Prediction of MS disability by multimodal evoked potentials: Investigation during relapse or in the relapse-free interval?

ObjectiveLittle is known about optimal timing of multimodal evoked potential (EP)-investigations regarding prediction of MS disability. The aim of this study was to investigate whether timing of EP-investigations during a relapse or in the relapse-free interval influences prediction of MS disability.MethodsTwo groups of MS patients with similar age and gender distributions received visual, motor and somatosensory EPs either during a relapse (Group 1) or in the relapse-free interval (Group 2). Expanded Disability Status Score (EDSS) was obtained at baseline (T0) and year 3 (T2). Linear regression analysis was performed to examine the association between EDSS_T2 and a baseline EP compound measure (s-EP-Q_T0) for each group.ResultsMedian EDSS_T0 was 3.0 for Group 1 and 1.5 for Group 2. Mean disease durations were 2.0 and 2.8 years, respectively. Median EDSS_T2 was 2.0 for both groups. The s-EP-Q_T0 significantly predicted EDSS_T2 (R² = 0.47) for patients in Group 2, but not for patients in Group 1 (R² = 0.07).ConclusionIn early MS the functional remnants of relapses are a better predictor for development of medium-term disability than is the extent of impulse propagation impairment measured during relapse.SignificanceThis suggests a role of multimodal EPs in prediction of MS disability if performed in the relapse-free interval.     

The utility of multimodal evoked potentials in multiple sclerosis prognostication

The ability to predict disability development in multiple sclerosis (MS) is limited. While abnormalities of evoked potentials (EP) have been associated with disability, the prognosticating utility of EP in MS remains to be fully elucidated. The present study assessed the utility of multimodal EP as a prognostic biomarker of disability in a cohort of clinically heterogeneous MS patients. Median and tibial nerve somatosensory, visual, and brainstem auditory EP were performed at initial assessment on 63 MS patients (53 relapsing–remitting and 10 secondary progressive) who were followed for an average of 2 years. A combined EP score (CEPS) was calculated consisting of the total number of abnormal EP tests, and was correlated with the Expanded Disability Status Scale (EDSS) at baseline and follow-up. There was a significant correlation between multimodal EP and baseline and follow-up EDSS. Specifically, tibial nerve P37 latencies correlated with EDSS (R_BASELINE = 0.49, p < 0.01; R_FOLLOW-UP = 0.47, p < 0.01), as did the median nerve N13 (R_BASELINE = 0.40, p < 0.01; R_FOLLOW-UP = 0.35, p < 0.05) and N20 latencies (R_BASELINE = 0.43, p < 0.01; R_FOLLOW-UP = 0.47, p < 0.01), and P100 full-field (R_BASELINE = 0.50, p < 0.001; R_FOLLOW-UP = 0.45, p < 0.001) and central field latencies (R_BASELINE = 0.60, p < 0.001; R_FOLLOW-UP = 0.50, p < 0.001). In addition, there was a significant correlation between the CEPS with baseline (R = 0.65, p < 0.001) and follow-up (R = 0.57, p < 0.01) EDSS. In contrast, white matter disease burden, as measured by T2 lesion load, exhibited a weaker correlation with EDSS (R_BASELINE = 0.28, p < 0.05). In conclusion, these findings suggest that abnormalities of EP, as quantified by the novel CEPS, may be a useful biomarker for prognosticating clinical disability in MS, and may aid in the quantification of MS disease severity and in guiding therapeutic decisions.     

Subjective and perceptual analysis of voice quality and relationship with neurological disfunction in multiple sclerosis patients

ObjectiveThe aim of the present study was to evaluate subjective voice changes by voice handicap index (VHI) and voice related quality of life questionnaire (VRQL) and perceptual voice changes by Grade Roughness Breathiness Asthenia Strain (GRBAS) scale and to compare these findings with expanded disability status scale (EDSS) in multiple sclerosis (MS) patients.MethodsThe patient group was composed of 36 MS patients, (mean age 45.2 ± 12.9, 13 male and 23 female) and compared with 32 healthy sex and age match individuals without neurological and voice symptoms.ResultsThe mean VHI was significantly higher in patients group (15.64 to 5.43; p = 0.043). Forty-four percent of MS patients (52% of female patients) report voice problems. According to the GRBAS scale, differences between two groups were significant for Grade, Roughness, Breathiness and Strain items. The mean EDSS was 2.69 ± 1.1, for a male patients 2.54 ± 1.1 and for female 2.78 ± 1.3. There was no correlation between the EDSS and the total VHI score, between the EDSS and each of the three item of VHI, between the EDSS and VRQL, nor between the EDSS and components of GRBAS scale except for EDSS and asthenia item, (r = ?0.5213, p = 0.011).ConclusionsSignificant number of MS patients experienced voice problems. We did not establish any significant correlation between the intensity of the voice disorders and EDSS, except between EDSS and asthenia item of the GRBAS scale. The patients with low EDSS may have serious voice problems and vice versa.     

Physical fitness assessment in multiple sclerosis patients: A controlled study

There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale^, test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F_1.19 = 9.420; p < 0.01), Berg (F_1.19 = 13.125; p < 0.01), handgrip MIVC (F_1.19 = 4.567; p < 0.05), lower limbs MIVC (F_1.19 = 7.429; p < 0.01), and 6MWT (F_1.19 = 28.061; p < 0.01) between groups. EDSS, Berg test and Borg scores explained 80% of 6MWT variation. Mild grade EDSS patients exhibited impaired balance, muscle strength, and low self pace-6MWT scores, whereas RPE response after the exercise was similar to that of sedentary individuals. Both groups showed similar global physiological adjustments to exercise.     

Vitamin D status in multiple sclerosis: Are there any correlations with the health related quality of life

ObjectiveOne of the factors implicated in increased risk of developing MS is low serum levels of 25-hydroxyvitamin D (25(OH)D). MS, on the other hand, may affect the quality of life of the patients’ including physical and social functioning among others. The aim of this study was to investigate 25(OH)D levels and to assess health related quality of life of patients by giving emphasis to possible correlations between these variables.Material and methodsFifty MS patients and 30 controls were enrolled in the study. Gender and age of patients, duration of disease, MS subtypes, Expanded Disability Status Scale (EDSS) scores and duration of sunlight exposure were recorded, 25(OH)D levels and bone mineral density (BMD) measurements were all performed. All the subjects in both groups were administered Short Form-36 (SF-36) for the assessment of quality of life.Results25(OH)D levels were found to be significantly decreased in MS patients (p < 0.05). BMD values including L1–L4 t score, L1–L4 z score, femur neck t and z scores were significantly reduced in the patient group (p < 0.05). All SF-36 subscale scores were significantly (p < 0.05) lower in MS group and all SF-36 subscale scores except bodily pain were significantly correlated with the EDSS scores.Conclusion25(OH)D and BMD screening should be considered as a routine procedure in the assessment of MS patients. In the long term treatment and follow-up of patients with MS, functional outcomes and quality of life issues should be kept in mind by all the physicians engaged in MS.     

Prognostic indicators for long-term disability in multiple sclerosis patients

BackgroundDaily practice is still faced with uncertainty in predicting the long-term disability of multiple sclerosis (MS). Most information comes from northern hemisphere cohorts, but in South America this information is scarce, and race, genetic and environmental factors could play an important role in the heterogeneity observed in disease outcomes.MethodsWe evaluated 197 patients attending our MS Center gathering clinical and demographic information. Outcome measures analyzed were time from first clinical symptom to EDSS of 6, 7 and 8. For survival analysis we employed Cox regression models and the Kaplan–Meier method.ResultsTime to EDSS 6 was 25.83 years (95% CI 15.36–36.31), and 36.25 years (95% CI 20.72–51.78) for EDSS 7. Male sex was associated with a 4.63 and 4.69 fold increased risk to EDSS 6 and 7, respectively (p < 0.001 and p = 0.006). Motor and brainstem symptoms at onset were also associated with an 8.1 and 13.1 fold increased risk to EDSS 6, respectively (p = 0.04 and p = 0.01). The number of relapses in five and ten years of disease onset was associated with a slightly increased risk to EDSS 8 (1.28 and 1.19, respectively; p = 0.032 and p = 0.015).ConclusionsMale patients presenting with frequent relapses, especially those with motor and brainstem involvement, deserve close observation and should be cautiously monitored to early signs of treatment failure.     

Early disturbances in multimodal evoked potentials as a prognostic factor for long-term disability in relapsing-remitting multiple sclerosis patients

Objective

The aim of this study was to investigate whether early alterations in evoked potentials (EPs) have a prognostic value in relapsing-remitting multiple sclerosis (RRMS).

Ten-year follow-up after mitoxantrone induction for early highly active relapsing-remitting multiple sclerosis: An observational study of 100 consecutive patients

BackgroundSix monthly courses of mitoxantrone were approved in France in 2003 for patients with highly active multiple sclerosis (MS).ObjectiveTo report the 10-year clinical follow-up and safety of mitoxantrone as an induction drug followed by maintenance therapy in patients with early highly active relapsing–remitting MS (RRMS) and an Expanded Disability Status Scale (EDSS) score < 4, 12 months prior to mitoxantrone initiation.MethodsIn total, 100 consecutive patients with highly active RRMS from the Rennes EDMUS database received monthly mitoxantrone 20 mg combined with methylprednisolone 1 g for 3 (n = 75) or 6 months (n = 25) followed by first-line disease-modifying drug (DMD). The 10-year clinical impact was studied through clinical activity, DMD exposure, and adverse events.ResultsTwenty-four percent were relapse-free over 10 years and the mean annual number of relapses was 0.2 at 10 years. The mean EDSS score remained significantly improved for up to 10 years, changing from 3.5 at mitoxantrone initiation to 2.7 at 10 years. The probability of disability worsening and improvement from mitoxantrone initiation to 10 years were respectively 27% and 58%, and 13% converted to secondary progressive MS. Patients only remained untreated or treated with a first-line maintenance DMD for 6.5 years in average. In our cohort, mitoxantrone was generally safe. No leukemia was observed and six patients developed neoplasms, including 4 solid cancers.ConclusionMonthly mitoxantrone for 3 or 6 months, followed by maintenance first-line treatment, may be an attractive therapeutic option for patients with early highly active RRMS, particularly in low-income countries.     

La SEP de l’enfant : est-elle différente de celle de l’adulte ?

IntroductionMultiple sclerosis (MS) is not uncommon in children. The aim of this study was to compare early onset MS (EOMS) with adult onset MS (AOMS).MethodsA retrospective study including MS cases between 1997 and 2010. EOMS was defined by age at MS onset < 18 years. Data were collected using the EDMUS database (European Database of Multiple Sclerosis) including: sex, age at onset, disease duration, EDSS, score after relapse. The MSSS and the Progression Index were calculated. Patients with disease duration less than one year were excluded. MS symptoms at onset and at further relapses were also noted. These parameters were compared between the EOMS and the AOMS groups.ResultsTwo hundred fifty-nine cases were included including 31 EOMS (11.96%). The mean follow-up was 96 months. The relapsing-remittent form was significantly more frequent in the pediatric group (94% vs 79%). Mean EDSS and MSSS scores and the percentage of fast progressors (MSSS > 5) were lower in the EOMS group. Analysis of neurological symptoms at the first MS attack and further neurological events showed a lower frequency of gait disturbances, motor symptoms and bladder symptoms in the EOMS group compared with the AOMS group. The 10-year mean EDSS score was 1.9 for EOMS and 4.1 for AOMS, after 25 years it was 4.5, and 7.27 respectively.ConclusionThis study highlights the relative frequency of EOMS in our MS population. However, different severity scores showed less disability progression in EOMS patients compared with AOMS patient; irreversible disability was reached at an early age.     

Interferon-beta and disability progression in relapsing-remitting multiple sclerosis

ObjectiveTo assess the impact of interferon (IFN)-beta treatment on the progression of unremitting disability in IFN-beta treated and untreated relapsing-remitting (RR) patients with multiple sclerosis (MS) using prospective cohort study.MethodsA cohort of 419 RRMS (236 IFN-beta-treated and 183 untreated) patients was followed for up to 7 years. Cox proportional hazards regression models adjusted for the number of relapses in the last year before first visit was used to assess the differences between the two groups for the three end points: secondary progression (SP), and sustained Expanded Disability Status Scale (EDSS) score 4 and 6. Time from disease onset was used as survival time variable.ResultsThe IFN-beta-treated group showed a highly significant reduction (hazard ratio [HR], 0.34, 95% confidence interval [CI] 0.19–0.61, p < 0.001) in the risk of SP when compared with untreated patients. There were significant differences in favor of the IFN-beta-treated group for the end point EDSS score of 4 (HR = 0.45, 95%CI 0.28–0.73, p = 0.001) and EDSS score of 6 (HR = 0.34, 95%CI 0.16–0.75, p = 0.007).ConclusionThis observational study further supports the notion that IFN-beta could have potential beneficial effect on disease progression in RRMS.     

Uric acid excretion in North American and Southeast European children with obstructive sleep apnea

Background and objectivesResponses to nocturnal hypoxemia accompanying sleep-disordered breathing (SDB) may vary in different populations. Aims of this study were to (1) assess whether severity of SDB is related to uric acid excretion in North American and Southeast European children and (2) evaluate the interaction between nocturnal hypoxemia and country of children’s origin in uric acid excretion.MethodsConsecutive US and Greek children with snoring who were referred for polysomnography were recruited. Uric acid excretion expressed as uric acid-to-creatinine concentrations ratio in a morning urine specimen was the primary outcome measure.ResultsOne hundred and twenty-six US children (6.8 ± 0.7 years old) and 123 Greek children (6.4 ± 2.5 years old) were recruited. Forty-three US and 53 Greek participants had moderate-to-severe nocturnal hypoxemia (SpO₂ nadir <90%). Obstructive apnea-hypopnea index and SpO₂ nadir were related to uric acid excretion in Greek (but not US) children after adjustment by age, gender and body mass index z-score (p < 0.05). There was a significant interaction between severity of hypoxemia and country of children’s origin in uric acid excretion after adjustment by age, gender and body mass index z-score (p = 0.036). Greek children with moderate-to-severe hypoxemia had higher uric acid excretion (0.85 ± 0.35) than those with mild/no hypoxemia (0.69 ± 0.25) (p = 0.005). US children with moderate-to-severe hypoxemia (0.41 ± 0.20) did not differ in uric acid excretion from those with mild/no hypoxemia (0.42 ± 0.22) (p = 0.823).ConclusionsUric acid excretion differs in children with SDB and different ethnic backgrounds or environmental exposures.     

Utilidad de la ecografía de nervio óptico como predictor de progresión en esclerosis múltiple

IntroductionProgressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time.Material and methodsWe conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the ‘as low as reasonably achievable’ (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0.ResultsDisease progression was significantly correlated with ultrasound findings (P = .041 for the right eye and P = .037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P = .07 for the right eye and P = .043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables.DiscussionUltrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).     

EEG in the healthy term newborn within 12 hours of birth

ObjectiveTo characterise and quantify the EEG during sleep in healthy newborns in the early newborn period.MethodsContinuous multi-channel video-EEG data was recorded for up to 2 hours in normal newborns within 12 hours of birth. The total amount of active (AS) and quiet sleep (QS) was calculated in the first hour of recording. The EEG signal was quantitatively analysed for symmetry and synchrony. Spectral edge frequency (SEF), spectral entropy (H) and relative delta power (δ_R) were calculated for a ten-minute segment of AS and QS in each recording. Paired t-test and Wilcoxon rank sum test were used for data analysis.ResultsThirty normal newborn babies were studied, 10 within 6 hours of birth and 20 between 6 and 12 hours. All babies showed continuous symmetrical and synchronous EEG activity and well-developed sleep–wake cycling (SWC) with the median percentage of AS – 48.5% and QS – 36.6%. Quantitative EEG analysis of sleep epochs showed that SEF and H were significantly higher (p < 0.0001) and δ_R was significantly lower (p < 0.0001) in AS than in QS.ConclusionThe normal newborn EEG shows symmetrical and synchronous continuous activity and well-developed SWC as early as within the first 6 hours of birth. Quantitative analysis of the EEG in the early postnatal period reveals differences in SEF, H and δ_R for AS and QS periods.SignificanceThese findings may have implications for quantitative analysis of the newborn EEG, including the EEG of babies with hypoxic ischaemic encephalopathy.     

Psychosocial,symptomatic and diagnostic changes with long-term psychodynamic art psychotherapy for personality disorders

In this study, we aimed to investigate the changes in the beginning and termination phases of psychotherapy in terms of psychosocial, symptomatic, diagnostic and personality qualities in patients with personality disorders receiving long term, individual psychodynamic art psychotherapy. This study was conducted with 17 patients at the Istanbul Medical Faculty, Department of Psychiatry. Psychosocial and clinical data were collected with a Personal Information Questionnaire, MMPI and DSM-III-R. The overall functioning (GAF) of the patients significantly increased (General: z = −3.631, p < .001), (highest level: z = −3.626, p < .001). There were statistically significant decreases in alcohol use (z = −2.45, p < .05), suicidal ideation (z = −3.00, p < .01), impulsive behaviors (z = −3.74, p < .001), self-mutilative behaviors (z = −2.24, p < .05), psychotic symptoms (z = −2.00, p < .05) and psychotropic medication use (z = −2.71, p < .01) at the termination phase. This study demonstrates that in the treatment of personality disorders, long-term psychodynamic artwork is beneficial and drawing is a good container that allows working through in psychotherapy.     

Validity of the Center for Epidemiological Studies Depression scale in Type 2 diabetes

ObjectiveDepressive symptoms are common among people with Type 2 diabetes mellitus (T2DM). This study aimed to validate the 3-factor structure of the 14-item Center for Epidemiological Studies Depression (CES-D) scale proposed by Carleton et al. (2013) in a T2DM population.MethodsThe CES-D was administered to consecutive patients with T2DM entering a rehabilitation program. Construct validity was assessed using confirmatory factor analysis. Subscale viability, differential item functioning, and associations with clinical characteristics were tested in bifactor models.ResultsAmong adults with T2DM (n = 305, age 56.9 ± 11.1, 44.9% male, duration of diabetes 7.8 ± 7.9 years, HbA1c 0.076 ± 0.014%), the construct validity of Carleton's 3-factor solution (negative affective, positive affective and somatic symptoms) was confirmed, although negative affective and somatic symptoms were highly correlated (r = 0.926). The CES-D items can be summed to arrive at a total score (ω_H = 0.869), but not subscale scores (ω_S > 0.7). Differential item functioning was not found based on age or body mass index (BMI), but Item 1 (“I was bothered by things that don't usually bother me”) was inflated in women and Item 7 (“I felt that everything I did was an effort”) was inflated in those with higher glycosylated haemoglobin (HbA1c). The general depression factor decreased with age (β = − 0.247, p < 0.001) and increased with BMI (β = 0.102, p = 0.041) but not HbA1c (β = 0.065, p = 0.461). Negative affective symptoms (β = 0.743, p = 0.001), but not other depressive symptoms, were higher in women.ConclusionsThe 14-item CES-D retained construct validity in adults with T2DM. Depressive symptoms were associated with younger age, female gender and BMI, but not with glycemic control.     

Secondary progressive multiple sclerosis: A national consensus paper on diagnostic criteria

BackgroundIn clinical practice, the diagnosis of secondary progressive multiple sclerosis (SPMS) is often delayed, retrospective and non-reproducible, as there are no consensus criteria that define the advent of SPMS. Early identification of SPMS is essential to improve patient care.MethodsEight regional board meetings in France involving 56 multiple sclerosis (MS) experts (neurologists) were convened to discuss diagnostic criteria for SPMS. Subsequently, a national board meeting of 13 neurologists (with an expert representing each geographical region) was held to review points of convergence or divergence between regions and to develop a national consensus document.ResultsBased on the discussions from the regional boards, the MS experts at the national board retained the worsening of the EDSS score, with compatible clinical features, as the only consensus criterion for the diagnosis of SPMS in clinical practice. The patient should have experienced during at least the previous 6 months and in the absence of any relapse, a worsening in the EDSS score of +1.0 point (if the previous EDSS was ≤ 5.0) or of +0.5 point (if the previous EDSS was ≥ 5.5), with a pyramidal or cerebellar functional system score ≥ 2 and without setting a minimum EDSS score; or, in case of a stable EDSS score ≥ 4.0, a worsening of a functional score. This worsening should be confirmed within 3 to 6 months. According to the MS experts, the patient's age, duration of illness and a minimal threshold EDSS score are only risk factors for transition to SPMS. Patient reports during consultation and cognitive impairment are important warning signs, which should trigger an objective assessment with specific tests or closer monitoring. Clinical relapse and/or MRI activities are non-discriminatory for making the diagnosis of SPMS.ConclusionsThe experts defined precise diagnostic criteria adapted to clinical practice for earlier identification of SPMS, paving the way for better management of this stage of the disease.     

The importance of polysomnography in the evaluation of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked potentials with patients’ clinical status

ObjectivesThe aim of our study was to evaluate the importance of sleep recordings and stimulus-related evoked potentials (EPs) in patients with prolonged disorders of consciousness (DOCs) by correlating neurophysiologic variables with clinical evaluation obtained using specific standardized scales.MethodsThere were 27 vegetative state (VS) and 5 minimally conscious state (MCS) patients who were evaluated from a clinical and neurophysiologic perspective. Clinical evaluation included the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS), and Glasgow Coma Scale (GCS). Neurophysiologic evaluation included 24-h polysomnography (PSG), somatosensory EPs (SEPs), brainstem auditory EPs (BAEPs), and visual EPs (VEPs).ResultsPatients with preservation of each single sleep element (sleep–wake cycle, sleep spindles, K-complexes, and rapid eye movement [REM] sleep) always showed better clinical scores compared to those who did not have preservation. Statistical significance was only achieved for REM sleep. In 7 patients PSG showed the presence of all considered sleep elements, and they had a CRS-R score of 8.29 ± 1.38. In contrast, 25 patients who lacked one or more of the sleep elements had a CRS-R score of 4.84 ± 1.46 (P < .05). Our multivariate analysis clarified that concurrent presence of sleep spindles and REM sleep were associated with a much higher CRS-R score (positive interaction, P < .0001). On the other hand, no significant associations were found between EPs and CRS-R scores.ConclusionsPSG recordings have proved to be a reliable tool in the neurophysiologic assessment of patients with prolonged DOCs, correlating more adequately than EPs with the clinical evaluation and the level of consciousness. The main contribution to higher clinical scores was determined by the concomitant presence of REM sleep and sleep spindles. PSG recordings may be considered inexpensive, noninvasive, and easy-to-perform examinations to provide supplementary information in patients with prolonged DOCs.     

A longitudinal study of neurocognitive function in individuals at-risk for psychosis

IntroductionClinically defined prodromal diagnostic criteria identify at-risk individuals with a 35–40% likelihood of developing a psychotic disorder within a year. The time course and predictive value of cognitive deficits in the development of psychosis has not been established.MethodsA comprehensive neurocognitive battery and clinical assessments were administered to 37 subjects meeting Criteria of Prodromal States (COPS) criteria for being at risk for psychosis, and two comparison groups: 59 first episode and 47 healthy subjects. Subjects were also evaluated at 6-month and 1-year follow-up periods. Primary analyses used a neurocognitive composite score derived from individual neurocognitive measures, including measures of vigilance, verbal memory, working memory, and processing speed.ResultsAt-risk subjects performed more poorly than healthy subjects (t = 2.93, P = 0.01), but better than first episode subjects (t = 4.72, p < 0.0001). At-risk subjects were particularly impaired on measures of vigilance and processing speed. Cognitive composite scores were significantly lower in at-risk subjects who progressed to psychosis (N = 11; z = − 1.2), while those at-risk subjects who did not progress to psychosis (N = 17) performed better (z = − 0.5), and not significantly different from controls. Poor CPT performance combined with better WAIS-R digit symbol performance predicted progression to psychosis. Severity of neurocognitive deficits was not related to duration of prodrome or to time to development of psychosis and neurocognitive function improved in all subjects except those who progressed to psychosis.ConclusionNeurocognitive impairment emerges early in the course of psychotic illness. Performance on tests of neurocognition may prove to be an early risk predictor for subsequent development of psychotic disorders.     

Is multiple sclerosis a risk factor for atherosclerosis?

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS.MethodsThirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded.ResultsSixty-nine participants were included. The mean age of the study population was 35.8 ± 7.1 years. Right CIMT was significantly greater in the patient population (P < 0.001). Spearman's correlation coefficient between age and right CIMT was r = 0.41, P = 0.01. When we compared the Hs-CRP with a cut-off value of ≤ 3, the right, left, and mean CIMT levels were not statistically significant (P = 0.17; P = 0.22; P = 0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P < 0.001). The statistically significant factors identified with univariate analysis with P < 0.2 were further entered into multivariate modelling.ConclusionCIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.