Clinical features of Sjogren’s syndrome in patients with multiple sclerosis

Annunziata P, De Santi L, Di Rezze S, Millefiorini E, Capello E, Mancardi G, De Riz M, Scarpini E, Vecchio R, Patti F. Clinical features of Sjogren’s syndrome in patients with multiple sclerosis.
Acta Neurol Scand: 2011: 124: 109–114.
© 2010 John Wiley & Sons A/S. Objectives – To assess the frequency of clinical features of Sjogren’s syndrome (SS) in patients with multiple sclerosis (MS) receiving treatment with disease‐modifying drugs (DMDs) or naïve to treatment and the possible association with clinical, cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) parameters. Methods – A multicentre cross‐sectional observational study was designed, based on a structured neurologist‐administered questionnaire to 440 patients. Results – Twenty‐eight of 230 (12%) patients receiving treatment with DMDs (DMDs⁺) and 14 of 210 (6.6%) treatment‐naïve patients (DMDs⁻) showed clinical features of SS. Four primary SS were diagnosed, two of which were DMDs⁺ and two were DMDs⁻. Sicca symptoms were significantly associated with higher EDSS scores (P = 0.018), a low frequency of gadolinium‐enhanced MRI‐positive lesions (P = 0.018) and cerebral disturbances (P = 0.001). Conclusions – Screening for the clinical features of SS should be performed in patients with MS both receiving treatment with immunomodulatory drugs and without therapy.     

Myelin glycosphingolipid immunoreactivity and CSF levels in multiple sclerosis

Haghighi S, Lekman A, Nilsson S, Blomqvist M, Andersen O. Myelin glycosphingolipid immunoreactivity and CSF levels in multiple sclerosis.
Acta Neurol Scand: 2012: 125: 64–70.
© 2011 John Wiley & Sons A/S. Objectives – Patients with multiple sclerosis were reported to harbour antibodies not only against proteins and glycoproteins but also against glycolipids, including sulfatide and galactosylceramide (GalCer), the two major glycosphingolipids of myelin. However, previous results were inconsistent concerning glycosphingolipid levels, antibody type, dominance of serum or Cerebrospinal fluid compartments and relationship to the multiple sclerosis (MS) course. Results – We hereby report that the cerebrospinal fluid levels of sulfatide were increased in patients with MS (n = 46) compared with controls (n = 50, P < 0.001). In addition, patients had higher serum IgM anti‐glycosphingolipid titres than controls (P = 0.03 for sulfatide, <0.001 for GalCer), while the anti‐glycosphingolipid IgM antibodies in the cerebrospinal fluid were essentially normal. However, in seven of 46 patients cerebrospinal fluid IgG antibodies against GalCer (P = 0.004) could be detected, which was not found in any of the control individuals, and this finding might mirror the occurrence of more specific B‐cell clones behind the blood–brain barrier. Conclusions – The IgM immunoreactivity in serum did not show any relationship to the type of course or severity of MS, arguing against a phenomenon secondary to myelin damage. Thus, the IgM antibody findings are compatible with an early antigen challenge or autoimmunity associated with natural antibodies.     

Natalizumab vs interferon beta 1a in relapsing-remitting multiple sclerosis: a head-to-head retrospective study

Background – No head‐to‐head study has been performed yet to assess whether natalizumab is more effective than classical immunomodulators in multiple sclerosis (MS). Aim – To retrospectively compare the efficacy of natalizumab vs IFN beta 1a SC (44 μg; Rebif^®) on clinical and radiological findings in two matched cohorts of patients with MS. Patients and methods – We retrospectively enrolled two cohorts of 42 patients (F/M: 35/7) with relapsing‐remitting multiple sclerosis treated with natalizumab or IFN beta 1a for at least 12 consecutive months. Outcome measures were annualized relapse rate (ARR), changes in expanded disability status scale (EDSS) score, and number of contrast‐enhancing lesions (CELs) at magnetic resonance imaging (MRI). Results – In both groups, the ARR in the 12 months of treatment was lower than in the 12 months before therapy (0.24 vs 1.50 in natalizumab‐treated group, P < 0.0000; 0.55 vs 1.10 in IFN beta 1a‐treated group, P = 0.0006), being the effect of natalizumab significantly stronger (P = 0.0125). EDSS reduction was significantly different between the two groups in favor of natalizumab (P = 0.0018). The frequency and number of CELs per patient were decreased in both groups. In the second year, the treatment affected ARR and EDSS progression in the two groups of patients similarly to the first year, whereas number of CELs decreased more significantly in natalizumab group (P = 0.008). Conclusions – After 12 and 24 months of therapy, natalizumab was more effective than IFN beta 1a SC on both disease activity and disability progression. Prospective head‐to‐head studies would be helpful to further evaluate the differences observed in the MRI outcomes.     

Serum somatostatin in early‐stage Parkinson’s disease

Shiraishi M, Kobayashi T, Watanabe H, Kamo T, Hasegawa Y. Serum somatostatin in early‐stage Parkinson’s disease.
Acta Neurol Scand: 2010: 121: 225–229.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To compare levels of plasma digestive hormones in patients with and without nausea or vomiting during initial treatment of early‐stage Parkinson’s disease (PD). Methods – This was a 3‐week, open‐label, randomized study of treatment with an antiparkinson drug in untreated PD patients. We measured the levels of plasma digestive hormones before (baseline) and 3 weeks after administration of an antiparkinson drug. Results – Mean value of serum somatostatin at baseline was significantly increased in PD patients compared with the control group (P < 0.01). Serum somatostatin levels were significantly increased after treatment in subjects who experienced nausea or vomiting (P < 0.01). However, significant increase in serum somatostatin levels after treatment was not observed in PD patients without nausea or vomitting. Conclusion – Serum somatostatin in early‐stage PD patients before treatment was increased compared with healthy subjects. The nausea and vomiting induced by antiparkinson drugs may be related to uncontrolled somatostatin secretion through central vagus nerve dysfunction .     

Natural history of solitary cerebral cysticercosis cases after albendazole therapy: a longitudinal follow‐up study from India

Goel D, Mittal M, Bansal KK, Singhal A. Natural history of solitary cerebral cysticercosis cases after albendazole therapy: a longitudinal follow‐up study from India.
Acta Neurol Scand: 2010: 121: 204–208.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To find out natural course of solitary cerebral cysticercosis (SCC) cases after treating them with 2 weeks albendazole therapy. Material and methods – All patients with SCC were treated with 2 weeks of albendazole therapy with follow‐up radiological scan at 6 months and 2 years. The evolution of lesion was noted as complete resolution, calcification or persistent active. Antiepileptic drugs (AED) prophylaxis was given for 1 year in patients with complete resolution and for 2 years in calcified lesion, respectively. AED was continued in persistent lesion group till it became calcified or resoluted completely. One‐year follow‐up was done in all after stopping AED. Results – Among 345 cases, 226 (65.5%) had complete resolution with very low seizure relapse rate with 1 year of seizure free period on AED treatment. On the contrary, 105 (30.5%) had calcified lesion with high seizure relapse rate after stopping AED treatment with 2 years of seizure free period. Fourteen patients (4%) could not stop their antiepileptic medication at all because of active lesion. Conclusion – Two‐third of patients with SCC have favorable outcome with complete resolution and needs short‐term AED prophylaxis and the rest one‐third requires long AED treatment to prevent seizures.     

Different responses to interferon beta‐1b treatment in patients with neuromyelitis optica and multiple sclerosis

Background: Although the benefit of treatment for relapsing–remitting multiple sclerosis (MS) is firmly established, whether interferon beta‐1b (IFNB‐1b) therapy is efficacious for neuromyelitis optica (NMO) has been debated. Methods: We reviewed the responses to IFNB‐1b treatment in 18 patients with relapsing NMO and compared the results with those from 38 patients with relapsing–remitting MS. We compared clinical characteristics, the annualized relapse rate (ARR) and the probability of being relapse free before and after IFNB‐1b treatment in patients with NMO and MS. Results: The proportion of patients with more than 50% increase in the ARR after IFNB‐1b treatment was much higher in NMO than in MS (P = 0.046). ARR was significantly lower in patients with MS after IFNB‐1b administration than before (P = 0.015), but not in NMO. Kaplan–Meier and log‐rank statistical analyses revealed that relapse‐free rates were lower in NMO than MS after IFNB‐1b treatment (P = 0.032). The analyses also showed lower relapse‐free rates during the pre‐IFNB‐1b treatment period than the post‐IFNB‐1b treatment period in MS (P < 0.001), but not in NMO. Conclusion: IFNB‐1b treatment does not appear to be effective for preventing relapse in NMO likely because of differences between the immune‐pathogenesis of NMO and MS.     

Whole‐body high‐field MRI shows no skeletal muscle degeneration in young patients with recessive myotonia congenita

Kornblum C, Lutterbey GG, Czermin B, Reimann J, von Kleist‐Retzow J‐C, Jurkat‐Rott K, Wattjes MP. Whole‐body high‐field MRI shows no skeletal muscle degeneration in young patients with recessive myotonia congenita.
Acta Neurol Scand: 2010: 121: 131–135.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Background – Muscle magnetic resonance imaging (MRI) is the most sensitive method in the detection of dystrophic and non‐dystrophic abnormalities within striated muscles. We hypothesized that in severe myotonia congenita type Becker muscle stiffness, prolonged transient weakness and muscle hypertrophy might finally result in morphologic skeletal muscle alterations reflected by MRI signal changes. Aim of the study – To assess dystrophic and/or non‐dystrophic alterations such as fatty or connective tissue replacement and muscle edema in patients with severe recessive myotonia congenita. Methods – We studied three seriously affected patients with myotonia congenita type Becker using multisequence whole‐body high‐field MRI. All patients had molecular genetic testing of the muscle chloride channel gene (CLCN1). Results – Molecular genetic analyses demonstrated recessive CLCN1 mutations in all patients. Two related patients were compound heterozygous for two novel CLCN1 mutations, Q160H and L657P. None of the patients showed skeletal muscle signal changes indicative of fatty muscle degeneration or edema. Two patients showed muscle bulk hypertrophy of thighs and calves in line with the clinical appearance. Conclusions – We conclude that (i) chloride channel dysfunction alone does not result in skeletal muscle morphologic changes even in advanced stages of myotonia congenita, and (ii) MRI skeletal muscle alterations in myotonic dystrophy must be clear consequences of the dystrophic disease process.     

Long‐term levetiracetam treatment in patients with epilepsy: 3‐year follow up

Kuba R, Novotná I, Brázdil M, Ko?varová J, Tyrlíková I, Mastík J, Rektor I. Long‐term levetiracetam treatment in patients with epilepsy: 3‐year follow up.
Acta Neurol Scand: 2010: 121: 83–88.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To assess the long‐term efficacy and tolerability of levetiracetam in routine clinical practice. Materials and methods – We retrospectively analysed 218 patients, mostly adults, presenting mostly with localisation‐related epilepsy, treated with levetiracetam as adjunctive therapy or monotherapy for up to 36 months. The primary points evaluated were: long‐term retention rate, reasons for discontinuing levetiracetam and the percentage of seizure‐free patients. Results – The retention rate at 6, 12, 24 and 36 months following the commencement of levetiracetam treatment was 91.7, 75.2, 60.1 and 53.7% respectively. Sixty‐seven (30.7%) patients discontinued levetiracetam treatment. During the clinical audit evaluation period, surgical resection or implantation of VNS was performed in 31 (14.3%) patients. In 53 of the 67 patients (79.1%), the treatment was discontinued due to lack of efficacy; in 14 patients (20.9%) treatment was discontinued due to adverse events. In total, 24 of 218 patients (11.0%) were seizure‐free for 36 months. Conclusions – Levetiracetam is an effective and well‐tolerated option for long‐term treatment of epilepsy in adults.     

Frequency and severity of headache is worsened by Interferon-β therapy in patients with multiple sclerosis

Patti F, Nicoletti A, Pappalardo A, Castiglione A, Lo Fermo S, Messina S, D’Amico E, Cimino V, Zappia M. Frequency and severity of headache is worsened by Interferon‐β therapy in patients with multiple sclerosis.
Acta Neurol Scand: 2012: 125: 91–95.
© 2011 John Wiley & Sons A/S. Background – The relationship between multiple sclerosis (MS) and headache (HA) is not well known. It was reported that interferon‐beta (IFNβ) could induce or worsen HA. Objective – To evaluate the impact of IFNβ treatment on HA and the relationship between HA and the various commercial preparations of IFNβ in mildly disabled patients with MS. Methods – A specific questionnaire was administered to 357 relapsing‐remitting MS patients. Characteristics of HAs were considered, including the temporal relationships with IFNβ administration. Results – One hundred and seventeen patients were treated with weekly intramuscular injections of interferon IFNβ‐1a (Avonex^®), 84 with subcutaneous injections of IFNβ‐1b (Betaferon^®) every other day, 48 and 108 with three times weekly subcutaneous injections of IFNβ‐1a (Rebif^®) 22 mcg or IFNβ‐1a (Rebif^®) 44 mcg, respectively. Three hundred and fourteen patients were affected by HA, and among them, 219 patients suffered of pre‐existing HA. In this latter group, 121 subjects (55%) noted a worsening of their HA after starting IFNβ therapy; this was more frequently reported by patients treated with Avonex^® and Rebif^® 44. Ninety‐five patients experienced new HA. Conclusion – IFNβ treatment could worsen HA in patients with pre‐existing HA or cause the appearance of new HA. Among different IFNβ preparations, Rebif^® 44 and Avonex^® seemed to be more cephalalgic than the other drugs.     

Idiopathic generalized epilepsies: a follow‐up study in a single‐center

Kharazmi E, Peltola M, Fallah M, Keränen T, Peltola J. Idiopathic generalized epilepsies: a follow‐up study in a single‐center.
Acta Neurol Scand: 122: 196–201.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To characterize adult patients with idiopathic generalized epilepsies (IGEs) with precise evaluation and to assess factors related to refractoriness. Materials and methods – Hospital records of all our patients with IGEs (n = 128) were evaluated in 2005 and followed‐up until 2008. Results – In 2005, 76% of patients were 1‐year seizure‐free. Seizure freedom increased to 82% during the 3‐year follow‐up. Seizure freedom was not significantly associated with age, age at diagnosis, epilepsy duration, exposure to inappropriate initial antiepileptic drug (AED), or delay time between starting initial AED and appropriate AED. Women constituted 78% of patients with merely provoked seizures. In 58% of women with recent seizure, one to two avoidable precipitating factors, such as lack of sleep, alcohol, and forgetting to take AED, were observed. In 2008, all patients with no medication, 91% of monotherapy patients, 60% of patients on two AED, and 14% of patients on three AED were seizure‐free. Conclusions – Most of patients with IGEs can be successfully treated with monotherapy. Refractory seizures in some patients may be because of avoidable factors, especially in young women.     

The influence of warm versus cold climate on the effect of physiotherapy in multiple sclerosis

Smedal T, Myhr K‐M, Aarseth JH, Gjelsvik B, Beiske AG, Glad SB, Strand LI. The influence of warm versus cold climate on the effect of physiotherapy in multiple sclerosis.
Acta Neurol Scand: 2011: 124: 45–52.
© 2010 John Wiley & Sons A/S. Objective – To compare the effect of inpatient physiotherapy in a warm versus cold climate in short‐ and long‐term perspectives. Methods – Sixty multiple sclerosis (MS) patients with gait problems, without heat intolerance, were included in a randomized cross‐over study of 4‐week inpatient physiotherapy in warm (Spain) and cold (Norway) climate. The primary outcome, 6‐min walk test (6MWT), and secondary physical performance and self‐reported measures were scored at screening, baseline, after treatment and at 3 and 6 months of follow‐up. Treatment effects were analysed by mixed models. Results – After treatment, the mean walking distance had increased by 70 m in Spain and 49 m in Norway (P = 0.060). Improvement in favour of warm climate was demonstrated at 6 months of follow‐up, 43 m (Spain) compared to 20 m (Norway) (P = 0.048). The patients reported less exertion after walking (6MWT) in favour of treatment in Spain at all time points (P < 0.05). No significant differences in change were detected for the other physical performance measures. Most self‐reported measures showed more improvement after treatment in Spain, but these improvements were not sustained at follow‐up. Conclusion – The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate.     

Elevated HSP27 levels during attacks in patients with multiple sclerosis

Ce P, Erkizan O, Gedizlioglu M. Elevated HSP27 levels during attacks in patients with multiple sclerosis.
Acta Neurol Scand: 2011: 124: 317–320.
© 2011 John Wiley & Sons A/S. Objectives – The small heat shock protein, HSP27, has been shown to have a more potent protective effect in the nervous system. However, there is limited information about the behavior of HSP27 in the course of multiple sclerosis (MS). Thus, we investigated the HSP27 levels during relapse and remission phases of MS. Materials and Methods – A total of 50 relapsing–remitting or secondary progressive MS patients and 45 age‐ and gender‐matched controls without any systemic diseases were enrolled. HSP27 levels were serologically detected in serum samples of both controls and MS patients during acute attacks and after a minimum of 2 months of each individual attack. Results – The mean HSP27 level was 12.41 ± 18.21 ng/ml in the attack phase, 4.58 ± 4.75 ng/ml during remission, and 2.58 ± 3.88 ng/ml in control patients. The heat shock proteins (HSP) levels of MS patients in the attack phase were significantly higher than those obtained in the remission phase (P = 0.005). Moreover, HSP levels in the attack and remission phases of MS patients were also significantly higher when compared to controls (P = 0.001 and P = 0.03, respectively). While there was no correlation between HSP27 levels in the attack phase and age, disease duration, or expanded disability status scale scores (P = 0.69, P = 0.32, and P = 0.91, respectively), a positive correlation was observed between the HSP27 levels and the total attack number (P = 0.001). Conclusions – Our findings revealed a marked elevation in HSP27 levels during the relapse phase. Therefore, it can be suggested that elevated HSP27 levels may guide in the accurate detection of an attack in patients with MS.     

Apraxia related with subcortical lesions due to cerebrovascular disease

Tabaki NE, Vikelis M, Besmertis L, Vemmos K, Stathis P, Mitsikostas DD. Apraxia related with subcortical lesions due to cerebrovascular disease.
Acta Neurol Scand: 2010: 122: 9–14.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To examine whether ideomotor apraxia exists in patients with subcortical ischemic lesions. Patients and Methods – A matched‐control, prospective and multi‐centered research design was used. Ideomotor apraxia, anxiety and depression were assessed by the Movement Imitation Test and the Hamilton scales, respectively. Results – Forty two consecutive patients with subcortical ischemic stroke and an equal number of healthy participants, matched in age and sex were included. Paired‐sample t‐tests showed that patients had significantly more apractic elements in their movements (t = 5.03, P < 0.01), higher anxiety (t = ?2.55, P = 0.0014) and depression levels (t = ?2.61, P = 0.012) than their healthy matched participants. Participants with higher anxiety and depression scores performed worse on the Movement Imitation Test. Conclusions – Ischemic damage of subcortical modular systems may affect praxis.     

Impact of cladribine on soluble adhesion molecules in multiple sclerosis

Mitosek‐Szewczyk K, Stelmasiak Z, Bartosik‐Psujek H, Belniak E. Impact of cladribine on soluble adhesion molecules in multiple sclerosis.
Acta Neurol Scand: 2010: 122: 409–413.
© 2010 The Authors Journal compilation © 2010 Blackwell Munksgaard. Background – Soluble forms of vascular cell adhesion molecule‐1 (VCAM‐1), intracellular adhesion molecule‐1 (ICAM‐1) and E‐Selectin play a role in the regulation of blood–brain barrier damage and represent markers of the clinical course of multiple sclerosis (MS) and magnetic resonance imaging activity. We determined sICAM, sVCAM and sE‐Selectin concentrations in the cerebrospinal fluid (CSF) and serum of patients with remitting–relapsing multiple sclerosis before and after cladribine treatment as well as in a control group. Methods – We examined 17 patients diagnosed according to McDonald’s criteria. Thirteen healthy age‐matched subjects served as controls. The ELISA method was used to measure sICAM‐1, sVCAM‐1 and sE‐Selectin. Results – The concentration of sICAM and sE‐Selectin decreased in sera (difference between patients and controls was statistically significant, in the former P < 0.04, in the latter P < 0.0003) but not in the CSF of MS patients after cladribine treatment. Conclusions – The reduction in sICAM and sE‐Selectin concentrations after cladribine treatment indicates an immuno‐suppressive effect of the drug. The changes in levels of sICAM and sE‐Selectin after cladribine treatment reflect disease activity and indicate a reduction in the inflammatory reaction.     

The Global Adherence Project (GAP): a multicenter observational study on adherence to disease‐modifying therapies in patients with relapsing‐remitting multiple sclerosis

Background: Most disease‐modifying therapies (DMTs) for multiple sclerosis (MS) are self‐injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing‐remitting MS. Methods: This was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta‐1a (IFNβ‐1a), subcutaneous IFNβ‐1a, IFNβ‐1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long‐term DMTs. Results: Two thousand six hundred and forty‐eight patients were studied, revealing an average treatment duration of 31 months. Seventy‐five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non‐adherence were forgetting to administer the injection (50.2%) and other injection‐related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non‐adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non‐adherent patients. Women were more likely than men to adhere to treatment. Conclusion: Identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long‐term DMTs.     

MRI and visual-evoked potentials in partners of multiple sclerosis patients

Hawkes CH, Chawda S, Derakshani S, Muhammed N, Visentin E, Boniface D. MRI and visual‐evoked potentials in partners of multiple sclerosis patients.
Acta Neurol Scand: 2012: 125: 424–430.
© 2011 John Wiley & Sons A/S. Objective – Some epidemiological evidence, particularly concerning the role of Epstein Barr Virus implies that multiple sclerosis (MS) may be transmissible and if correct, this might be revealed by increased prevalence of MS in cohabiting partners. Methods – We addressed this problem by neurological assessment, visual‐evoked potentials (VEP) and magnetic resonance imaging (MRI) in 112 partners of patients with MS in comparison to a control group of 93 individuals with clinically non‐significant head or neck pain and in comparison to UK prevalence. Results – We found one instance of conjugal definite MS. Including this case, VEP were abnormal in five instances with either significant delay (n = 3) or increased interocular latency difference (IOLD) (n = 2) in partners of MS patients thus raising the possibility of subclinical optic nerve demyelination. The mean absolute value of IOLD in partners was greater than the value in controls (P = 0.033). There were no significant differences in MRI findings between the two groups. Conclusion – The finding of one conjugal pair and abnormal VEP in a further four MS partners could have several explanations. It is compatible with the concept of a transmissible agent, although our observations could be due to several biases as well as the play of chance alone.     

D‐dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

Krarup L‐H, Sandset EC, Sandset PM, Berge E. D‐dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation.
Acta Neurol Scand: 2011: 124: 40–44.
© 2010 John Wiley & Sons A/S. Background – Patients with acute ischemic stroke and atrial fibrillation are at increased risk of stroke progression and recurrence. We sought to assess whether D‐dimer and other markers of hemostatic activation could predict these adverse events in such patients. Method – Blood samples were obtained from patients included in the Heparin in Acute Embolic Stroke Trial. Stroke progression was defined as a ≥3‐point worsening on the Scandinavian Stroke Scale during the first 48 h after randomization. Blood samples were analyzed for D‐dimer, prothrombin fragment 1 + 2, soluble fibrin monomer, and C‐reactive protein. Results – A total of 382 patients were included in the analyses. Levels of D‐dimer and other markers of hemostatic activation were not significantly higher in patients with stroke progression than in other patients (D‐dimer median values: 1025 ng/ml vs 970 ng/ml, P = 0.73). The same was true for recurrent stroke (D‐dimer: 720 ng/ml vs 973 ng/ml, P = 0.96), and the combined endpoint of stroke progression, recurrent stroke, and death (D‐dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion – D‐dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death in patients with acute ischemic stroke and atrial fibrillation.     

Multiple sclerosis and cognitive decline: is ApoE‐4 a surrogate marker?

Carmona O, Masuet C, Santiago O, Alía P, Moral E, Alonso‐Magdalena L, Casado V, Arbizu T. Multiple sclerosis and cognitive decline: is ApoE‐4 a surrogate marker?
Acta Neurol Scand: 2011: 124: 258–263.
© 2011 John Wiley & Sons A/S. Background – The role of the apolipoprotein E (ApoE) polymorphism has been well demonstrated in neurodegenerative disorders such as Alzheimer. However, its role in multiple sclerosis (MS) remains unclear. Aims – The aims of our study were as follows: (i) to assess whether ApoE‐4 might be a surrogate marker of cognitive decline in MS; (ii) to confirm the presence of cognitive impairment in mildly disabled patients treated with interferon‐beta; and (iii) to analyse the correlation between cognitive disturbances and clinical variables. Material and methods – Fifty relapsing‐remitting MS patients underwent a battery of neuropsychological tests and were genotyped for ApoE. Their scores were compared with those of 35 controls. Results – No association was found between ApoE‐4 and cognitive impairment. Significant differences in most domains were observed between MS and the control group. Cognitive decline was not related to disability progression. Conclusion – No association between cognitive impairment and ApoE‐4 or clinical markers was detected in our MS patients.     

Multiple sclerosis in Vest-Agder County, Norway

Vatne A., Mygland Å., Ljøstad U. Multiple sclerosis in Vest‐Agder county, Norway.
Acta Neurol Scand: 2011: 123: 396–399.
© 2010 John Wiley & Sons A/S. Objective – To examine multiple sclerosis (MS) prevalence, rate of immunomodulatory treatment and frequency of Borrelia Burgordorferi (Bb) antibodies in Vest‐Agder, Norway. Materials and methods – Patients in the period 1996–2006 who met the Poser criteria for definitive or probable MS were included. Clinical and demographical data, and presence of Bb antibodies were registered. Results – A total of 295 patients were identified. The crude prevalence was 180 per 100,000 population (95% CI = 160.9–218.0), age‐adjusted prevalence was 186 per 100,000 population (95% CI = 166.3–225.3). The age‐adjusted incidence rates were 7.5 and 8.0 for 1996–2000 and 2001–2006, respectively. Thirty‐eight per cent were treated with immunomodulatory agents when compared to 28% in the rest of the country. Bb serum antibodies were detected in 7% of patients with MS. Conclusions – Vest‐Agder county has the highest prevalence of MS reported in Norway, and a high treatment rate. Bb antibodies were not more prevalent than in healthy individuals.     

Dysphagia and dysphonia among persons with post‐polio syndrome – a challenge in neurorehabilitation

Söderholm S, Lehtinen A, Valtonen K, Ylinen A. Dysphagia and dysphonia among persons with post‐polio syndrome – a challenge in neurorehabilitation.
Acta Neurol Scand: 2010: 122: 343–349.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To study the occurrence of dysphagia and dysphonia in persons with post‐polio syndrome admitted into the centre for neurological rehabilitation in Finland. Materials and methods – Fifty‐one persons with post‐polio syndrome who were rehabilitated at Käpylä Rehabilitation Centre, Helsinki, Finland, in 2003–2004 were interviewed on problems with swallowing and voice production. Pulmonary function testing and grip strength measurement were performed. A clinical assessment of oral motor and laryngeal functions was carried out for those who reported daily problems with voice production or swallowing. Results – Fifteen persons (29.4%) reported daily problems with swallowing or voice production. In the clinical assessment, the most commonly observed deficits in swallowing included decreased pharyngeal transit (n = 13) and the food catching in the throat (n = 4). The disturbance of co‐ordination of breathing and voice production was seen in 12 persons. There were no significant differences in any of the potential predictors between the groups. Conclusions – Professionals need to be aware of the routine evaluation of dysphagia and dysphonia in patients with post‐polio syndrome.