New Oral Treatments Expected to be Available for Multiple Sclerosis

WOS: 000299604900005Several disease-modifying drugs are actually approved for the treatment of relapsing-remitting and secondary progressive multiple sclerosis. These common therapies have three major disadvantages: (1) they only have a limited effect, (2) they are administered by subcutaneous or intramuscular injection, and (3) they have considerable side effects. As a result, patient satisfaction and treatment adherence are only suboptimal. A lot of scientific research is focused on developing new therapies, and especially oral treatment options are being looked forward to. In this article, candidates for future oral therapies are reviewed including cladribine, BG-12, lakinimode and teriflunomide. All these agents have different mechanisms of action and their efficacy and safety characteristics are different, as well as their potential role in clinical practice. However, it seems likely that injection therapies which were the mainstay of disease-modifying treatment in MS in the last 15 years may soon be replaced by oral agents. (Archives of Neuropsychiatry 2011; 48 Supplement 2: 67-72

Mycophenolate mofetil as a novel immunosuppressant in the treatment of neuro-Behçet's disease with parenchymal involvement: Presentation of four cases

PubMed ID: 21968239Background. Behçet's disease is a multisystemic, relapsing, inflammatory disorder of unknown origin. Among Turkish cohorts, 5-15% of patients show involvement of the central nervous system (CNS) at some time during their disease. There are mainly two types of clinical presentation: parenchymal CNS inflammation manifesting mainly as meningoencephalitis of the brainstem, or dural sinus thrombosis. Several drugs like high-dose steroids or immunosuppressive agents, mainly azathioprine, are used in the treatment. For patients who do not respond sufficiently to these agents or are not able tolerate them, other options are needed. Patients. We are presenting 4 cases with parenchymal neuro-Behçet's disease, where commonly used immunosuppressive drugs could not be continued due to intolerance or inefflcacy. However, the patients benefited well from mycophenolate mofetil. The benefit was sustained during 3-7 years of follow-up (median 6.5 years). Conclusion. Mycophenolate mofetil seems to be an alternative drug in parenchymal neuro-Behçet's disease; however, large controlled studies should be performed for verification of our results. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2011

Mycophenolate mofetil as a novel immunosuppressant in the treatment of neuro-Behcet's disease with parenchymal involvement: presentation of four cases

WOS: 000295669200012PubMed ID: 21968239Background. Behcet's disease is a inultisystemic, relapsing, inflammatory disorder of unknown origin. Among Turkish cohorts, 5-15% of patients show involvement of the central nervous system (CNS) at some time during their disease. There, are mainly two types of clinical presentation: parehchymal CNS inflammation manifesting mainly as meningoencephalitis of the brainstem, or dural sinus thrombosis. Several drugs like high-dose steroids or immunosuppressive agents, mainly azathioprine, are used in the treatment. For patients who do not respond sufficiently to these agents or are not able tolerate them, other options are needed. Patients. We are presenting 4 cases with parenchymal neuro-Behcet's disease, where commonly used immunosuppressive drugs could not be continued due to intolerance or inefficacy. However, the patients benefited well from mycophenolate mofetil. The benefit was sustained during 3-7 years of follow-up (median 6.5 years). Conclusion. Mycophenolate mofetil seems to be an alternative drug in parenchymal neuro-Behcet's disease; however, large controlled studies should be performed for verification of our results

Primer Ekstranodal İntestinal Lenfomalı Bir Hastada Gözlenen Guillain Barré Sendromu: Paraneoplastik Kökenli mi, İlaç Yan Etkisi mi, Rastlantısal mı?

Neurological involvement is observed in 5%–25% of patients with lymphoma being either the first presentation of the disease or emerging during its course. However, Guillain-Barré syndrome is rarely reported. In this article, we present a case with intestinal lymphoma developing Guillain-Barré syndrome during the course of the disease. A 66-year-old male patient with primary extranodal intestinal lymphoma developed quadriparesis, sensory deficits and autonomic dysfunction while receiving chemotherapy. The findings of clinical, electrophysiological and laboratory examinations were consistent with Guillain-Barré syndrome. Guillain-Barré syndrome can potentially be fatal and mimic chemotherapy-induced neurotoxicity, especially in patients with lymphoma, and therefore, must be considered in the differential diagnosis

Kleptomania in Patients with Neuro-Behcet's Disease

WOS: 000327463200006PubMed ID: 23920112Objective: This study was conducted to characterize the prevalence and clinical features of kleptomania, an impulse control disorder, in patients with Behcet's disease involving the central nervous system. Subjects and Methods: Medical records of 350 patients with neuro-Behcet's disease were evaluated, and clinical and neuropsychological features of patients with kleptomania were noted. Results: Of the 350 neuro-Behcet's disease patients 6 (1.7%) had presented with symptoms that fulfilled the criteria of kleptomania according to the revised 4th version of the Diagnostic and Statistical Manual of Mental Disorders. The 6 patients (5 men, 1 woman) had parenchymal lesions and had developed kleptomania during remission. Magnetic resonance imaging done on the 6 patients before the onset of kleptomania mostly revealed brainstem lesions. Psychiatric assessment did not show any comorbid psychiatric disorders and neuropsychological evaluation showed executive dysfunction in all patients. Conclusion: The 6 patients with kleptomania had developed a frontal lobe syndrome. Copyright (C) 2013 S. Karger AG, Base

Guillain-Barre Syndrome in a Patient with Primary Extranodal Intestinal Non-Hodgkin's Lymphoma: Paraneoplastic, Drug Induced or Coincidental?

Neurological involvement is observed in 5%-25% of patients with lymphoma being either the first presentation of the disease or emerging during its course. However, Guillain-Barre syndrome is rarely reported. In this article, we present a case with intestinal lymphoma developing Guillain-Barre syndrome during the course of the disease. A 66-year-old male patient with primary extranodal intestinal lymphoma developed quadriparesis, sensory deficits and autonomic dysfunction while receiving chemotherapy. The findings of clinical, electrophysiological and laboratory examinations were consistent with Guillain-Barre syndrome. Guillain-Barre syndrome can potentially be fatal and mimic chemotherapy-induced neurotoxicity, especially in patients with lymphoma, and therefore, must be considered in the differential diagnosis

Long-term MRI findings in neuromyelitis optica: seropositive versus seronegative patients

Background and purpose Neuromyelitis optica (NMO) is a severe demyelinating inflammatory disorder associated with serum antibodies against aquaporin 4 (AQP4-Ab). A significant number of patients with NMO remain seronegative over time. Long-term observational magnetic resonance imaging (MRI) studies of the CNS in patients with NMO are rare or of limited duration. The objective of this study is to determine long-term MRI characteristics of seropositive and seronegative patients, and assess possible overlap with multiple sclerosis (MS). Methods Clinical and radiological characteristics of 28 patients with NMO at onset and of 17 patients after an average follow-up time of 9years were recorded. Fifty percent of patients were seropositive for AQP4-Ab. Onset and final brain/spinal MRI scans were retrospectively analysed and compared. Results Significantly more patients in the seronegative group had brain lesions at onset. Spinal lesions of seropositive patients were longer and showed increased cord swelling at onset MRI scans. After the follow-up time the differences between both groups disappeared. Patients in the seropositive group tended to develop brain lesions over time. No patient fulfilled Barkhof's or McDonald's radiological criteria for MS at onset or over time. Conclusion Brain MRI features show differences between seropositive and seronegative patients at time of onset in NMO, but differences between groups vanish over time. None of the AQP4-negative patients fulfill radiological MS criteria on a long-term basis, suggesting that seronegative NMO constitutes an independent entity

Coexistence of Guillain-Barre syndrome and Behcet's disease

Behcet's disease (BD) is a multisystemic, recurrent and inflammatory disorder. Neurological involvement is rare and affects mainly the central nervous system (CNS) in the form of brainstem meningoencephalitis or dural sinus thrombosis. Peripheral neuropathy is usually not observed during the course of BD but some reports have shown electrophysiologic evidence of subclinical neuropathy, mononeuritis multiplex and cranial neuropathy in BD patients. The co-occurrence of Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating neuropathy, with other autoimmune or systemic diseases is rare. We present a case of BD with clinical and electrophysiological diagnosis of GBS. The findings of the patient were discussed with reference to literature

Coexistence of Guillain-Barre syndrome and Behcet's disease

WOS: 000326356700018PubMed ID: 23433066Behcet's disease (BD) is a multisystemic, recurrent and inflammatory disorder. Neurological involvement is rare and affects mainly the central nervous system (CNS) in the form of brainstem meningoencephalitis or dural sinus thrombosis. Peripheral neuropathy is usually not observed during the course of BD but some reports have shown electrophysiologic evidence of subclinical neuropathy, mononeuritis multiplex and cranial neuropathy in BD patients. The co-occurrence of Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating neuropathy, with other autoimmune or systemic diseases is rare. We present a case of BD with clinical and electrophysiological diagnosis of GBS. The findings of the patient were discussed with reference to literature

Long-term MRI findings in neuromyelitis optica: Seropositive versus seronegative patients

PubMed ID: 23279782Background and purpose: Neuromyelitis optica (NMO) is a severe demyelinating inflammatory disorder associated with serum antibodies against aquaporin 4 (AQP4-Ab). A significant number of patients with NMO remain seronegative over time. Long-term observational magnetic resonance imaging (MRI) studies of the CNS in patients with NMO are rare or of limited duration. The objective of this study is to determine long-term MRI characteristics of seropositive and seronegative patients, and assess possible overlap with multiple sclerosis (MS). Methods: Clinical and radiological characteristics of 28 patients with NMO at onset and of 17 patients after an average follow-up time of 9years were recorded. Fifty percent of patients were seropositive for AQP4-Ab. Onset and final brain/spinal MRI scans were retrospectively analysed and compared. Results: Significantly more patients in the seronegative group had brain lesions at onset. Spinal lesions of seropositive patients were longer and showed increased cord swelling at onset MRI scans. After the follow-up time the differences between both groups disappeared. Patients in the seropositive group tended to develop brain lesions over time. No patient fulfilled Barkhof's or McDonald's radiological criteria for MS at onset or over time. Conclusion: Brain MRI features show differences between seropositive and seronegative patients at time of onset in NMO, but differences between groups vanish over time. None of the AQP4-negative patients fulfill radiological MS criteria on a long-term basis, suggesting that seronegative NMO constitutes an independent entity. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS