Sequestro linfocitario linfonodale versus cross-trafficking blockade nell'autoimmunità demielinizzante

Nei pazienti con Sclerosi Multipla spesso il trattamento con Interferon beta o Glatiramer Acetato riduce la frequenza delle ricadute cliniche e la progressione di disabilità a breve termine, tuttavia nei pazienti che continuano a sperimentare attività di malattia la strategia comune è cambiare verso una terapia più efficace (ESCALATION therapy). In quest’ottica attualmente vengono presi in considerazione Natalizumab o Fingolimod che con il loro meccanismo di blocco linfocitario a livello di barriera ematoencefalica per il primo e livello dei linfonodi per il secondo, raggiungono un’efficacia maggiore rispetto agli iniettabili. La terapia di escalation a Natalizumab versus quella a Fingolimod è stata difficilmente comparata in studi clinici, sebbene più frequentemente sia stata messa a confronto la loro efficacia e tollerabilità mediante un’analisi longitudinale dei registri di malattia esistenti. Il nostro studio parte da questi presupposti per valutare in base alla pratica clinica quale strategia di escalation sia preferibile, andando quindi ad analizzare il profilo rischio/beneficio di questi due farmaci nella nostra coorte di pazienti

Epilepsy in elderly patients: focus on treatment

Epilepsy is a disorder widely distributed across all age groups, although its incidence and prevalence favours elderly patients. In this population the development of epilepsy is mainlyrelated to other brain disorders that facilitate the occurrence of late seizures, mostly of focal onset. Apart from the difficulties faced in current practice with the appropriate diagnosis of the epileptic nature of the episodes, old subjects require an individualised drug treatment, tailored on their characteristics, such as comorbidity, polytherapy, age-associated biological impairment and compliance. Among the various antiepileptic drugs available for the treatment of epilepsy, rational selection and combination of drugs should drive both initiation and maintenance of the treatment. Choice of antiepileptic drugs should first focus on avoidance of adverse effects and potential drug interactions. The pharmacological control of seizures is usually favourable at this age, with a good prognosis. However, alternative therapeutic options should be considered as soon as drug-response is unsatisfactory

Sclerosi Multipla e Depressione: studio di comorbidità mediante la Scala CES-D

Questo studio osservazionale, ha valutato la prevalenza della comorbidità depressiva in pazienti con Sclerosi Multipla confrontando le caratteristiche di questa popolazione con un gruppo di soggetti di controllo. Lo screening per il rilievo di depressione è stato condotto mediante una self-rating scale, la CES-D, già impiegata in studi analoghi

Very late onset multiple sclerosis likely associated with restless legs syndrome. A case report.

Introduction: We describe the case of P.R., a 84 years-old woman suffering from Restless Legs Syndrome since 2002 and Multiple Sclerosis since 2007. Case report: MS clinical onset was characterized by walking difficulties and abnormal sensitivity in lower limbs especially in the evening. Then other symptoms added: dysesthesies on the left leg and arm and left emitrunk, visual acuity reduction, blurred vision and fatigue. She first performed an electromyographic and polysomnographic examination, with a diagnosis of Restless Legs Syndrome. At the MRI of the brain, multiple lesions in white matter were detected, unconsistent with a vascular disease but suggestive for a demielinating disease. The patient was admitted to hospital and the lumbar puncture was performed: the analysis of the cerebrospinal fluid showed 11 oligoclonal bands. VEPs, SSEPs, Trigeminus-facial reflex and a new brain MRI were performed later, and confirmed the MS. The patient regularly performed medical examinations and brain MRI to keep the condition under control. She claimed light and slow worsening of the ambulation, but her brain MRI didn’t show any increase of lesions burden nor pathological enhancement. Due to her age, she doesn’t take DM therapy for multiple sclerosis, the only drugs being represented by symptomatic agents. Discussion: The association between multiple sclerosis and restless leg syndrome has been already described especially in old patients, but the onset of MS in elderly in unusual and it’s described as LOMS (late onset multiple sclerosis), with an onset after the age of 50 with typical clinical and neuroradiological features: the presence of motor and cerebellar symptoms seem to be more frequent in this sub-group of patients, as well as low frequency of Gadolinium enhacement lesions. This could be related to a more degenerative and less inflammatory form of the disease. Moreover, in this late onset patients is essential the different diagnosis with other diseases interesting the white matter, i.e. vascular, infective, paraneoplastic, metabolic diseases or nutritional deficiencies, which could confound the true diagnosis. Conclusions: The present case report is interesting for the association between RLS and MS, but also as this comorbidity occurs I a very old patient, who could be described as a patient with a “very late onset multiple sclerosis”