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3-31-02 Multiple sclerosis, social level and permanent disability
Multiple
S184
31
Multiple Sclerosis
I3-31
01
Neuropsychological profile in patients with multiple sclerosis. A preliminary study
J.C. Alcantara, C. Oehninger, R. Buz6, A. G6mez, L. Boccos, N. Gonzalez. lnstituto de Neurofogla del Hospital de Clinicas, Uruguay
M. Calawuich, Montevideo,
Neuropsychological dysfunction had not been considered a major cause of impairment in Multiple Sclerosis (MS) until a battery of validated, standardised cognitive studies demonstrated that cognitive deficits were more common than it was believed. 12 patients (males and females, aged 16 to 66) with clinically definite MS were included in a Neuropsychological study. The battery of tests performed included short and long term memory tests; verbal and visual memory tests; constructive apraxia and IQ (Intelligence Quotient) tests (Weschler) and speech tests applied to selected patients. 7 patients (58%) were impaired on one or more of the areas tested. 6 patients (50%) had alterations of their short term memory. 6 patients (50%) had alterations of their long term memory in verbal or visual tests. 2 patients (16%) had deficit in their semantic memory and in speech tests. Constructive apraxia was abnormal in 3 of the patients (26%) and the IQ test performed in IO of the 12 patients did not show intellectual deterioration in anyone of them. All patients with cognitive impairment had their short and long term memory affected. Two of them were predominantly impaired on their verbal evaluations, while two others were predominantly impaired on their visual evaluations. The last 3 patients were impaired on both their visual and their verbal evaluations. These results confirm the existence of neuropsychological disturbances in a high percentage of MS patients. In our study, the most commonly affected cognitive function was memory. Further cognitive evaluations are being performed in order to determine the prognostic value of the alterations described as well as their correlation with the EDSS score, CFS profiles and quantitative electroencephalography.
3-31-02 n
Multiple sclerosis, social level and permanent disability
D. Callegaro, L. Moraes, M. Goldbaum. Faculdade
P. Costa, F. Beites, L. Souza Jr., M.C. Beltrami, de Medicina da Universidade de Seiko Paolo, Bras/l
Introduction: These are the preliminary data of a cross-sectional study about MS in Sao Paolo City-Brazil. In order to compare 2 groups of MS outpatients from 2 services with different social level -private clinic of the main author and University Hospital clients-the authors studied 129 patients out a population of 1100 patients (600 from University Hospital and 300 from private clinic) registered in these services during the last 5 years. The outcome considered was disability level: physical capacity to walk and to stay at work. Patients and Methods: We selected 129 patients from the 2 services, all of them were confinned cases according to Poser criteria, checked by the senior author. We only selected relapsing-remitting form. They were submitted to an interview and a clinical examination during January and February 1997 in their last visit to our outpatients service. At this time they were interviewed and evaluated as to disease duration, physical capacity to walk and work. The data were filed and analysed in EPI-INFO 6.0 software. Results: We studied 59 patients from private clinic and 70 patients from University Hospital. The follow-up period was 10 years, and was similar for the 2 groups. The mean age at January I, 1997 was 41 f 9.5 for private clinic and 36 years * 12.0 for the University Hospital. There was no difference in disease severity between the 2 groups, the only difference was the lower social level of patients who attend the University Hospital. Between the private clinic patients 40 (67.8%) ware able to work and 19 (32.2%) were retired because of the disease’s condition. In the University Hospital 45 (50%) were able to work while 45 (50%) were retired. This difference was statistically significant (c2 = 4.13; p = 0.04) 95% of confidence. We did not find significant difference in ability to walk. Conclusions: The results suggest a correlation between social level and permanent disability to work in Multiple Sclerosis.
3-31 03 D
Lymphocyte patients
P. de Castro, Immunology
M. Otano, M. Carreiio, M.L. Subira. Dpt of Neurology Clinica Universitaria de Navarra, Pamp/ona, Spain
Objective:
In previous
studies
subsets in multiple sclerosis
we have found abnormal
peripheral
(MS) and blood lym-
Sclerosis phocyte subsets in MS patients in comparison to healthy controls. Our objective is to describe the variations in these subsets in a group of MS patients and to make the correlation with the clinical course of the illness. Patlents and Method: 46 patients, 28 women and 18 men, with clinically definite MS (Poser’s Al), without treatment. Mean age: 38 years. Mean evolution time: 9 years. Clinical course: 25 relapsing-remitting (RR) and 21 relapsing-progressive (RP). Mean EDSS: 3. Clinical activity in 12 patients: 7 RR (relapse), 5 RP (progression). Quantification of lymphocyte subsets in peripheral blood. We considered a test like abnormal when almost 2 subsets where different of the normal rank. Fisher test for statistical analysis. Results: In RR patients the test was normal in 9 and abnormal in 16 (56%). In the RP patients the test was abnormal in the 21 (100%). There are significant differences between the two groups (p < 0.05). The subsets more often increased where in RR patients: CD4+CD8+, CD4+CD29+ and CDB+DR+, in RP patients basically CD4+CD29+. Conclusion: These results suggest that the immunological activity changes in a different pattern according to the clinical course of the MS (RR versus RP).
13-31-04
1 A model of multiple sclerosis: Relapsing experimental autoimmune Encephalomyelitis in the SJUJ mouse
(EAE)
A. Champion, C. Gonet, D. Cottez, J.C.R. Randle, J.-M. Stutzmann, P. Delay-Goyet. Neuroinflammation Laboratory, Neurodegenerative Diseases Group, CNS Program, Rhbne-Poulenc Rorec Vitry-sur-Seine, France Multiple sclerosis (MS), a demyelinating disorder of the human central nervous system, commonly results in profound neurologic dysfunction. An experimental model of CNS demyelination - experimental autoimmune encephalomyeliiis (EAE) - shares with MS many clinical and neuropathological characteristics and is now established as a useful model for MS. We have set up a model of chronic, remitting-relapsing, EAE in the SJUJ mouse. EAE was induced in SJUJ mice by subcutaneous (s.c.) injection of an emulsion of bovine myelin basic protein (MBP) and Mycobacterium tuberculosis in complete Freund’s adjuvant. The same day and 48 h later, Bordetella pwtussis toxin was injected i.p. Animals were examined daily for clinical signs of EAE for the duration of the experiment. Disease seventy was graded on a scale of 0 to 5. Animals were observed for 6 months. During this period all (15) mice suffered at least 1 attack of EAE. The initial attack occurred from 14 to 25 days post-induction. Three animals died as a result of their first episode of EAE. All (12) surviving mice entered remission. This remission was total in 6 mice. Almost all remitted animals (11112) had a first relapse, occurring from 28 to 133 days post-induction. Ten mice developed a second remission. A second relapse was observed in 6 mice, starting from 38 to 132 days post-induction. Four mice developed a third remission. A third relapse was developing in two animals when the study was stopped. The clinical expression of the EAE in these conditions is characteristic of a chronic, remitting-relapsing model. Since chronic, remitting-relapsing course is the most frequent pattern of evolution in patients with multiple sclerosis, we propose therefore to use this EAE model for further pharmacological and biochemical investigations.
3-31-05
Sensitivity of mathematical formulas in quantification of intrathecal IgG synthesis multiple sclerosis patients
E. Dincic, A. Jovicic, D. Djorjdevic, R. Raicevic, D. Veljancic. Neuroiogyl Military Medical Academy; Belgrade, Yugoslavia
in
Department
of
lntrathecal synthesis of immunoglobulin G (IgG) is parameter of immune response in central nervous system. The aim of this study was determination of the most sensitive mathematical formula for intrathecal IgG quantification; dependence of different mathematical formulas on brain-barrier damage and estimation of best correlation between chosen formula and clinical status. In 60 MS patients durina acute phase, levels in cerebra-spinal fluid (CSF) and sera of albumin and IgG were estimated. Following mathematical formulas were used: Tourtellotte, modified Tourtellotte, Reiber, Schuller. Among those formulas mod. Tourteflote showed 76.6% of positive findings, while Reiber’s formula revealed only 58.89/o, on the same sample of patients. Significant difference was found between results obtained by mod. Tourtellotte and Reiber, Schuller and Reiber. Negative correlation was found between albumin ratio and IgG ratio, Schuller and Reiber. Only Touttellotte’s formula correlated with clinical status. In conclusion the most sensitive fomulas for IgG intrathecal quantification are Tourtellotte and mod. Tourtellotte.
S184
31
Multiple Sclerosis
I3-31
01
Neuropsychological profile in patients with multiple sclerosis. A preliminary study
J.C. Alcantara, C. Oehninger, R. Buz6, A. G6mez, L. Boccos, N. Gonzalez. lnstituto de Neurofogla del Hospital de Clinicas, Uruguay
M. Calawuich, Montevideo,
Neuropsychological dysfunction had not been considered a major cause of impairment in Multiple Sclerosis (MS) until a battery of validated, standardised cognitive studies demonstrated that cognitive deficits were more common than it was believed. 12 patients (males and females, aged 16 to 66) with clinically definite MS were included in a Neuropsychological study. The battery of tests performed included short and long term memory tests; verbal and visual memory tests; constructive apraxia and IQ (Intelligence Quotient) tests (Weschler) and speech tests applied to selected patients. 7 patients (58%) were impaired on one or more of the areas tested. 6 patients (50%) had alterations of their short term memory. 6 patients (50%) had alterations of their long term memory in verbal or visual tests. 2 patients (16%) had deficit in their semantic memory and in speech tests. Constructive apraxia was abnormal in 3 of the patients (26%) and the IQ test performed in IO of the 12 patients did not show intellectual deterioration in anyone of them. All patients with cognitive impairment had their short and long term memory affected. Two of them were predominantly impaired on their verbal evaluations, while two others were predominantly impaired on their visual evaluations. The last 3 patients were impaired on both their visual and their verbal evaluations. These results confirm the existence of neuropsychological disturbances in a high percentage of MS patients. In our study, the most commonly affected cognitive function was memory. Further cognitive evaluations are being performed in order to determine the prognostic value of the alterations described as well as their correlation with the EDSS score, CFS profiles and quantitative electroencephalography.
3-31-02 n
Multiple sclerosis, social level and permanent disability
D. Callegaro, L. Moraes, M. Goldbaum. Faculdade
P. Costa, F. Beites, L. Souza Jr., M.C. Beltrami, de Medicina da Universidade de Seiko Paolo, Bras/l
Introduction: These are the preliminary data of a cross-sectional study about MS in Sao Paolo City-Brazil. In order to compare 2 groups of MS outpatients from 2 services with different social level -private clinic of the main author and University Hospital clients-the authors studied 129 patients out a population of 1100 patients (600 from University Hospital and 300 from private clinic) registered in these services during the last 5 years. The outcome considered was disability level: physical capacity to walk and to stay at work. Patients and Methods: We selected 129 patients from the 2 services, all of them were confinned cases according to Poser criteria, checked by the senior author. We only selected relapsing-remitting form. They were submitted to an interview and a clinical examination during January and February 1997 in their last visit to our outpatients service. At this time they were interviewed and evaluated as to disease duration, physical capacity to walk and work. The data were filed and analysed in EPI-INFO 6.0 software. Results: We studied 59 patients from private clinic and 70 patients from University Hospital. The follow-up period was 10 years, and was similar for the 2 groups. The mean age at January I, 1997 was 41 f 9.5 for private clinic and 36 years * 12.0 for the University Hospital. There was no difference in disease severity between the 2 groups, the only difference was the lower social level of patients who attend the University Hospital. Between the private clinic patients 40 (67.8%) ware able to work and 19 (32.2%) were retired because of the disease’s condition. In the University Hospital 45 (50%) were able to work while 45 (50%) were retired. This difference was statistically significant (c2 = 4.13; p = 0.04) 95% of confidence. We did not find significant difference in ability to walk. Conclusions: The results suggest a correlation between social level and permanent disability to work in Multiple Sclerosis.
3-31 03 D
Lymphocyte patients
P. de Castro, Immunology
M. Otano, M. Carreiio, M.L. Subira. Dpt of Neurology Clinica Universitaria de Navarra, Pamp/ona, Spain
Objective:
In previous
studies
subsets in multiple sclerosis
we have found abnormal
peripheral
(MS) and blood lym-
Sclerosis phocyte subsets in MS patients in comparison to healthy controls. Our objective is to describe the variations in these subsets in a group of MS patients and to make the correlation with the clinical course of the illness. Patlents and Method: 46 patients, 28 women and 18 men, with clinically definite MS (Poser’s Al), without treatment. Mean age: 38 years. Mean evolution time: 9 years. Clinical course: 25 relapsing-remitting (RR) and 21 relapsing-progressive (RP). Mean EDSS: 3. Clinical activity in 12 patients: 7 RR (relapse), 5 RP (progression). Quantification of lymphocyte subsets in peripheral blood. We considered a test like abnormal when almost 2 subsets where different of the normal rank. Fisher test for statistical analysis. Results: In RR patients the test was normal in 9 and abnormal in 16 (56%). In the RP patients the test was abnormal in the 21 (100%). There are significant differences between the two groups (p < 0.05). The subsets more often increased where in RR patients: CD4+CD8+, CD4+CD29+ and CDB+DR+, in RP patients basically CD4+CD29+. Conclusion: These results suggest that the immunological activity changes in a different pattern according to the clinical course of the MS (RR versus RP).
13-31-04
1 A model of multiple sclerosis: Relapsing experimental autoimmune Encephalomyelitis in the SJUJ mouse
(EAE)
A. Champion, C. Gonet, D. Cottez, J.C.R. Randle, J.-M. Stutzmann, P. Delay-Goyet. Neuroinflammation Laboratory, Neurodegenerative Diseases Group, CNS Program, Rhbne-Poulenc Rorec Vitry-sur-Seine, France Multiple sclerosis (MS), a demyelinating disorder of the human central nervous system, commonly results in profound neurologic dysfunction. An experimental model of CNS demyelination - experimental autoimmune encephalomyeliiis (EAE) - shares with MS many clinical and neuropathological characteristics and is now established as a useful model for MS. We have set up a model of chronic, remitting-relapsing, EAE in the SJUJ mouse. EAE was induced in SJUJ mice by subcutaneous (s.c.) injection of an emulsion of bovine myelin basic protein (MBP) and Mycobacterium tuberculosis in complete Freund’s adjuvant. The same day and 48 h later, Bordetella pwtussis toxin was injected i.p. Animals were examined daily for clinical signs of EAE for the duration of the experiment. Disease seventy was graded on a scale of 0 to 5. Animals were observed for 6 months. During this period all (15) mice suffered at least 1 attack of EAE. The initial attack occurred from 14 to 25 days post-induction. Three animals died as a result of their first episode of EAE. All (12) surviving mice entered remission. This remission was total in 6 mice. Almost all remitted animals (11112) had a first relapse, occurring from 28 to 133 days post-induction. Ten mice developed a second remission. A second relapse was observed in 6 mice, starting from 38 to 132 days post-induction. Four mice developed a third remission. A third relapse was developing in two animals when the study was stopped. The clinical expression of the EAE in these conditions is characteristic of a chronic, remitting-relapsing model. Since chronic, remitting-relapsing course is the most frequent pattern of evolution in patients with multiple sclerosis, we propose therefore to use this EAE model for further pharmacological and biochemical investigations.
3-31-05
Sensitivity of mathematical formulas in quantification of intrathecal IgG synthesis multiple sclerosis patients
E. Dincic, A. Jovicic, D. Djorjdevic, R. Raicevic, D. Veljancic. Neuroiogyl Military Medical Academy; Belgrade, Yugoslavia
in
Department
of
lntrathecal synthesis of immunoglobulin G (IgG) is parameter of immune response in central nervous system. The aim of this study was determination of the most sensitive mathematical formula for intrathecal IgG quantification; dependence of different mathematical formulas on brain-barrier damage and estimation of best correlation between chosen formula and clinical status. In 60 MS patients durina acute phase, levels in cerebra-spinal fluid (CSF) and sera of albumin and IgG were estimated. Following mathematical formulas were used: Tourtellotte, modified Tourtellotte, Reiber, Schuller. Among those formulas mod. Tourteflote showed 76.6% of positive findings, while Reiber’s formula revealed only 58.89/o, on the same sample of patients. Significant difference was found between results obtained by mod. Tourtellotte and Reiber, Schuller and Reiber. Negative correlation was found between albumin ratio and IgG ratio, Schuller and Reiber. Only Touttellotte’s formula correlated with clinical status. In conclusion the most sensitive fomulas for IgG intrathecal quantification are Tourtellotte and mod. Tourtellotte.