Multiple sclerosis and related disorders
-
Mult Scler Relat Disord · Oct 2018
Brain and spinal cord lesion criteria distinguishes AQP4-positive neuromyelitis optica and MOG-positive disease from multiple sclerosis.
Test the ability of a brain and spinal cord MRI criteria to differentiate neuromyelitis optica spectrum disorders and MOG-disease from MS. MRI criteria was further tested in patients with CIS and pediatric MS. ⋯ Our data suggest radiological criteria can be useful to separate MS from MOG- and aquaporin-4-positive neuromyelitis optica spectrum disorders, in particular in patients with optic neuritis. Further work is needed to support their use in CIS.
-
Mult Scler Relat Disord · Oct 2018
Use of the new oral disease-modifying therapies for multiple sclerosis in British Columbia, Canada: the first five-years.
Little is known about the use of the new oral disease-modifying therapies (DMTs: fingolimod, dimethyl fumarate, teriflunomide) for multiple sclerosis (MS) in clinical practice. We describe their rate of uptake, and their use as compared to the established first-generation (beta-interferon and glatiramer acetate) and second-generation (natalizumab and alemtuzumab) parenteral DMTs. ⋯ The uptake and use of the oral DMTs increased substantially over the first 2 to 5 years after their introduction. These recent changes highlight the importance of monitoring the risks and benefits in the real world.
-
Mult Scler Relat Disord · Aug 2018
ReviewAn introduction to Mendelian randomization with applications in neurology.
Mendelian randomization studies have become increasingly common due to the maturation of genome-wide association studies and its potential to ascertain causal relationships. With the increasing use of this method comes the need for medical practitioners and clinicians to develop an understanding of its rationale, limitations, and interpretation. Mendelian randomization attempts to ascertain a causal relationship between some risk factor of interest and some outcome or disease of interest. ⋯ This random assortment of genetic variants mimics the main principle of randomization used in clinical trials; with the genetic variant replacing the randomly allocated treatment. In this paper we provide a readable introduction to the rationale behind Mendelian randomization and its limitations. We also discuss and interpret several examples of Mendelian randomization analyses which pertain to neurological diseases.
-
Mult Scler Relat Disord · Jul 2018
Case ReportsAutonomic dysreflexia following acute myelitis due to neuromyelitis optica.
Cardiovascular autonomic dysfunction is a relatively common secondary complication of tetraplegia. In addition to low baseline arterial blood pressure, tetraplegics can develop sudden-onset hypertensive episodes associated with a variety of symptoms and signs (so-called autonomic dysreflexia). Unfortunately, this potentially life-threatening medical entity is often overlooked and mismanaged. With this, a case of typical presentation of autonomic dysreflexia in an individual with acute severe cervical spinal cord impairment due to neuromyelitis optica (NMO) is reported and discussed. ⋯ This case report illustrates a clinically relevant, but still under-recognized cardiovascular autonomic complication of severe, cervical or high-thoracic spinal cord impairment due to NMO. In addition to low baseline blood pressure and orthostatic hypotension, the patient developed episodes of autonomic dysreflexia during the acute stage after tetraplegia. Autonomic dysreflexia requires early diagnosis and proper treatment in order to prevent severe complications or death. Greater awareness of this potentially life-threatening cardiovascular emergency of spinal cord impairment is needed among patients, caregivers, and healthcare professionals, including neurologists.
-
Mult Scler Relat Disord · Jul 2018
Phase sensitive reconstruction of T1-weighted inversion recovery in the evaluation of the cervical cord lesions in Multiple Sclerosis; is it similarly eligible in 1.5 T magnet fields?
In primary studies with 3 T Magnets, phase sensitive reconstruction of T1-weighted inversion recovery (PSIR) have showed ability to depict the cervical multiple sclerosis (MS) lesions some of which may not be detected by short tau inversion recovery (STIR). Regarding to more availability of 1.5 T MRI, this study was designed to evaluate the eligibility of PSIR in 1.5 T for detection of spinal cord MS lesions. ⋯ This study shows that in the setting of a 1.5 T magnet field, STIR significantly has a superiority over both of the PSIR reconstructions (i.e. real and magnitude) for the detection as well as the boundary definition of the cervical cord lesions of MS. These results have a good relevance to clinical practice by using MRI scanners and sequences routinely available, however, it is discrepant with other reports performed by 3 T Magnet fields.