MS Abstracts 12-99c

  1. Procarin - transdermal Histamine in Multiple Sclerosis:
    Part I - clinical experience

    Altern Med Rev 1999 Dec;4(6):424-428

  2. NidoVirus infections: experimental model systems of human Neurologic Diseases
    J Neuropathol Exp Neurol 1999 Dec;58(12):1197-206

  3. Management of Neurogenic Bladder dysfunction with incontinent IleoVesicoStomy
    Urology 1999 Dec;54(6):1008-11

  4. Model systems for studies of Leukocyte migration across the Blood-Brain Barrier
    J NeuroVirol 1999 Dec;5(6):579-590

  5. Physiology and pathology of the Blood-Brain Barrier: implications for microbial PathoGenesis, drug delivery and neurodegenerative disorders
    J NeuroVirol 1999 Dec;5(6):538-555

  6. Specificities of Multiple Sclerosis CerebroSpinal Fluid and Serum AntiBodies against mimotopes
    Clin Immunol 1999 Dec;93(3):283-93

  7. Bradykinin B1 receptor expression and function on T-Lymphocytes in active Multiple Sclerosis
    Neurology 1999 Dec 10;53(9):2087-92

  8. Clinical use of the Odstock Dropped Foot stimulator: its effect on the speed and effort of walking
    Arch Phys Med Rehabil 1999 Dec;80(12):1577-83


Procarin - TransDermal Histamine
In Multiple Sclerosis

Part I - Clinical Experience

Gillson G, Wright JV, DeLack E, Ballasiotes G
Altern Med Rev 1999 Dec;4(6):424-428
Tahoma Clinic, Nutritional Medicine, Private practice, e-mail:
Tahoma Clinic, 515 West Harrison, Kent, WA 98032

PMID# 10608915

Histamine has a long history of therapeutic use in many diseases, including Multiple Sclerosis (MS). Recently, transdermal Histamine has been successfully employed for the amelioration of symptoms of both Relapsing/Remitting And Progressive Multiple Sclerosis.

This paper summarizes preliminary experiences with transdermal Histamine for MS at the Tahoma Clinic: 67 percent of 55 patients using Histamine transdermal cream had improvements in one or more areas including: Extremity Strength, Balance, Bladder Control, Fatigue, Activities Of Daily Living, and Cognitive Functioning, sustained for periods of up to three months.

One-third of patients had improvements in three or more areas of functioning. Five possible mechanisms of action are postulated:

  1. Augmentation of subnormal Cerebral tissue levels of Histamine
  2. Improved electrical function of DeMyelinated fibers
  3. Increased Cerebral blood flow
  4. Suppression of AutoImmune Responses
  5. Stimulation of ReMyelination.

These will be discussed in detail in Part II of this article.


NidoVirus Infections: Experimental Model Systems Of Human Neurologic Diseases

Lavi E, Schwartz T, Jin YP, Fu L
J Neuropathol Exp Neurol 1999 Dec;58(12):1197-206
Univ of Pennsylvania School of Medicine, Dept of Pathology and Laboratory Medicine, Philadelphia 19104-6100, USA
PMID# 10604745; UI# 20068245

The presence of terminally differentiated slow- and non-dividing cells in the Central Nervous System (CNS) provides a safe harbor for Viral persistence and latency and constitutes a unique Immunologic environment for Viral Infections.

Studies of experimental model systems of Viral infections of the CNS provide insight into mechanisms of Viral persistence and Immune-Mediated Pathology.

NidoViruses are comprised of 2 families of Viruses, CoronaViruses and ArteriViruses, and are common Pathogens of humans and a variety of animal species.

Both families of Viruses contain NeuroTropic strains that produce experimental Neurologic Diseases in rodents. These include acute Meningitis and EncCphalitis; Acute PolioMyelitis; and Chronic Inflammatory, Immune-mediated, DeMyelination.

CoronaVirus-induced DeMyelinating Disease mimics many of the pathologic features of Multiple Sclerosis (MS).


Management Of NeuroGenic Bladder Dysfunction With Incontinent IleoVesicoStomy

Gudziak MR, Tiguert R, Puri K, Gheiler EL, Triest JA
Urology 1999 Dec;54(6):1008-11
Wayne State Univ, School of Medicine, Dept of Urology, Detroit, Michigan 48201, USA
PMID# 10604699; UI# 20068199

Incontinent IleoVesicoStomy is an alternative form of Urinary management applied to patients with NeuroGenic Vesical Dysfunction, who are either unable or unwilling to perform clean intermittent Self-Catheterization or assisted Catheterization.

We review our operative results, Urodynamic data, and complications observed in patients who underwent creation of Incontinent IleoVesicoStomy at our institution.

Thirteen patients (mean age 43.2 years) with Neurogenic Bladder Dysfunction underwent an Incontinent IleoVesicoStomy between 1994 and 1998.

The etiologies of the Neurogenic Bladder Dysfunction were

  1. Spinal Cord Injury in 8 patients
  2. Multiple Sclerosis in 4 patients
  3. Tuberculous Meningitis in 1 patient

The preoperative data, surgical records, Urodynamic findings, and postoperative complications were assessed.

All patients experienced complications of their pretreatment Bladder management. The mean operating room time was 242 minutes (range 170 to 395), including 14 additional procedures in 11 patients.

The mean estimated blood loss was 403.8 mL (range 50 to 2000). No patient required blood transfusion. There were no intraoperative complications. Only 1 patient required reoperation for Stomal revision.

One patient had a Ureteral stone 2 years after surgery; 1 patient has continued to have Urinary Tract Infections despite a negative workup. The mean follow-up was 23 months (range 6 to 57). The mean Bladder leak point pressure through the Stoma was 8.2 cm H2O.

The Incontinent IleoVesicoStomy is a useful technique in the treatment of patients with Neurogenic Bladder unable to perform clean intermittent Catheterization. It provides patients with a low-pressure Urinary conduit that empties readily without an Indwelling Catheter.


Model Systems For Studies Of Leukocyte Migration Across The Blood-Brain Barrier

Persidsky Y
J NeuroVirol 1999 Dec;5(6):579-590
Center for NeuroVirology and Neurodegenerative Disorders, Dept of Pathology and Microbiology, 985215 Nebraska Medical Center, Omaha, Nebraska, NE 68198-5215 USA
PMID# 10602399

The Blood-Brain Barrier (BBB) plays a crucial role in Central Nervous System (CNS) HomeoStasis. Serving as the Brain's protective shield, it regulates soluble factor and Cellular exchanges from blood to Brain.

Critical to its function, the BBB is composed of Brain MicroVascular Endothelial Cells (BMVEC), a Collagen matrix, and Astrocytes. Astrocytic endfeet surround the BMVEC abluminal surface and influence the 'tightness' and trafficking role of the Barrier.

In NeuroDegenerative disorders (for example Stroke, Multiple Sclerosis and HIV EnCephalitis) the BBB becomes compromized. This is, in part, Immune mediated.

An accumulating body of evidence demonstrates that the Cellular components of the BBB are themselves ImmunoCompetent. PeriVascular Cells (Astrocytes, Macrophages and Microglial Cells) and BMVEC produce inflammatory factors that affect BBB permeability and expression of Adhesion Molecules.

These affect cell trafficking into the CNS. Leukocyte BBB migration can be influenced by Cytokines and Chemokines produced by Glia. Astrocytes and Macrophages secrete a multitude of factors that affect Brain Immune Responses.

Interactions between BMVEC, Leukocytes and/or Glia, Immunological activation and noxious (infectious, toxic and Immune-mediated) Brain insults all appear to play important roles in this BBB cell trafficking.

New information gained into the mechanisms of Leukocyte-Brain penetration may provide novel insights in the PathoGenesis and treatment strategies of NeuroDegenerative Disorders.


Physiology & Pathology Of The Blood-Brain Barrier: Implications For Microbial PathoGenesis, Drug Delivery & NeuroDegenerative Disorders

Banks WA
J NeuroVirol 1999 Dec;5(6):538-555
Veterans Affairs Medical Center-St. Louis
GRECC, and Saint Louis Univ, School of Medicine, Division of Geriatrics, Dept of Internal Medicine, St. Louis, Missouri, MO 63106, USA
PMID# 10602396

The Blood-Brain Barrier (BBB) regulates the passage of solutes between the CNS and the blood.

The BBB not only restricts the entry of Serum proteins into the CNS, but it also controls the passage of Nutrients, Electrolytes, Vitamins, Minerals, Free Fatty Acids, Peptides, and regulatory proteins in both the Brain to blood and blood to Brain direction.

    The BBB performs these functions through a number of saturable and non-saturable mechanisms. For example:
  • Efflux (CNS to blood) mechanisms regulate the levels of nutrients and minerals in the CSF
  • Detoxify the CNS
  • Reinforce the impermeability of the BBB against circulating toxins and many drugs
  • Secrete CNS-originating substances into the blood
  • Drain substances directly into the Cervical Lymphatic Nodes

Influx mechanisms control the HomeoStatic environment of the CNS, supply the Brain with nutrients, and help to integrate CNS and peripheral functions. These mechanisms are altered in and can be the basis for disease and many of these systems are altered in NeuroAIDS.

We review here examples of several diseases in which the functions of the BBB are altered, and some conditions, such as Alcoholism, Multiple Sclerosis, Obesity, and a subtype of Mental Retardation, where those altered functions may underlie the PathoPhysiology.

Finally, we consider some of the ways in which these aspects of the BBB could be active in NeuroAIDS, including the efflux of Anti-Virals, the transport of Virus by adsorptive Endocytosis, egress routes for HIV-1 via Brain Lymphatics, and the release of neurotoxins from Brain Endothelial Cells.


Specificities Of Multiple Sclerosis CerebroSpinal Fluid And Serum AntiBodies Against Mimotopes

Jolivet-Reynaud C, Perron H, Ferrante P, Becquart L, Dalbon P, Mandrand B
Clin Immunol 1999 Dec;93(3):283-93
Centre National de la Recherche Scientifique-bioMerieux, Unite Mixte de Recherche 103, 46 Allee d'Italie, Lyon Cedex 07, 69364, France
PMID# 10600340; UI# 20071226

In order to characterize antigenic Epitopes specifically targeted by the Immune response of patients with Multiple Sclerosis (MS), the AntiBody specificities of CerebroSpinal Fluids (CSF) and Sera from the same MS patients have been analyzed using a random pentadecapeptide library displayed on phage.

The 3 peptides (mimotopes) selected with MS Sera were not disease-specific. In contrast, the combination of 4 MS CSF selected mimotopes, allowed the detection of specific AntiBodies in 21 of 60 MS CSF whereas only 2 of 27 CSF from patients with Other Neurological Diseases equally recognized the 4 mimotopes.

Some Amino Acid similarities were found between two MS CSF selected mimotopes and two envelope regions (319-329 and 433-443, respectively) of MSRV (Multiple-Sclerosis-Associated RetroVirus) and the related endogenous RetroVirus HERV-W.

Copyright 1999 Academic Press.


Bradykinin B1 Receptor Expression And Function On T-Lymphocytes In Active Multiple Sclerosis

Prat A, Weinrib L, Becher B, Poirier J, Duquette P, Couture R, Antel JP
Neurology 1999 Dec 10;53(9):2087-92
McGill University, The Multiple Sclerosis Clinic, Montreal Neurological Institute, NeuroImmunology Unit, Montreal, Canada
PMID# 10599786; UI# 20066769

Lesion development in MS is initiated by migration of inflammatory cells into the Central Nervous System, a process dependent on Endothelial Cell-Lymphocyte interaction.

Bradykinin B1 Receptor is a membrane-bound G protein-coupled receptor shown to be upregulated on the surface of various cells types during inflammation.

Objective & Methods
To assess the expression and function of the Bradykinin B1 receptor on T-Lymphocytes from MS patients. The authors used multiplex polymerase chain reaction amplification and Western blot techniques to demonstrate B1 receptor expression by T-Cells.

A modified Boyden chamber assay also was used to assess the effect of B1 agonist and antagonist on T-Cell migration.

The authors demonstrated that the expression of B1 receptor was upregulated on T-Cells derived from peripheral blood of MS patients.

Expression of this receptor was upregulated on T-Cells from patients with Secondary/Progressive MS and Relapsing/Remitting patients in active relapse.

Expression was lower in Relapsing/Remitting patients in remission and least in control subjects, including patients with Epilepsy, Chronic Inflammatory DeMyelinating PolyNeuritis, and Systemic Lupus Erythematosus.

In vitro treatment of cells from healthy control subjects with Tumor Necrosis Factor-alpha and Interferon-gamma also induced the expression of B1 receptors.

The authors also found that the significantly higher rate of migration of MS T-Lymphocytes, compared with control subjects in the Boyden chamber assay, could be prevented by the addition of the selective and stable B1 agonist Sar (D-Phe8) desArg9-BK.

The authors demonstrate that B1 receptors are upregulated by T-Lymphocytes during the course of MS and that signaling through this receptor with a B1 agonist can negatively regulate T-Cell migration in vitro.


Clinical Use Of The Odstock Dropped Foot Stimulator: Its Effect On The Speed And Effort Of Walking

Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, Singleton C, Swain ID
Arch Phys Med Rehabil 1999 Dec;80(12):1577-83
Salisbury District Hospital, Dept of Medical Physics and Biomedical Engineering, Wiltshire, United Kingdom
PMID# 10597809; UI# 20064679

To assess the clinical effectiveness of the Odstock Dropped Foot Stimulator by analysis of its effect on Physiological Cost Index (PCI) and speed of walking.

This Functional Electrical Stimulation (FES) device stimulates the common Peroneal Nerve during the swing phase of Gait.

Design & Subjects
A retrospective study of patients who had used the device for 4 1/2 months. One hundred fifty-one patients with a Dropped Foot resulting from an Upper Motor Neuron lesion.

A medical physics and biomedical engineering department of a district general hospital specializing in the clinical application of FES and a NeuroPhysiotherapy department at a separate hospital.

Main Outcome Measures
Changes in walking speed and effort of walking, as measured by PCI over a 10-meter course.

There was a 92.7% compliance with treatment. Stroke patients showed a mean increase in walking speed of 27% (p<.01) and reduction in PCI of 31% (p<.01) with stimulation, and changes of 14% (p<.01) and 19% (p<.01), respectively, while not using the stimulator. Multiple Sclerosis patients gained similar Orthotic benefit, but no "carry-over."

The measured differences in walking with and without stimulation were statistically significant in the Stroke and Multiple Sclerosis groups.

In this study use of the stimulator improved walking. Those with Stroke demonstrated a short-term "carry-over" effect.

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