 94251563
Fast Spin Echo (FSE) sequences enable T2-weighted MR scans to be obtained in a fraction of the time necessary for conventional SE sequences with long TR and long TE.
Comparison has been made of a FSE sequence (TR = 4000 ms, effective TE = 100 ms, 2 NEX) with the T2-weighted SE sequence (TR = 2000 ms, TE = 90 ms, 1-2 NEX) normally used in 35 patients referred for Cranial MR.
Contrast-to-noise ratios (CNR) for Gray:White Matter and Brain:CSF on the FSE sequence compared favorably with Variable Echo (VE) sequences which take up to three times as long to acquire.
Although the conspicuity of some pathological Lesions such as Multiple Sclerosis plaques was inferior to that of conventional T2-weighted SE scans, no lesions were missed on FSE scans.
The FSE sequence was more prone to movement artefacts.
The benefit of the markedly increased patient throughput made possible by using the FSE sequence outweighs the slight reduction in sensitivity for small lesions.