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Drugs in development for relapsing multiple sclerosis.

Drug development for multiple sclerosis (MS), as with any other neurological disease, faces numerous challenges, with many drugs failing at various stages of development. The disease-modifying therapies (DMTs) first introduced for MS are only moderately effective, but given the lack of competition, they have been widely accepted in clinical practice. Although safety and efficacy continue to be the two main metrics by which drugs will be judged, the newer agents in the market also face challenges of a more comparative nature-are they more efficacious than the currently available drugs on the ma…

Инфодемиология и инфовелленс множественных склерозов в Италии

Множественный склероз (MS) является хроническим изнурительным заболеванием вероятной аутоиммунной провокационной природы, аэтология которого не в полной мере понята, несмотря на многочисленные усилия и исследования. В этой рукописи мы пересматриваем концепцию < < мультипликаторного склероза 2.0 > > , т.е. использование Интернета пациентами, страдающими MS, для поиска медицинских и связанных с болезнями материалов для целей самообслуживания и саморегулирования, и внедряем основанный на Google Trends подход к мониторингу связанных с MS запросов и поисков в Google, который называется

Совпадение в аннотации оригинала
Multiple Sclerosis (MS) is a chronic debilitating disease of probable autoimmune inflammatory nature, whose aetiology is not fully understood, despite the many efforts and investigations. In this manuscript, we review the concept of “Multiple Sclerosis 2.0”, that is to say the Internet usage by MS patients, for seeking health and disease-related material for…

Poor sleep in patients with multiple sclerosis.

BACKGROUND: Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed to study the prevalence of poor sleep and the influence of socio-demographic and clinical factors on sleep quality in MS- patients. METHODS: A total of 90 MS patients and 108 sex-and age- matched controls were included in a questionnaire survey. Sleep complaints were evaluated by Pittsburgh Sleep Quality Index (PSQI) and a global PSQI score was used to separate good sleepers (≤ 5) from…

Sexual dysfunction in patients with multiple sclerosis.

BACKGROUND: Sexual dysfunction (SD) is a common complaint in female and male patients with multiple sclerosis (MS) and can arise at anytime during the course of the disease even in patients with low disability. Increasing neurological and physical impairment, psychological factors, and medication side effects are thought to increase rates of SD. OBJECTIVE: To determine the prevalence of various SD symptoms among MS patients, their impact on patient self-reported sexual activity and satisfaction (SAS), and to examine the rates at which symptomatic patients utilize therapies for their complaint…

Reward responsiveness and fatigue in multiple sclerosis.

BACKGROUND: Fatigue is a common symptom in individuals with multiple sclerosis (MS). To date, the pathophysiology of fatigue in MS remains ill-understood; however, converging evidence seems to suggest that a key factor in fatigue development might be the dysregulation of neuropsychological processes underpinning the evaluation of the rewarding outcomes of actions. OBJECTIVES: To explore the relationship between reward-related cognition and fatigue in MS and to explore the usefulness of reward perception testing to predict the efficacy of monoamine-modulating drugs on fatigue. METHODS: The st…

Psychiatric symptoms in patients with multiple sclerosis.

OBJECTIVES: This study was intended to identify general psychiatric symptoms in multiple sclerosis (MS) patients and to determine the distribution of these psychiatric symptoms by type of MS and degree of disability. METHODS: One hundred fifty-two volunteers, 76 MS patients and 76 healthy controls, matched in terms of age, gender, marital status, years spent in education and income, were included. Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Padua Inventory, Rosenberg Self-Esteem …

Fungal infection in a patient with multiple sclerosis.

Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, whose causes are still unknown. We have proposed that MS, as well as some ophthalmologic diseases, are associated with fungal infection. In the present study, we closely monitored a patient with MS over a three-year period. Antibodies against different Candida spp. were detected in peripheral blood serum, although the titer of these antibodies fluctuated. The presence of fungal macromolecules, such as proteins, polysaccharides, and DNA, was also tested. In several sera samples, antigens related to C. fama…

Prevalence of celiac disease in multiple sclerosis.

BACKGROUND: Celiac disease (CD) is a common systemic disease related to a permanent intolerance to gluten and is often associated with different autoimmune and neurological diseases. Its mean prevalence in the general population is 1-2% worldwide. Our aim was to study the prevalence of celiac disease in a prospective series of Multiple Sclerosis (MS) patients and their first-degree relatives. METHODS: We analyzed the prevalence of serological, histological and genetic CD markers in a series of 72 MS patients and in their 126 first-degree relatives, compared to 123 healthy controls. RESULTS: …

Depression in multiple sclerosis: reactive or endogenous?

Multiple sclerosis is associated with high rates of depression. The extent to which this is related to living with chronic illness or part of the disease process remains unclear. This question was investigated by comparing rates of depression in MS with those in rheumatoid arthritis, which involves similar physical and psychosocial stressors but without central nervous system involvement. The study involved an on-line survey, which included measures of depression not confounded by somatic symptoms, medication use, self-reported physical functioning, pain, and other demographic variables. Resul…

Evidence for viral etiology of multiple sclerosis.

The etiology of multiple sclerosis (MS) is unknown, and several hypotheses have been advanced over the past century to explain it. Despite much effort, no single cause has been established. One of the most appealing hypotheses is that of infection due to a neurotropic infectious agent, possibly a virus. There are several lines of data to support this hypothesis. First, there are clear examples of inflammatory demyelinating disease caused directly or indirectly by viral infections in both humans and animals. Second, there is a strong environmental component to multiple sclerosis. Finally, there…

Advances in multiple sclerosis research in 2009.

The following review summarizes the progress in multiple sclerosis research published in the Journal of Neurology in 2009.

Influence of neurosteroids on the pathogenesis of multiple sclerosis.

This paper summarizes neuroendocrine effects on myelination and their possible relevance for the pathogenesis of multiple sclerosis (MS). Steroid hormones known as neurosteroids are synthesized in the human central nervous system (CNS) and exert local effects on glial and neuronal tissue. Progesterone derivatives seem to act as promyelinating factors in the slow but continuous process of myelin maintenance in the adult human brain. Diminished production of these myelin-promoting factors may lead to the formation of structurally altered and less stable myelin, resulting in the observed patholog…

Diagnosis and differential diagnosis of multiple sclerosis.

No single test to diagnose multiple sclerosis is available, and its cause is unknown. The diagnosis relies on recognition of the clinical patterns of the disease as well as exclusion of other possible mimics. Waxing and waning neurologic deficits that localize to the CNS are the hallmark of the disease in most patients. The diagnosis can be supported by laboratory studies, including MRI of the brain and spinal cord, analysis of CSF, and evoked-potential studies of the visual and somatosensory pathways.

Fatigue in Japanese people with multiple sclerosis.

The aim of this study was to obtain descriptions of the experiences of fatigue of people with multiple sclerosis, including experiences related to their interpersonal relations and social life. We used a qualitative, exploratory, and descriptive design and conducted semistructured interviews with nine participants. Seven concepts emerged from the data analysis: "fatigue as an individualized and novel sensation", "self-analysis of the factors that are associated with fatigue", "effects of fatigue on living and the self", "unique measures for handling fatigue", "insufficient coping", "living wit…

The Brazilian database on pregnancy in multiple sclerosis.

OBJECTIVES: To report the results from the Brazilian database on multiple sclerosis (MS) and pregnancy. METHODS: Retrospective data from MS patients who became pregnant at any time of their disease were sent to a Brazilian database, using a specific file for this purpose. RESULTS: Data on 128 women (142 pregnancies) from 30 neurologists working in 21 cities in Brazil were collected. Patients' average age at pregnancy was 29.8 years (range 16-42). EDSS at start of pregnancy was 1.5±1.4; and the relapse rate in the year preceding pregnancy was 1.2±1.5. Exposure to medication at any time during…

Neuroimmune interactions in a model of multiple sclerosis.

Psychological stress has been implicated in both the onset and exacerbation of multiple sclerosis (MS). Our research has focused on the role of stress at the onset of MS, using the mouse model Theiler's murine encephalomyelitis virus-induced demyelination. Theiler's virus is a natural pathogen of mice that causes a persistent infection of the central nervous system (CNS) and inflammatory immune-mediated demyelination that is very similar to MS. Our research has shown that restraint stress sufficiently increases corticosterone secretion to cause immunosuppression. Stressed mice develop decrease…

HLA-DRB1 and multiple sclerosis in Argentina.

BACKGROUND: The association of multiple sclerosis (MS) with HLA DR subtypes, and particularly human leukocyte antigen (HLA)-DRB1*15 has been a consistent finding across nearly all Caucasian MS populations. In South America, scarce data exist about this issue. As the complete characterization of the HLA association range around the world is important to understand the role of this locus in MS susceptibility, we analyzed the frequency of HLA-DRB1* allelic groups in an MS population in Argentina. METHODS: HLA-DRB1 locus was genotyped using PCR and sequence-specific primer amplification in 61 MS …

Autonomic dysreflexia in a man with multiple sclerosis.

BACKGROUND/OBJECTIVE: To report manifestation of autonomic dysreflexia (AD) in a man with multiple sclerosis (MS). DESIGN: Case report. FINDINGS: A young man presented with a history of several admissions to the emergency department with complaints of hypertensive attacks, palpitations, difficulty in breathing, headaches, and flushing. The attacks were attributed to a previously diagnosed anxiety disorder. Onset of numbness of the left leg numbness prompted a more thorough study, which showed evidence of MS. AD was suspected as the cause of his recurrent attacks of hypertension. Bladder dist…

Complementary and alternative medicine in multiple sclerosis.

Complementary and alternative medicine (CAM) is often used by patients with multiple sclerosis (MS) but has been disregarded in research until lately. Various confounding factors on CAM utilisation exist, though have hardly been investigated. Besides socio-demographic variables like education, income, gender and age, illness-related factors like severity of disease are discussed. Furthermore, the important role of psychological factors on CAM utilisation is described. In particular, coping strategies such as "rumination", "search for information" and "search for meaning in religion" are more o…

Corticosteroids and plasma exchange in multiple sclerosis.

Corticosteroids (CS) remain a mainstay of treatment for relapses in multiple sclerosis (MS) and optic neuritis. Currently, there is not enough evidence that long-term corticosteroid treatment delays progression of long-term disability in patients with MS. Likewise, it is unclear whether there are, in fact, true differences among the various CS agents, doses, and their applications in specific pulse and tapering regimens.In some patients suffering from severe steroid-resistant relapses, the clinical response to CS treatment may be insufficient. Such patients may obtain clinical benefit from sub…