Coping with a diagnosis of multiple sclerosis.

Examined the relation between coping and depression in 38 women and 12 men (aged 21–58 yrs) recently diagnosed with multiple sclerosis (MS). A semistructured interview was used to assess how Ss coped with the onset of disabling illness, and to assess depressive symptomatology. According to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria, 18 Ss were diagnosed with major depression, 11 Ss were diagnosed with adjustment disorder with depressed mood, and 21 Ss did not satisfy the criteria for any affective disorder. Interview results indicate that nondepressed Ss were more likely to use present focus and avoidance/denial strategies to deal with illness onset than Ss with major depression or adjustment disorder. Discussion addresses why these strategies may be an adaptive means of dealing with the onset of MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of the use of immunological methods in clinical laboratory diagnosis

The efficacy of treatment of stomatological manifestations and visceral diseases in patients with Sjogren's disease (syndrome) by therapeutic complexes including plasmapheresis is assessed. Plasmapheresis was administered to 7 inpatients in an intermittent mode with exfusion of up to 1 liter of plasma per session. A course consisted of one to three sessions, the total duration of treatment was three to four weeks. The efficacy of plasmapheresis in a complex of therapeutic measures was assessed from the time course of the clinical picture, results of studies of the function of salivary glands, and parameters of metabolic processes and immunity. Plasmapheresis helped attain long remissions and improved the general status of the patients, this being paralleled by a positive time course of local symptoms of the disease and the principal homeostasis parameters.     

The use of the auditory evoked potential in the diagnosis of multiple sclerosis

Auditory evoked potentials, both early and middle components, were recorded from 227 patients with a variety of conditions including multiple sclerosis, brain stem vascular disease, intracranial tumours and Arnold-Chiari malformation. Abnormalities were found in a substantial proportion of patients with definite multiple sclerosis and a smaller proportion of those in the less definite clinical categories of this condition. There was a high correlation between clinical evidence of brain stem involvement and an abnormal auditory evoked potential in multiple sclerosis. Abnormalities were also found in a few patients presenting with an isolated episode of central nervous system dysfunction involving the brain stem. The auditory evoked potential was abnormal in other patients with known diagnoses including half of those with Arnold-Chiari malformation. Tumours involving the brain stem caused abnormalities of the brain stem evoked potentials in some cases and more frequently distortion of the middle components. The specificity of these auditory evoked potential abnormalities to multiple slcerosis is discussed.     

The natural history of multiple sclerosis and its diagnosis

The treatment of multiple sclerosis (MS) is a dynamic field that is rapidly evolving. It encompasses tow main areas. The first is the direct treatment of MS itself, having evolved from using primarily steroids to the newest immunotherapies that come from the extensive research into the immune system and the role it plays in so many diseases. The second area for treatment is in the management of the effects or symptoms resulting from MS.     

Disseminated encephalomyelitis in children and its differential diagnosis from multiple sclerosis

Acute disseminated encephalomyelitis (ADEM) has been studied in a series of 30 children (16 girls, 14 boys) who ranged from 1.5 to 15 years old versus 24 pediatric patients (12 girls, 9 boys) aged 4-15 years with diagnosed disseminated sclerosis (DS). Conducted in the above series were the following investigations: computerized tomography, magnetic resonance imaging, recording of visual evoked potentials, indices for cellular and humoral immunity. ADEM, as distinct from DS, was marked by: an acute onset; the presence of general infectious symptoms together with general cerebral ones; involvement into the process of not only white matter but also of nuclear formations and peripheral nervous system; unidirectional course resulting in residual events. In 16 children a clear distinction was seen between ADEM and DS, while the rest of this pediatric population (n = 14) who had residual events presenting as pyramidal syndrome, might well develop DS in later life. Additional differential-diagnostic tests employed in the above study were found to be of little informative value.     

Neuroimaging in multiple sclerosis

Neuroimaging in multiple sclerosis is now dominated by MR imaging. This article will focus primarily on conventional MR imaging studies in multiple sclerosis, but will also discuss briefly some of the more recent advances related to MR imaging. Fast spin-echo imaging, fluid attenuated inversion recovery MR studies, three-dimensional volumetric studies, magnetization transfer, and magnetic resonance spectroscopy as it applies to multiple sclerosis are examined.     

Prognosis in multiple sclerosis

Prognosis of the natural course of multiple sclerosis is most often measured on Kurtzke's "expanded disability status scale" (EDSS), a non-linear scale over 20 steps, heavily weighted on mobility. Optic neuritis and sensory disturbances as initial symptoms, lower age at onset of the disease, female sex and a longer interval between relapses are indicators of a more favorable prognosis. As a rule, disability as measured on this scale 5 years after onset corresponds to 3/4 of the disability status after 15 years. The number of relapses diminishes naturally over the course of the disease. Presence and extent of lesions on the initial MRI of the brain in clinically isolated syndromes are valuable predictors of dissemination of the disease process over the following 5-10 years. New therapies (e.g. interferon beta 1b and 1a, copolymer 1) reduce relapse frequency by 1/3 and diminish the extent of pathological lesions in brain MRI, but fail to show (as yet) significant influence on disability.     

MRI in the study of multiple sclerosis

Magnetic resonance imaging (MRI) has provided considerable insight into the pathological process and disease activity and progression in multiple sclerosis. MRI has become an important tool for the diagnosis of multiple sclerosis, and increasingly for monitoring treatment trial. The growing use of MRI calls for careful consideration in applications so that the technology is not misused. Here we propose a summary of the literature on MRI in application in clinical neurology.     

Injuries in the etiopathogenesis of multiple sclerosis

An injury might derange the protective function of the blood-brain barrier, and thus it represents one of the possible pathogenetic factors in the demyelination of the neural axis. However, the effect of injury on the occurrence or deterioration of multiple sclerosis is still controversial. According to most authors, the importance of injury in individual cases of multiple sclerosis is undeniable, as well as the fact that injuries are factors of progression and deterioration of the disease, but never its cause. Consequently, injuries can cause only temporary disability, and not permanent. Nevertheless, the incidence of multiple sclerosis increases proportionally to the severity of injury. The length of the period from the occurrence of injury to possible demyelination is still not established. Studies and clinical reports point to the fact that in the evaluation of injury as a precipitating factor for the vulnerability of the blood-brain barrier, the severity of the injury is of greater importance than its site.     

The role of nuclear magnetic resonance monitoring in early clinical-instrumental diagnosis of multiple sclerosis

Nucleo-magnetic resonance tomography (NMRT) facilitated considerably early diagnosis of multiple sclerosis. Yet, there appeared data indicating the existence of NMRT negative forms. These were found in 15 patients of 82 ones examined using NMRT only which failed to defect foci of demyelinization in spite of a clear-cut clinical picture. NMRT monitoring during 3 years (from 2 to 5 NMRT investigations) permitted to visualize the foci of demyelinization located primarily in the periventricular cerebral region. The conclusion was made that a presence of clear clinical symptoms as well as a remitting character of the pathologic process confirmed by visualization of multiple foci of CNS demyelinization by means of NMRT monitoring, gave full chance for a reliable diagnosis of multiple sclerosis. A lack of such confirmation may be explained by the fact, that clinical debut of the disease reflected only the phase of multiple sclerosis and forestalled forming of a focal demyelinizating process, pathognomonic for this disease.     

Genetics of multiple sclerosis

The cause of MS is unknown. There is considerable circumstantial evidence that MS is a complex trait, probably autoimmune in nature, and is determined by both genetic and environmental factors. At present, it must be acknowledged, however, that our understanding of the pathogenesis of MS is minimal. Very little is known about the genes determining disease susceptibility and perhaps even less is understood about environmental factors that influence penetrance or the geographic distribution. This lack of knowledge results neither from lack of effort nor from a shortage of fertile imaginations. Almost every imaginable hypothesis has, in the past, found some support. The intractability of the problem could well result from its complexity, because answers to testable hypotheses are commonly negative or ambiguous. Today, the opportunity exists for researchers to provide such answers because of recent major developments. The first development is the recognition that MS research requires a relatively large pool of well-ascertained, carefully diagnosed, and longitudinally well-characterized MS patients. The last two developments are the identification and successful application of statistical and molecular genetic techniques carrying sufficient power to allow the exploration of complex traits such as MS.     

Mitoxantrone immunotherapy in multiple sclerosis

We compared the effects of postural changes on intraocular pressure, systemic blood pressure, and pupil size with and without induced mydriasis in 15 chronic chagasic patients and 20 healthy age-matched controls. The chagasic patients showed a marked fall in intraocular pressure on rising. However, systemic systolic blood pressure changes and pupil size in patients did not differ from those measured in controls. Our findings may be explained by an alteration in the autonomic ocular system that regulates homeostasis of ocular pressure and the probable existence of a baroreceptor arc-reflex that restores the equilibrium of sudden changes in the intraocular pressure.     

Subjective interpretation, laboratory error and the value of forensic DNA evidence: three case studies

This article discusses two factors that may profoundly affect the value of DNA evidence for proving that two samples have a common source: uncertainty about the interpretation of test results and the possibility of laboratory error. Three case studies are presented to illustrate the importance of the analyst's subjective judgments in interpreting some RFLP-based forensic DNA tests. In each case, the likelihood ratio describing the value of DNA evidence is shown to be dramatically reduced by uncertainty about the scoring of bands and the possibility of laboratory error. The article concludes that statistical estimates of the frequency of matching genotypes can be a misleading index of the value of DNA evidence, and that more adequate indices are needed. It also argues that forensic laboratories should comply with the National Research Council's recommendation that forensic test results be scored in a blind or objective manner.