Journal of the neurological sciences
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Controlled Clinical Trial
Differences in cerebral activation patterns in idiopathic inflammatory demyelination using the paced visual serial addition task: an fMRI study.
We performed a functional MRI (fMRI) study during the execution of the Paced Visual Serial Addition Task (PVSAT) in 9 patients with a clinically isolated syndrome suggestive of multiple sclerosis (CIS), 9 patients with clinically definite multiple sclerosis (CDMS), and 18 matched healthy control subjects. In controls, the PVSAT elicited a fronto-parietal network with cerebellar activation which we expected for this kind of working memory test and which indicates that this PVSAT version is an appropriate tool for measuring functional changes during a cognitive task. Although there were no significant differences in the actual test results of patients vs. controls, CDMS and CIS patients activated distinct cerebral networks in their attempt to solve the fMRI-PVSAT. ⋯ In contrast, compared to CDMS patients and healthy controls, CIS patients demonstrated stronger activation of the anterior cingulate cortex, which might indicate focused involvement of executive processes. On the PASAT (Paced Auditory Serial Addition Task) patients also performed similarly to controls but they showed decreased scores on most of the sub-tests of the Wechsler Memory Scale. Based on our observations using the fMRI-PVSAT, we hypothesize that distinct differences in cognitive processing occur with the evolution of MS and that, at these early stages of the disease, they cannot be detected with sufficient sensitivity using only the PASAT.
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Comparative Study
Assessment of MRI abnormalities of the brainstem from patients with migraine and multiple sclerosis.
In patients with migraine, functional changes have been described in the red nucleus (RN), substantia nigra (SN) and periaqueductal gray matter (PAG). ⋯ T2-visible lesions in the brainstem are frequent in patients with migraine, but do not seem to be associated with the presence of aura. Demyelinating lesions in the RN, SN and PAG might be among the factors responsible for the presence of migraine in patients with MS.
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Greek and Roman physicians developed distinct and detailed ideas, which can be regarded as early versions of our modern concept of dementia. Several classical sources--some of them medical--offer intriguing descriptions of many cognitive and behavioral symptoms in dementia, which are currently used for diagnostic purposes. Limitations of this ancient concept are due to terminological and epidemiological factors, but also to the physicians' social role. Only a small part of this early literature is cited in contemporary work on the origin of the dementia concept, which can be clearly traced back to the Age of Enlightenment and whose earlier history still needs to be elucidated.