37 research outputs found
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 m贸zgu i rdzenia kr臋gowego oraz stwardnienie rozsiane; dwie r贸偶ne choroby - spojrzenie krytyczne
Podj臋cie leczenia immunomodulacyjnego bezpo艣rednio po wyst膮pieniu
pierwszego izolowanego zespo艂u objaw贸w (CIS, clinically
isolated syndrome), sugeruj膮cego stwardnienie rozsiane
(SM, sclerosis multiplex), powinno by膰 poprzedzone diagnostyk膮
r贸偶nicow膮 z wykluczeniem rozsianego zapalenia m贸zgu i rdzenia
kr臋gowego (DEM, disseminated encephalomyelitis). Przebieg kliniczny,
w艂a艣ciwo艣ci genetyczne, obraz histopatologiczny oraz
wyniki bada艅 obrazowych wskazuj膮, 偶e DEM i SM s膮 odr臋bnymi
jednostkami chorobowymi. Ostre i nawracaj膮ce DEM cz臋艣ciej dotyczy
dzieci, ale mo偶e r贸wnie偶 wyst膮pi膰 u os贸b doros艂ych. Przebieg
DEM jest wieloobjawowy. W por贸wnaniu z SM cz臋艣ciej wyst臋puj膮
gor膮czka, zaburzenia 艣wiadomo艣ci, zaburzenia poznawcze,
afazja i objawy oponowe. Rzadko stwierdza si臋 obecno艣膰
pr膮偶k贸w oligoklonalnych w p艂ynie m贸zgowo-rdzeniowym. Rezonans
magnetyczny (MRI, magnetic resonance imaging) jest najlepsz膮
metod膮 obrazowania o艣rodkowego uk艂adu nerwowego
wykorzystywan膮 w diagnostyce r贸偶nicowej DEM i SM. W przypadku
DEM wyst臋puje wiele ognisk demielinizacji w istocie bia艂ej.
Zmiany umiejscawiaj膮 si臋 tak偶e we wzg贸rzu i j膮drach podstawy.
W pocz膮tkowej fazie choroby s膮 zwykle bardziej rozleg艂e ni偶
w przypadku SM i wzmacniaj膮 si臋 po podaniu gadoliny. W obrazie
MRI stwierdza si臋 wyst臋powanie ognisk demielinizacyjnych obejmuj膮cych co najmniej trzy segmenty rdzenia kr臋gowego oraz
zapalenie nerw贸w wzrokowych (NMO, neuromyelitis optica). Niekiedy
NMO towarzyszy obecno艣膰 przeciwcia艂 przeciw akwaporynie
4, ale bywaj膮 tak偶e stwierdzane w SM oraz DEM. W wi臋kszo艣ci
przypadk贸w NMO jest sk艂adow膮 DEM, a nie SM i przypomina
„orientaln膮” lub „wzrokowo-rdzeniow膮” posta膰 SM
Panencefalitis esclerosante subaguda : La soluci贸n de un acertijo
Pocas enfermedades han atra铆do m谩s la atenci贸n en recientes a帽os que la panencefalitis esclerosante subaguda. Posiblemente, esto se deba a que 茅sta enfermedad destruye ni帽os y adolescentes, o a que su curso es inexorable, lento y devastador progresando siempre hacia la muerte. Su peculiar distribuci贸n geogr谩fica la hizo una interesante 谩rea de estudio aunque jam谩s proporcion贸 clave etiol贸gica o patog茅nica alguna, pero como resultado de todo lo anterior, cient铆ficos de varios pa铆ses contribuyeron a facilitar el conocimiento de esta enfermeda
Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis
Abstract (provisional)
Background
Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice.
Methods
This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change.
Discussion
This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration: Current Controlled Trials ISRCTN7651747