Fatigue in multiple sclerosis is not due to sleep apnoea

Fatigue is a frequent and disabling phenomenon among patients with multiple sclerosis (MS). Daytime sleepiness is a typical symptom of the sleep apnoea/hypopnoea syndrome due to nocturnal hypoxia and recurrent arousals causing sleep fragmentation. Since MS plaques are often found in the midbrain, brain stem and upper cervical cord on magnetic resonance imaging (MRI) we hypothesized that fatigue in MS patients might be caused by a central respiratory dysfunction. We investigated 10 patients with definite MS by oligography, two questionnaires assessing fatigue (Fatigue Severity Scale, FSS) and daytime sleepiness (Epworth Sleepiness Scale, ESS), MRI and pulmonary function tests. A total of six patients had either an elevated FSS and/or an elevated ESS. None of the six patients with an elevated FSS and/or ESS has an apnoea index > 5/hour. CT₉₀ was normal in nine patients. We conclude that fatigue and daytime sleepiness in MS cannot be explained by nocturnal apnoeas or oxygen desaturations. The Fatigue Severity Scale should be integrated to the extended Barthel index, which is a new instrument for disability assessment in MS patients.     

Detection of anterior horn lesions by MRI in central European tick-borne encephalomyelitis

We report a case of central European tick-borne encephalitis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper limbs with proximal asymmetrical pareses and atrophies. There were no sensory deficits nor signs of lesions of the spinal pathways or signs of encephalitis or meningitis. The affected motor fibers of the upper limbs were electrically inexcitable, but sensory findings were normal. Electromyography of the paralyzed muscles revealed pathological denervation activity without voluntary activation. The initial magnetic resonance imaging (MRI) showed a large hyperdense lesion in the anterior part of the cervical cord from C3 to T1. Despite the fact that MRI changes disappeared completely within 6 weeks the patient showed only little improvement in the paralyzed muscles after 6 months. To our knowledge, these MRI changes in patients with tick-borne encephalitis, consistent with an isolated anterior horn lesion, have never been reported previously. The course may have been aggravated by an initial antibiotic treatment with cephalosporins. Received: 4 May 1999 Received in revised form: 22 July 1999 Accepted: 26 July 1999     

Reversible neuropsychological deficits after mild traumatic brain injury

OBJECTIVES: To determine the influence of motivation on performance in a divided attention test of patients after mild traumatic brain injury (MBI). METHODS: Comparison of the performance of 12 patients with MBI with 10 patients with severe brain injury (SBI) and 11 healthy controls in a computer supported divided attention task before (T1) and after (T2) verbal motivation. RESULTS: At T1, the MBI group performed the same as the SBI group but significantly worse than the controls in all variables. At T2, the MBI group performed worse than the controls at T2 but the results were equal to the results of the controls at T1 and significantly better than the SBI group at T1 or T2. At T2 the MBI group performed at the level of published norms for the rest. CONCLUSION: Before verbal motivation the MBI group's results in the divided attention task were comparable with those from patients with severe brain injury. They failed to exploit their performance potential when it depended on self motivation but were able to perform at the level of the control group when external motivation was applied.     

Endurance training in MS: short-term immune responses and their relation to cardiorespiratory fitness, health-related quality of life, and fatigue

The influences of exercise on cytokine response, health-related quality of life (HR-QoL), and fatigue are important aspects of MS rehabilitation. Physical exercises performed within these programs are often practiced in water, but the effects of immersion have not been investigated. To investigate the influences of short-term immune responses and cardiorespiratory fitness on HR-QoL and fatigue during 3 weeks endurance training conducted on a cycle-ergometer or an aquatic-bike. Randomized controlled clinical trial in 60 MS patients. HR-QoL, fatigue, cardiorespiratory fitness, and short-term immune changes (serum concentrations in response to cardiopulmonary exercise test) of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), interleukin-6, and the soluble receptor of IL-6 (sIL-6R) were determined at the beginning and end of 3 weeks of training intervention. Subjects performed daily 30 min training at 60 % of their VO2peak. SF-36 total (p = 0.031), physical (p = 0.004), and mental health (p = 0.057) scores show time effects within both groups. Between-group effects were shown for FSMC total (p = 0.040) and motor function score (p = 0.041). MFIS physical fatigue showed time effects (p = 0.008) for both groups. Linear regression models showed relationships between short-term immune responses and cardiorespiratory fitness with HR-QoL and fatigue after the intervention. This study indicates beneficial effects of endurance training independent of the training setting. Short-term immune adaptations and cardiorespiratory fitness have the potential to influence HR-QoL and fatigue in persons with MS. The specific immune responses of immersion to exercise need further clarification.     

Immune responses triggering colitis and colitis-associated carcinoma

Inflammatory bowel diseases compromise of two forms of chronic intestinal inflammatory disorders: Crohn's disease and ulcerative colitis. Both forms of inflammatory bowel disease result from inappropriate inflammatory responses to the intestinal microbiota, but have different underlying immune responses. The connection between inflammation and cancer has long been established and longstanding inflammatory bowel diseases are an important risk factor for developing colorectal cancer. Colitis-associated colorectal cancer pathogenesis is highly influenced by specific inflammatory processes during inflammatory bowel disease. This article reviews the immunological responses affecting Crohn's disease and ulcerative colitis as well as the linkage of inflammatory bowel disease to the development of colitis-associated cancer. Finally, we discuss the prospects of using new research efforts to devise new immunotherapeutic approaches.     

Fatigue in MS is related to sympathetic vasomotor dysfunction

The authors studied standard autonomic function tests and measures of heart rate variability in 60 patients with multiple sclerosis (MS) and correlated results with the Fatigue Severity Scale and the Modified Fatigue Impact Scale. The authors found that autonomic responses correlated with fatigue resembling a hypoadrenergic orthostatic response, possibly due to a sympathetic vasomotor lesion with intact vagal heart control. Treatments to control sympathetic dysfunction for MS-associated fatigue deserve further study.     

Significance of Partial and Total Cohesion Parameters of Pharmaceutical Solids Determined from Dissolution Calorimetric Measurements

The total and partial adhesion-derived cohesion parameters of three solid pharmaceutical substances (caffeine, theophylline, and phenylbutazone) were determined from dissolution calorimetric measurements, a new technique devised for this purpose. Calorimetry has the advantage of leading directly to enthalpies, from which the solute cohesion parameter(s) is(are) deduced. An equation was developed that relates partial molar enthalpies of mixing (obtained by subtracting enthalpies of fusion from enthalpies of dissolution) to the cohesion parameters of the solute and of the solvents. Solvents were selected on the basis of their known cohesion parameters by applying the experimental research methodology.     

Team approach to total auricular reconstruction

The surgery of microtia is a procedure that demands surgical and artistic skills, as well as precise planning of interventions. In cases where a functioning inner ear is present, functional and esthetic reconstruction is performed jointly with ear, nose, and throat surgeons. The middle ear plasty is performed through a transmastoidial approach at the time of the second stage of the outer ear reconstruction. We demonstrate the special requirements of this team approach and also pay a tribute to Burt Brent, who has set the standards of modern ear reconstruction.     

Ungewöhnliche Exzisionen in der ästhetischen Gesichtschirurgie

In aesthetic facial cosmetic surgery the trend is to achieve the desired aesthetic result by using the smallest possible and hidden incisions. However, in certain areas the aged skin can sometimes be repaired in this way only with unsatisfactory results. When standard aesthetic plastic surgery procedures cannot give an optimal result, atypical approaches such as direct incisions and resections can be valuable alternatives. This article describes and illustrates some of these alternative techniques.