Journal of neurology
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In this review, we summarize advances in knowledge derived from the application of magnetic resonance imaging (MRI)-based techniques to patients with multiple sclerosis (MS) published in the Journal of Neurology over the past year. We highlight the pivotal role played by conventional MRI techniques for a correct and early diagnosis of this condition and the exclusion of alternative disorders. Advanced MR methods have contributed to demonstrating how damage to selected brain structures is related to disease clinical manifestations, thus contributing to overcome the well-known "clinical-radiological" paradox of MS, and ameliorating the understanding of the mechanisms underlying the accumulation of irreversible disability. Finally, we discuss the use of MRI to assess treatment efficacy and optimize therapeutic approaches in this condition.
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Journal of neurology · Mar 2013
The relationship between cortisol and verbal memory in the early stages of Huntington's disease.
Hypothalamic pituitary adrenal (HPA) axis hyperactivity has been linked to learning and memory difficulties in a range of neurodegenerative and neuropsychiatric conditions. In Huntington's disease (HD), both declines in learning and memory and HPA axis dysfunction are present early in the disease. However, the relationship between specific learning and memory deficits and HPA axis functioning in HD has not been examined. ⋯ Of these two classification approaches, HD motor sign severity was more strongly associated with high evening cortisol levels and both reduced information encoding and memory retrieval. Separately, there was also a trend of higher cortisol levels in pre-HD. The findings suggest hypercortisolism and the underlying pathological changes may begin many years before a clinical diagnosis is made, but the memory decline associated with HPA axis disturbance may only become detectable once motor signs become pronounced.
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Journal of neurology · Mar 2013
Controlled Clinical TrialMortality, health, social and economic consequences of amyotrophic lateral sclerosis: a controlled national study.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that imposes a great burden on the patient, the patient's family and society. However, we lack information about the total disease burden at a national level, especially regarding costs before and after diagnosis and the consequences for spouses. We aimed to estimate the factual direct and indirect costs of ALS in a national sample. ⋯ However, spouses showed no excess health usage; in fact, their employment and income rates were higher, and the net cost was reduced by -
3,420. We conclude that ALS has serious mortality, health and socioeconomic consequences for patients. However, the consequences for spouses are complex; they tend to compensate for the social consequences to patients by increasing their net income after ALS diagnosis. -
Journal of neurology · Mar 2013
Comparative StudyPeripheral nociceptor sensitization mediates allodynia in patients with distal symmetric polyneuropathy.
Patients with painful neuropathy frequently complain of pain in response to normally non-painful brushing, namely dynamic mechanical allodynia. Despite many animal studies suggesting that allodynia arises when the spontaneous firing in damaged nociceptive afferents sensitise second-order nociceptive neurons to Aβ-fibre input, no studies have sought to confirm this mechanism by investigating Aβ-fibre sparing in human patients with allodynia. ⋯ Whereas no statistical difference was found in nerve conduction study data between patients with and without allodynia, LEP amplitudes were larger in patients with allodynia than in those without (P < 0.01 by Mann-Whitney U test). The lack of difference in NCS data between patients with and without allodynia suggest that this type of pain, rather than arising through second-order nociceptive neuron sensitization to Aβ-fibre input, might reflect a reduced mechanical threshold in sensitised intraepidermal nociceptive nerve terminals.
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Journal of neurology · Feb 2013
ReviewA mechanism-based classification of pain in multiple sclerosis.
Pharmacological treatment of pain in multiple sclerosis (MS) is challenging due to the many underlying pathophysiological mechanisms. Few controlled trials show adequate pain control in this population. ⋯ The new mechanism-based classification we propose here distinguishes nine types of MS-related pain: trigeminal neuralgia and Lhermitte's phenomenon (paroxysmal neuropathic pain due to ectopic impulse generation along primary afferents), ongoing extremity pain (deafferentation pain secondary to lesion in the spino-thalamo-cortical pathways), painful tonic spasms and spasticity pain (mixed pains secondary to lesions in the central motor pathways but mediated by muscle nociceptors), pain associated with optic neuritis (nerve trunk pain originating from nervi nervorum), musculoskeletal pains (nociceptive pain arising from postural abnormalities secondary to motor disorders), migraine (nociceptive pain favored by predisposing factors or secondary to midbrain lesions), and treatment-induced pains. Identification of various types of MS-related pain will allow appropriate targeted pharmacological treatment and improve clinical practice.