Change in disability profile and quality of life in multiple sclerosis patients: a five-year longitudinal study using the Multiple Sclerosis Impact Profile (MSIP)

Background: Evidence on the progress of disease severity in Multiple Sclerosis (MS) is generally limited in scope. Objectives: To examine the course of a broad spectrum of MS-related disabilities and quality of life (QOL) in relation to disease severity, and responsiveness of the Multiple Sclerosis Impact Profile (MSIP). Methods: The mortality rate was calculated after checking the national population register for vital status of the initial cohort. We performed a longitudinal study among 245 patients with MS attending the Groningen MS Center in the Netherlands. We assessed these patients in 2004 and 2009 using a postal survey including the MSIP to evaluate disabilities, the World Health Organization Quality of Life-Abbreviation version (WHOQOL-BREF) to evaluate QOL, and the ambulation question of the Expanded Disability Status Scale (EDSS) to evaluate disease severity. Responsiveness of the MSIP was estimated using standardized response mean (SRM). Results: Increase of disability in the MSIP disability domains and loss of QOL were most prevalent and pronounced in patients with EDSS 0 to < 4.5 in 2004. MSIP and QOL scores were remarkably stable in the higher disease severity groups. Mortality rates were highest (24%) in patients with EDSS >= 7 to < 10 in 2004. SRM indices for the MSIP ranged between 0.26 and 0.56. Conclusions: Prominent increases in multiple aspects of disability and loss of QOL occur especially in the early stages in MS. Health care interventions may lead to health and QOL gains, in particular when offered to patients in the first stage of the MS process. Responsiveness was sufficient for nine of the 11 MSIP domains

Autoantibodies against alpha B-crystallin, a candidate autoantigen in multiple sclerosis, are part of a normal human immune repertoire

Human T-cell responses to the stress protein alpha B-crystallin in multiple sclerosis (MS)-affected brain samples are dominant when compared to other myelin antigens. The establishment of the apparent autoimmune repertoire against this antigen has been suggested to involve cross-priming during viral infection. Yet, another possibility would be that determinant spreading during ocular inflammation could generate a response to alpha B-crystallin, since it is also a major component of the eye. In this study, we compared serum IgG, IgA and IgM repertoires against a range of eye lens-derived ocular antigens using sera from healthy control subjects and MS patients with or without uveitis. This comparison revealed that among ocular antigens, alpha B-crystallin is the dominant target antigen for serum autoantibodies in both MS patients and healthy controls. Uveitis generally did not affect the antibody reactivity profile. These data provide further support for the notion that a normal adult human immune system is selectively reactive to alpha B-crystallin and they indicate that this responsiveness is unlikely to result from determinant spreading following ocular inflammation. © 2006 Edward Arnold (Publishers) Ltd. Chemicals / CAS: immunoglobulin G, 97794-27-9; immunoglobulin M, 9007-85-6; alpha-Crystallin B Chain; Autoantibodies; Autoantigens; Eye Protein

Operative treatment of anterior thoracic spinal cord herniation: three new cases and an individual patient data metaaAnalysis of 126 case reports

OBJECTIVE: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Sequard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative Outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Sequard syndrome have a better prognosis with respect to postoperative motor function improvement, In this review, spinal cord release and subsequent widening of the dural defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder,

[Guideline 'Diagnostics of small-vessel vasculitis']

Item does not contain fulltextThe multidisciplinary guideline 'Diagnostics of small-vessel vasculitis' gives recommendations for the diagnostics of small-vessel vasculitis, which is often associated with cutaneous manifestations. The aim of this guideline is to accelerate the diagnostic process to prevent or reduce irreversible organ damage. The clinical presentation of small-vessel vasculitis is variable and often atypical. The most common general symptoms are general malaise, unexplained fever, weight loss, fatigue, loss of appetite, and night sweats. If these symptoms are accompanied by one or more organ-specific symptoms, the probability of the diagnosis 'small-vessel vasculitis' is increased. When small-vessel vasculitis is suspected a comprehensive history should be taken and a physical examination focused on internal organs, joints, skin and nervous system should be performed. With additional laboratory investigations possible organ involvement can be demonstrated and the small-vessel vasculitis can be further classified. To make a definite diagnosis histological examination of an affected organ is necessary. Because of the possible involvement of multiple organ systems, multidisciplinary collaboration is essential in the diagnostic work-up