Evolution of diagnostic criteria for multiple sclerosis

Multiple sclerosis is a chronic demyelinating disease of the central nervous system that occurs primarily in young adults. There is no single diagnostic test to recognize the disease. The diagnostic criteria, based on clinical examination and laboratory tests, have changed considerably over time. The first guidelines involved only the results of the patient's neurological examination. The diagnostic criteria developed by Poser in 1983 were based largely on the results of additional tests, including visual evoked potentials and analysis of cerebrospinal fluid. The McDonald criteria, developed in 2001and updated in 2005 and 2010, reflected the diagnostic breakthrough caused by widespread use of magnetic resonance imaging (MRI). Currently, the diagnosis depends largely on the results of the MRI examination. An early diagnosis is particularly important for starting disease-modifying treatments

Żywienie chorych na stwardnienie rozsiane — przegląd piśmiennictwa

Stwardnienie rozsiane (SM, sclerosis multiplex) jest przewlekłą chorobą autoimmunologiczną ośrodkowego układu nerwowego. Jak wskazują liczne badania, istnieje wiele powiązanych ze sobą czynników genetycznych i środowiskowych sprzyjających powstawaniu tej choroby. Obecnie poszukuje się także związku między dietą a przebiegiem chorób przewlekłych, w tym SM. Również rodzaj spożywanych substancji odżywczych uznaje się za jeden z czynników, który może modyfikować naturalny przebieg SM. W wielu badaniach dowiedziono, że prawidłowe żywienie w SM może znacząco wpływać na procesy istotne dla rozwoju choroby, jak również na występowanie dolegliwości jej towarzyszących. Także zaostrzenie niektórych objawów SM jest wiązane z określonymi składnikami diety. Choć ich wpływu ostatecznie nie potwierdzono, to jednak uważa się, że wdrożenie właściwej terapii żywieniowej u chorych na SM, zapobiegając niedoborom substancji odżywczych, wpływa na ogólną poprawę ich stanu zdrowia, łagodzenie objawów oraz poprawę efektywności podstawowego leczenia. Rodzaj diety powinien być uzależniony od stopnia zaawansowania choroby, występowania objawów towarzyszących oraz stosowanego leczenia farmakologicznego. Konieczne jest także dostosowanie sposobu żywienia do indywidualnych potrzeb pacjenta, z uwzględnieniem jego płci, wieku, stopnia aktywności fizycznej oraz ewentualnych chorób współistniejących. Wyniki badań dotyczących wpływu wybranych składników żywności na SM nie są jednoznaczne, co uzasadnia prowadzenie dalszych, wieloośrodkowych, niezależnych badań klinicznych w tym zakresie

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

Over the last few years, several reports on the safety of antidepressants use in pregnancy have been published. Studies concerning the adverse effects of exposure to selective serotonin reuptake inhibitors (SSRI) during pregnancy on the developing foetus have indicated an increased risk of various congenital malformations and untoward effects such as poor neonatal adaptation syndrome or persistent pulmonary hypertension, but there still remain inconsistencies between various study results. This paper aims at reviewing the literature on the risks of exposure to antidepressants during pregnancy. SSRIs are generally considered as first-line antidepressant treatment in pregnancy, as they are generally safe and effective. To minimize the teratogenic risks, pregnant women should receive the minimal effective dose of the medication. Depression during pregnancy must not be left untreated, and it should also be remembered that the condition may extend into the postpartum period

Targeting of calcitonin gene-related peptide action as a new strategy for migraine treatment

Migraine is a chronic, recurrent disorder, characterized by attacks of severe pain, affecting around 1% of adult population. Many studies suggest, that trigeminovascular system plays a key role in pathogenesis of migraine and other primary headaches. Calcitonin gene-related peptide (CGRP) is an endogenous substance, which is regarded a key mediator released from trigeminovascular system after stimulation of sensory nerve endings, responsible for dilatation of peripheral vessels and sensory transmission. CGRP is and extensively studied peptide as one of the most promising targets in migraine drug research. In the article we focus on the role of CGRP in the pathophysiology of migraine and present current data on CGRP antagonists and CGRP monoclonal antibodies

Demographic and clinical profile of patients with multiple sclerosis diagnosed over the last 30 years according to different diagnostic criteria

The aim of this study was to investigate the demographic and clinical characteristics of patients with multiple sclerosis (MS) diagnosed between 1986 and 2015. 333 patients with definite MS were divided into four subgroups according to the following diagnostic criteria: Group A) Poser (n = 145), Group B) McDonald 2000 (n = 66), Group C) McDonald 2005 (n = 62), and Group D) McDonald 2010 (n = 60). We investigated: 1) patient sex and age at diagnosis, 2) symptoms and number of relapses that prompted MS diagnosis, 3) time between first symptoms suggestive of MS and confirmed diagnosis, and 5) Expanded Disability Status Scale (EDSS) score at disease onset. The overall female-to-male ratio was 2.3:1, but in the subgroups it differed significantly (A — 1.9; B — 1.6; C — 4.7; D — 3.6). The mean age at diagnosis (in years) decreased from 39.6 ± 13.3 in Group A to 29.9 ± 9.3 in Group D, p < 0.001. Pyramidal signs remained the most common manifestation regardless of the diagnostic criteria, although an increased trend of visual dysfunction was observed (A — 16%, B — 14%, C — 19%, D — 23,3%; A vs D, p < 0.001). The number of relapses before diagnosis decreased from median 4.0 to 2.5 in Group A and Group D, p < 0.001. Time from the first symptom to diagnosis shortened from 88.9 ± 80.2 months (Group A) to 33.6 ± 68.2 months (Group D), p < 0.0001. Mean EDSS score at diagnosis also decreased: A — 4.4 ± 2.3; B — 3.1 ± 1.7; C — 2.7 ± 1.3; D — 2.8 ± 1.4, p < 0.001. Our study indicates significant differences in demographic and clinical characteristics of MS diagnosed according to the changing criteria

Olfactory dysfunction in patients with Wilson’s Disease

Introduction. Many neurodegenerative disorders are associated with olfactory dysfunction (OD), but little is known about OD in Wilson’s Disease (WD). We evaluated olfactory function in patients with WD. Material and methods. OD was examined in 68 patients with WD and 70 sex- and age-matched healthy controls using subjective testing with ‘Sniffin Sticks’. Threshold discrimination identification (TDI) score and its three components (odour detection threshold, discrimination, and identification) were assessed. Results. Compared to controls, patients with WD had a significantly weaker sense of smell in terms of TDI (p < 0.01), odour discrimination (p < 0.01), and identification (p < 0.01), but not in terms of odour detection threshold (p = 0.27). Patients with predominantly neurological symptoms were characterised by greater OD by TDI (p < 0.01), odour detection threshold (p = 0.01), and discrimination (p = 0.03). The presence of pathological lesions (p = 0.04) in brain magnetic resonance imaging and generalised brain atrophy (p = 0.02) predisposed to worse TDI. In the WD group, weak inverse correlations between age and TDI score (r = –0.27), odour detection threshold (r = –0.3), and discrimination (r = –0.3) were found. Male gender was a risk factor for abnormal TDI in both WD and controls (both p = 0.02). Conclusions. Patients with WD, particularly older individuals, more frequently had OD than healthy volunteers. Predominantly neurological symptoms, and the presence of typical brain MRI changes, predisposed patients with WD to smell disorders