Analysis of the upper urinary tract function in multiple sclerosis patients

Aims –  The objective of this study was to analyse the upper urinary tract (UT) function in a group of consecutive multiple sclerosis (MS) patients, who had not previously been treated by urologist.
Materials and methods –  Ninety-two MS patients suffering from lower UT dysfunction were included in the study. The group of patients consisted of 69 women and 23 men. The average Expanded Disability Status Scale (EDSS) score in our group was 4.29 (0–8.5). Functional examination of the kidneys using assessment of creatinine clearance and morphological examination of the kidneys using ultrasound was performed in all patients. Analysis of the upper UT function is presented.
Results –  The average serum creatinine clearance in our group was 132.84 ml/min/1.73 m² (46.8–510). Lower levels than normal were found in three patients (3.3%). Abnormal ultrasound findings were recorded in five patients (5.4%). The creatinine clearance was correlated with the clinical subtype of MS, the severity expressed by EDSS, the urodynamic parameters, the duration of the disease, the duration of the symptoms of lower UT and the EDSS score. We did not find a statistically significant correlation for any of these parameters.
Conclusions –  Our results suggest that impairment of the upper UT function is exceptional in MS patients.     

Neuropsychiatric symptoms in patients with multiple sclerosis

OBJECTIVE: To explore the range of psychiatric symptoms in patients with multiple sclerosis (MS) and their association with neurological disability. METHOD: Patients diagnosed with MS during 1998-2000 in Rogaland and Hordaland counties, western Norway, were included. Psychiatric symptoms were assessed by the Neuropsychiatric Inventory (NPI). Patients with systemic lupus erythematosus (SLE) served as controls. RESULTS: Eighty-six of 93 eligible MS patients were included, and 80% showed at least one psychiatric symptom. The most frequent symptoms were depression (59%), sleep disturbance (48%), irritability/emotional lability (42%), and apathy (31%). Depression was associated with higher disability score. MS patients showed significantly higher NPI irritability score (P = 0.002), appetite disturbance score (P < 0.001), and apathy score (P = 0.01) than SLE patients. CONCLUSION: Neuropsychiatric symptoms occur frequently in patients with MS. Irritability and apathy are independent of disability and chronic disease and represent unique disease manifestations.     

Patient information on cognitive symptoms in multiple sclerosis - acceptability in relation to disease duration

OBJECTIVE: Recently, regular cognitive screening assessments have been advised in multiple sclerosis (MS). No studies have been carried out yet on the acceptability of information on cognitive deficits among MS patients. MATERIALS AND METHODS: Translation of an information booklet developed by a working group of European MS Rehabilitation Centers. Distribution of the booklet among 133 MS patients of two rehabilitation units and one outpatient clinic together with a one-page questionnaire. RESULTS: The booklet was highly understandable and rated to give moderate new information. Overall, the brochure was perceived as encouraging but significantly less so (P = 0.014) in recently diagnosed patients. Patients with subjectively perceived deficits considered the brochure to be significantly more relevant (P = 0.002). CONCLUSION: Information on cognitive deficits does not increase fears even in recently diagnosed MS patients. Patients with perceived deficits found the information more relevant than others and also less familiar. Thus, it seems appropriate to offer information about cognitive impairments to MS patients.     

Onset symptoms as predictors of mortality and disability in multiple sclerosis

941 cases of definite/probable multiple sclerosis living in Los Angeles County, California and King and Pierce Counties, Washington in 1970 who had onset between 1960 and 1969 were followed for mortality and disability through 1980. Early age of onset and residence in Washington State were predictors of less rapid and severe subsequent course. Coordination symptoms at onset were prognostic of rapid progression to disability and/or early death, whereas early motor weakness was significantly predictive only for disability. The presence of sensory symptoms in addition to motor and/or coordination symptoms at onset, however, indicated a better prognosis than coordination and/or motor symptoms alone. This observation and the results of regression analyses indicated that specific groupings of symptoms at onset were more important for predicting course than the number of symptoms present at onset.     

Correlation between magnetic resonance imaging and clinical parameters in multiple sclerosis

In this study, the course of 60 consecutive multiple sclerosis patients (relapsing-remitting (RR), relapsing-progressive (RP), primary-progressive (PP)) was compared with the number and mean size of the lesions as well as the total load of the lesions as shown on magnetic resonance imaging (MRI). Significant differences were found between RR and RP patients in total load and number of lesions. Between RR and PP patients statistical significant differences were found in total load, number and size of the lesions when correlated with EDSS. Between RP and PP patients statistical differences were found in total load and size of the lesions on MRI. Patients with a relapsing course of the MS (RR or RP) had a higher total load and size of the lesions than PP patients. The total load, number and size of the lesions corrected for EDSS were also lower compared to relapsing patients. Factor analysis showed a correlation between clinical progression rate and progression rate of MRI abnormalities. No correlation between EDSS and total load of MRI lesions could be found. In conclusion, this study confirms the results of previous studies of differences between MRI scans of patients with a different course of MS.     

Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis

OBJECTIVES: The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence. MATERIALS AND METHODS: A literature search was carried out looking for studies published between 1990 and 2003 which evaluated desmopressin in MS patients with bladder dysfunction. RESULTS: The grand total mean effect sizes show the following estimates of clinical relevant differences: desmopressin has a moderate effect on the number of voids during the day or during the night over a period of 6 h after taking the drug. A large effect associated with the use of desmopressin was detected by the mean difference in urine volume (ml) in 6 h. A small effect was detected in the mean 24-h urine volume. Serum sodium levels were combined with plasma osmolality in some studies and were found to be not significantly affected by desmopressin treatment.     

Paroxysmal convergence spasm in multiple sclerosis

Paroxysmal phenomena are rare but relatively typical clinical symptoms of multiple sclerosis (MS) caused by abnormal excitation in demyelinated plaques. We report the case of a 25-year-old woman with ocular convergence spasms as a new type of paroxysmal phenomenon in MS. MRI revealed the associated brainstem lesion in the region of the medial longitudinal fasciculus. Bromocriptine treatment was successful in resolving the paroxysms.     

Depressive symptoms and MRI changes in multiple sclerosis

To determine whether changes in specific regions of the brain can contribute to the development of depression in patients with multiple sclerosis (MS). We prospectively studied 90 patients with clinically definite MS. Disability, independence, cognitive performances, and depressive and anxiety symptoms have been assessed at baseline and 2 years later. At these two time-points, patients underwent a 1.5-T magnetic resonance examination of the brain including T1- and T2-weighted images. Calculation of regional and total lesion loads (LL) have been performed by a semiautomatic technique; total and regional brain volumes have been calculated by a fully automatic highly reproducible computerized interactive program. Measurements of LL did not show any significant difference between depressed and non-depressed patients. Brain atrophy was significantly more conspicuous in the left frontal lobe (P=0.039), in both frontal lobes (P=0.046) and showed a trend towards a difference in the right frontal lobe (P=0.056), in the right temporal lobe (P=0.057) and in both temporal lobes (P=0.072) of depressed patients. Disability, independence and cognitive performances were similar in depressed and non-depressed patients (P=NS). Spearman correlation analysis and multiple-regression analysis demonstrated that the severity of the depressive symptoms score was associated both with the disability score and the right temporal brain volume. Destructive lesions in the right temporal lobe can contribute to the severity of depression in patients with MS but the influence of the severity of neurological impairment should be taken into account.     

Stress and depression symptoms in patients with multiple sclerosis: the mediating role of the loss of social functioning

Kirchner T, Lara S. Stress and depression symptoms in patients with multiple sclerosis: the mediating role of the loss of social functioning.
Acta Neurol Scand: 2011: 123: 407–413.
© 2010 John Wiley & Sons A/S. Objective – Depression symptoms are very frequent in patients with multiple sclerosis (MS) and have been associated with several quality of life indicators, especially physical and social functioning. The objectives were as follows: (i) to analyse the extent to which the loss of physical and social functioning may explain the depression symptoms observed in 65 Spanish patients diagnosed with MS; and (ii) to analyse the degree to which loss of social functioning may act as a mediator between depression symptoms and the stress associated with the disease. Materials and Methods – Participants were 65 Spanish patients diagnosed with MS and recruited from several MS centres and foundations. Results – The loss of social functioning had greater explanatory power as regards depression symptoms than did the loss of physical functions. Social functioning was also found to have an important mediating effect between MS stress and depression symptoms: specifically, more than half (52%) of the relationship between MS stress and depression symptoms was mediated by the perceived loss of social functions in Spanish patients with MS. Conclusion – The importance of social functioning for Spanish patients with MS may have noteworthy implications when designing prevention and treatment programmes aimed at improving their quality of life.     

Cardiovascular dysfunction in multiple sclerosis

Cardiovascular dysfunction (CD) in multiple sclerosis (MS) is related to involvement of reflex pathways in the brainstem. The battery of CD tests was applied to a group of 40 healthy subjects and 40 patients with MS, divided in 2 subgroups according to the expanded disability status scale (EDSS). The tests included: 1) postural blood pressure changes, 2) postural heart rate changes, 3) heart rate changes on inspiration/forced expiration and 4) ECG R-R interval measurement on the Valsalva maneuver. Both groups were subjected to the functional independence scale (FIM). Imaging studies were reviewed and autonomic dysfunction at other levels was explored. The results showed a statistically significant difference (P < 0.05) in all tests when comparing patients to controls. Tests 1 and 4 had the highest significance, with findings of more severe involvement in patients with a higher EDSS and lower FIM. A correlation was also found between CD and brainstem lesions on MRI (P < 0.01). A significant number of MS patients had evidence of CD. Test 1 may be considered a simple marker, in daily clinical practice, to detect subclinical CD. Subclinical CD is a cause of disability in this group of patients.     

Activity, tolerability and efficacy of levetiracetam on cerebellar symptoms in multiple sclerosis patients: a pilot kinematic study

Background and purpose:  The aim of this study was to evaluate the activity measured by kinematic analysis, tolerability and efficacy of levetiracetam (LEV) in multiple sclerosis (MS) patients affected by cerebellar symptoms, in a randomized single-blind, placebo-controlled cross-over study.
Methods:  Eight MS subjects with cerebellar signs (five female and three male; mean EDSS: 4.77; mean disease duration 9.2) performed a reaching task on a digitizing tablet and their trajectories went through a kinematic analysis. The subjects were assessed at baseline, after 21 days of treatment, after wash-out period (day 35) and after 21 days of treatment (day 56). LEV was used at the maximum dosage of 1500 mg daily. The primary outcome was the modification on smoothness (JERK) whilst aiming error (AAI) and centripetal acceleration (CA) were considered as secondary outcomes.
Results:  Two subjects were excluded from the final analysis. Primary outcome (i.e. JERK) was significantly affected by the administration of LEV overtime (nine arms in active treatment versus three arms in placebo decreased the mean values of their JERK). Regarding secondary outcomes CA was significantly affected by the administration of LEV. No statistical significant results were found comparing clinical scales during the four assessments.
Discussion:  The results indicate that LEV was able to modify kinematic parameter so the medication was active but no improvement in clinical scales was observed. LEV needs to be tested in a larger group of subjects designed to verify treatment efficacy using higher dosage of the medication.     

Attention and memory dysfunctions in mild multiple sclerosis

This study investigated the relationship between clinical symptoms and cognitive dysfunction in multiple sclerosis. Cognitive dysfunction and visual evoked potentials (VEPs) were studied in patients free of physical disability and mildly to moderately disabled patients with multiple sclerosis (MS). Disability–free patients (EDSS ≤ 1.5; n = 13),mildly to moderately disabled patients (EDSS ranging from 2 to 6; n = 13) and a healthy matched control group (n = 16) were examined with respect to attention, verbal and nonverbal memory and early visual processing (VEPs). Disability–free patients showed mild impairments on phasic alertness and divided attention. Deficits were more pronounced in mildly to moderately disabled patients who were additionally impaired with respect to non–verbal memory. Despite adequate visual acuity, one half of all patients showed abnormal VEP latencies for both eyes at the same time. The findings suggest that cognitive deficits are already present in multiple sclerosis even in the absence of physical disability. Even with normal visual acuity, perceptual impairments should be considered as part of the CNS affection. Drs. Tinnefeld and Treitz contributed equally to this work.     

P wave duration and dispersion in multiple sclerosis

Abstract Background Multiple sclerosis (MS) has been reported to be associated with extensive autonomic dysfunction as well as to involve the cardiovascular system. In this study we compared P wave duration and dispersion (PWD) of MS patients to healthy control subjects. Method Thirty-one MS patients (mean age 35±9 years) and 33 healthy control subjects (mean age 34±7 years) were included in the study. Twelve-lead surface ECG recording (paper speed of 50 mm/s) was obtained from all participants. The change in maximum and minimum P wave duration was measured manually and the difference between the two values was defined as PWD. Results There was no difference between the two groups in terms of baseline demographic characteristics. Maximum P wave duration was higher in MS patients than controls (126±6 vs. 122±5 ms, p=0.004). Minimum P wave duration was found to be similar in MS patients and healthy controls (72±8 vs. 75±8 ms, p=0.2).Mean PWD value of MS patients was also found to be higher than those of controls (53±10 vs. 47±10 ms, p=0.01). Conclusion P wave duration and PWD was found to be statistically different in patients with MS and control subjects.     

多发性硬化患者的认知功能障碍及其与头颅MRI病灶的相关性

目的　研究多发性硬化 (MS)患者认知功能障碍的特点及其与头颅MRI病灶的相关性。方法　对 70例MS患者进行韦氏智力量表 (WAIS)测试及头颅MRI检查 ,并用多元回归分析方法对各相关因素进行分析。结果　MS组全量表智商 (FIQ)异常 (<90分 )率为 4 0 %(2 8/70 ) ,与对照组比较差异有显著性 (P <0 0 1)。对智商成绩影响最显著的因素为病变部位 (脑部病变 )。MRI显示病灶的等级与病程呈显著正相关(r=0 348,P <0 0 5 ) ,胼胝体病灶数与FIQ呈负相关 (r=- 0 2 8,P <0 0 5 ) ,其他均无显著相关性 (均P >0 0 5 )。结论　MS患者存在认知障碍 ,MS的病变部位 (脑部病变 )对智能影响最显著 ,头颅MRI所示病灶与MS患者的认知障碍的相关性大多不显著。     

多发性硬化患者正电子发射体层成像显像与认知功能障碍的关系

目的 探讨正电子发射体层成像(PET)与多发性硬化(MS)患者认知功能障碍的关系.方法 对2例确诊的MS患者进行认知功能测定、头颅MRI及PET扫描,并对检查结果进行综合分析.结果 例1简易精神状态检查(MMSE)量表评分19分,低于正常;例2韦氏智商测试为正常水平.PET影像检查显示2例患者存在多处皮质、皮质下代谢减低区;MRI中未发现相应皮质或皮质下白质病灶.结论 MS患者存在皮质及皮质下代谢减低,可能与其认知功能障碍有关.