Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis

It is unusual for acute disseminated encephalomyelitis and multiple sclerosis to present as purely psychiatric disorders. We report five patients with such demyelinating diseases and symptoms of psychosis, depression or anxiety. The importance of excluding demyelination as the basis for these psychiatric disturbances is emphasized, especially in the presence of unexplained neurologic findings. The possible relationship between psychiatric symptoms and demyelinating disorders is explored

Rozsiane zapalenie mózgu i rdzenia kręgowego oraz stwardnienie rozsiane; dwie różne choroby - spojrzenie krytyczne

Podjęcie leczenia immunomodulacyjnego bezpośrednio po wystąpieniu pierwszego izolowanego zespołu objawów (CIS, clinically isolated syndrome), sugerującego stwardnienie rozsiane (SM, sclerosis multiplex), powinno być poprzedzone diagnostyką różnicową z wykluczeniem rozsianego zapalenia mózgu i rdzenia kręgowego (DEM, disseminated encephalomyelitis). Przebieg kliniczny, właściwości genetyczne, obraz histopatologiczny oraz wyniki badań obrazowych wskazują, że DEM i SM są odrębnymi jednostkami chorobowymi. Ostre i nawracające DEM częściej dotyczy dzieci, ale może również wystąpić u osób dorosłych. Przebieg DEM jest wieloobjawowy. W porównaniu z SM częściej występują gorączka, zaburzenia świadomości, zaburzenia poznawcze, afazja i objawy oponowe. Rzadko stwierdza się obecność prążków oligoklonalnych w płynie mózgowo-rdzeniowym. Rezonans magnetyczny (MRI, magnetic resonance imaging) jest najlepszą metodą obrazowania ośrodkowego układu nerwowego wykorzystywaną w diagnostyce różnicowej DEM i SM. W przypadku DEM występuje wiele ognisk demielinizacji w istocie białej. Zmiany umiejscawiają się także we wzgórzu i jądrach podstawy. W początkowej fazie choroby są zwykle bardziej rozległe niż w przypadku SM i wzmacniają się po podaniu gadoliny. W obrazie MRI stwierdza się występowanie ognisk demielinizacyjnych obejmujących co najmniej trzy segmenty rdzenia kręgowego oraz zapalenie nerwów wzrokowych (NMO, neuromyelitis optica). Niekiedy NMO towarzyszy obecność przeciwciał przeciw akwaporynie 4, ale bywają także stwierdzane w SM oraz DEM. W większości przypadków NMO jest składową DEM, a nie SM i przypomina „orientalną” lub „wzrokowo-rdzeniową” postać SM

Correlation of the VEMP score, ambulation and upper extremity function in clinically isolated syndrome

OBJECTIVE: To investigate the correlation of the vestibular evoked myogenic potential (VEMP) score with Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), Paced Auditory Serial Addition Test (PASAT) and EDSS in patients with multiple sclerosis (MS). ----- METHODS: This prospective, cross sectional study included 52 patients with clinically isolated syndrome (CIS). Cervical VEMP (cVEMP) and ocular VEMP (oVEMP), analyzed in the form of the cVEMP, oVEMP and VEMP scores, T25FW, 9HPT, PASAT and Expanded Disability Status Scale (EDSS) were performed. ----- RESULTS: The only predictor of walking impairment in this study was general disability as measured by the EDSS, after controlling for age, gender, PASAT and EDSS the effect of VEMP score was non-significant (p=0.419). 9HPT of the dominant hand did not correlate with the oVEMP score (rs=0.258, p=0.065), however after controlling for age, gender, PASAT and EDSS, the effect of the oVEMP score on 9HPT of the dominant hand was statistically significant (p=0.017). After controlling for age, gender and oVEMP score, the effect of the PASAT on 9HPT variable for the non-dominant hand was statistically significant (p=0.001). ----- CONCLUSION: We found possible effects of brainstem dysfunction on walking impairment, however they were not seen after correction for EDSS and cognitive dysfunction. On the other hand, dominant hand function seems to be influenced by upper brainstem dysfunction measured with oVEMP, while cognitive dysfunction is related to non-dominant hand function

Should MS be Treated by Escalation or Induction Therapy?

MS is a chronic, increasingly disabling disease whose long-term outcomes determine the key social, medical and economic impact of this disease. Disease-modifying therapies (DMTs) for multiple sclerosis (MS) are prescribed to delay disease progression and to protect a patient’s functional capability. The concepts of escalation and induction immunotherapy in MS represent different therapeutic strategies for the treatment of MS. Both strategies may be valuable options for patients starting on DMT, however, induction therapy mainly focuses on patients with very aggressive course of MS from the onset. Using a patient unique approach to selection of treatment, MS can be effectively control disease and may delay or even prevent the development of secondary progressive MS

Gordon Holmesov sindrom prvi put dijagnosticiran u Hrvatskoj

Prikazuje se 38-godišnja bolesnica koja se klinički prezentirala ataksijom, kognitivnom disfunkcijom i sekundarnom amenorejom, s izraženim hiperintenzivnim promjenama na magnetskoj rezonanciji mozga (MR). Klinički simptomi počeli su u dobi od 20 godina razvojem sekundarne amenoreje, nestabilnosti u hodu i kognitivnom disfunkcijom. Iako je ovakav skup povezanih simptoma ataksije, primarne/sekundarne amenoreje uslijed hipogonadotropnog hipogonadizma i kognitivne disfunkcije poznat kao Gordon Holmesov sindrom (GHS), takav do sada nije opisan u Hrvatskoj. Zbog navedenog, dotadašnja klinička dijagnostika u različitim neurološkim institucijama koja je bila u početku usmjerena primarno na ataksiju, kognitivni poremećaj te nalaz hiperintenzivnih promjena na MR-u mozga, zanemarujući sekundarnu amenoreju, bila je neuspješna. Analizom velike grupe autosomno-recesivnih cerebelarnih ataksija naša grupa uočila je podudarnost skupa kliničkih simptoma: cerebelarne ataksije, kognitivne disfunkcije i hipogonadotropnog hipogonadizma, uz karakterističan MR nalaz specifičnih subkortikalnih hiperintenzivnih promjena bijele tvari, talamusa i moždanog debla i cerebelarne atrofije, koji čine sindrom uzrokovan mutacijom gena ATM RNF216, Gordon Holmesov sindrom. Sekvencijska genomska analiza učinjena u Variantyx laboratoriju u SAD-u pokazala je u naše bolesnice složenu heterozigotnu mutaciju RNF216 što je potvrdilo dijagnozu GHS-a, prvi put dijagnosticiranog u Hrvatskoj

Typical course of cystinuria leading to untypical complications in pregnancy: A case report and review of literature

Cystinuria is a rare genetic disorder inherited by an autosomal recessive pattern which affects the transmembrane transporter for the base amino acid cystine. It has a general prevalence of 1 in 7000 with demographic variations. Patients with cystinuria have excessive urinary excretion of cystine, which can lead to the formation of stones. Up to 70% of patients will develop chronic kidney disease that can progress even to end-stage renal disease. Symptoms usually start in the first two decades of life with a typical presentation consisting of flank pain and renal colic, usually accompanied by urinary tract infection and deterioration of kidney function. Men are typically affected twice as often as women and have a more severe clinical course. Diagnosis is made by spectrophotometric analysis of the stones that are collected after spontaneous expulsion or medical intervention. Genetic testing is not mandatory but is recommended in uncertain cases or as a part of genetic counseling. Treatment consists of diet modification, alkalization of urine, and thiol-based therapies if other measures fail to prevent stone formation. In pregnancy, cystinuria with the formation of cystine stones represents a therapeutic challenge and requires a multidisciplinary approach consisting of an uro-nephrology team and a gynecologist. We present the case of a 34-year-old woman with cystinuria on whom the diagnosis was made by analysis of the expulsed stone. While her previous pregnancies were without complications, her third pregnancy was accompanied by frequent urinary tract infections, acute worsening of kidney function, and urological interventions during pregnancy due to the formation of new stones. Despite the complicated course, the pregnancy was successfully carried to term with the delivery of a healthy female child

Cytogenetic Effects of Met-enkephalin (Peptid-M) on Human Lymphocytes

The structure, complementary structure and cytogenetic/proliferative effects of the Met-enkephalin on human peripheral blood lymphocytes were analyzed. Met-enkephalin, i.e. Peptid-M (LUPEX®), is a low molecular weight synthetic pentapeptide that corresponds to thymus Met-enkephalin. Its structure was examined by means of NMR spectroscopy. The influence of Met-enkephalin on in vitro normalization of chromosomally aberrant lymphocytes of patients suffering from different immune-mediated diseases, was analyzed by the sensitive cytogenetic tests for screening and detection of genome damages in human lymphocytes. The tests showed that in vitro stimulation of human lymphocytes with the Met-enkephalin led to dissapearance of different types of chromosome aberrations, reduction in the number of micronuclei, decrease in the frequency of sister chromatid exchange (SCE) and apoptosis as well as a cytostatic effect on mitosis cycles. They have also confirmed normalization of chromosomally aberrant cell findings in patients suffering from different immune-mediated diseases. These results suggest a possible role of Met-enkephalin (Peptid-M) in immunotherapy of different diseases which involve chromosomal aberrations as well as abnormal cell proliferation and offer new approaches to immunotherapy by the use of Peptid-M. Based on the molecular recognition theory and the SCA method, peptide complementary to Peptid-M was designed, synthesized and denoted Peptide-D. Peptide-D is a calpastatin fragment. Predicted ligand-receptor interaction between both peptides is confirmed by the results showing that Peptide-D blocked the Peptid-M induced lymphocyte proliferation in a dosedependent manner