Neurology
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Multicenter Study
Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy.
To demonstrate the relationship between epidermal nerve fiber density (ENFD) in the leg and the phenotype of HIV-associated distal sensory polyneuropathy (HIV-DSP) in a multicenter prospective study (ACTG A5117). ⋯ In subjects with advanced HIV-1 infection, epidermal nerve fiber density (ENFD) assessment correlates with the clinical and electrophysiologic severity of distal sensory polyneuropathy (DSP). ENFD did not correlate with previously established risk factors for HIV-DSP, including CD4 cell count, plasma HIV-1 viral load, and neurotoxic antiretroviral therapy exposure.
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Comparative Study Clinical Trial
The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial.
Transcranial Doppler ultrasound (TCD) and magnetic resonance angiography (MRA) can identify intracranial atherosclerosis but have not been rigorously validated against the gold standard, catheter angiography. The WASID trial (Warfarin Aspirin Symptomatic Intracranial Disease) required performance of angiography to verify the presence of intracranial stenosis, allowing for prospective evaluation of TCD and MRA. The aims of Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial were to define abnormalities on TCD/MRA to see how well they identify 50 to 99% intracranial stenosis of large proximal arteries on catheter angiography. ⋯ Both transcranial Doppler ultrasound and magnetic resonance angiography noninvasively identify 50 to 99% intracranial large vessel stenoses with substantial negative predictive value. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis trial methods allow transcranial Doppler ultrasound and magnetic resonance angiography to reliably exclude the presence of intracranial stenosis. Abnormal findings on transcranial Doppler ultrasound or magnetic resonance angiography require a confirmatory test such as angiography to reliably identify stenosis.
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The impact of neutralizing antibodies (NAbs) to interferon-beta (IFN-beta) on clinical and imaging parameters in multiple sclerosis (MS) is reviewed. An effect on relapse rates and imaging parameters was noted in patients who tested positive for NAbs, but disability measures were unaffected or showed a trend toward improvement. Patients who developed NAbs during treatment with IFN-beta1a tended to remain NAb+, whereas those who developed NAbs during IFN-beta1b treatment tended to revert to NAb- over time. ⋯ The prevalence of NAbs was lower when a higher-than-standard dose of IFN-beta1b was given in a dose-comparison study. The prevalence of NAbs in an observational study of MS patients who exhibited suboptimal treatment responses to IFN-beta1b was significantly less than the reported prevalence in clinical trials. An immunoregulatory effect of immune complexes of cytokine and anticytokine antibodies is proposed to account for the variability of clinical responses seen in patients who develop NAbs to IFN-beta1b.