Journal of the neurological sciences
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in multiple sclerosis.
We investigated the effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in patients with multiple sclerosis. Following a double blind trial designed to compare the effect of oral and intravenous methylprednisolone treatment on promoting recovery from acute relapses of multiple sclerosis, 80 patients were followed for two years with six-monthly assessments during which all subsequent relapses were recorded. ⋯ The time to onset and the severity of the first relapse after treatment, the number of relapse free patients at the end of the follow-up period, and the severity of the relapses during the follow-up period were similar in the two groups. This trial did not show a statistically significant difference in relapse rate during the first two years following oral compared with intravenous methylprednisolone treatment.
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Imaging considerations for the diagnosis and differential diagnosis of MS are based primarily on results of MR studies of the brain. Recent studies suggest that with current technology, MR imaging of the spinal cord can make important contributions, particularly in cases with equivocal or negative brain MRI studies. Spinal cord MRI may also assume an important role in early diagnosis.
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Motor evoked potentials (MEPs) are widely used in various neurological diseases, but have not been systematically employed in neurocritical care patients. We evaluated the clinical and predictive value of MEPs by magnetic transcranial stimulation in intensive care patients with acute brainstem lesions of predominantly vascular origin. ⋯ MEP recordings can be safely performed in neurointensive care patients and yield utilizable results. In patients with brainstem lesions, MEPs correlate with radiological findings and predict final motor function more accurately than clinical findings. MEPs are a reliable diagnostic tool for assessing motor function in otherwise unresponsive patients.
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Cerebral venous sinus thrombosis is not a recognized complication of end-stage liver disease. A case of sagittal sinus thrombosis in a 44-year-old male with end-stage hepatic cirrhosis is described. ⋯ He was treated with low molecular weight heparin and underwent an orthotopic liver transplant after three months. Follow-up helical CT venogram showed resolution of the sinus thrombosis.
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Multicenter Study Clinical Trial
The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III).
The ALS Functional Rating Scale (ALSFRS) is a validated rating instrument for monitoring the progression of disability in patients with amyotrophic lateral sclerosis (ALS). One weakness of the ALSFRS as originally designed was that it granted disproportionate weighting to limb and bulbar, as compared to respiratory, dysfunction. ⋯ The Revised ALSFRS (ALSFRS-R) retains the properties of the original scale and shows strong internal consistency and construct validity. ALSFRS-R scores correlate significantly with quality of life as measured by the Sickness Impact Profile, indicating that the quality of function is a strong determinant of quality of life in ALS.