Clinical Neuroscience

[Experimential allergic encephalomyelitis multiplex sclerosis!]

KAPÓCS Gábor1

NOVEMBER 20, 1993

Clinical Neuroscience - 1993;46(11-12)

[T-lymphocytes and molecular engineering]

AFFILIATIONS

  1. Egyetemi Tanársegéd, SOTE Neurológiai Klinika

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[In Memoriam György Bekény]

HORVÁTH Sándor

[After a life of struggle and success, and after a serious illness borne with dignity and discipline, death took him at the age of seventy-eight. Even in the last years of his life, ill but tireless, he served his vocation with his knowledge: healing and teaching; patients and interested students; the Clinic. Shortly before his death, he completed his last scientific work, The History of Hungarian Neurology.]

Clinical Neuroscience

[The illogical therapy]

SZIRMAI Imre, SUREK György, KAMONDI Anita, MAGYAR Hedvig, JUHÁSZ Csaba

[Most of the causative pathological factors in ischemic cerebrovascular events cannot be recognized during the acute stage of the disease partly because of to the complexity of biophysical model of cerebral microcirculation, partly because the causative factors in this model cannot be confidently weighted. Clinical diagnoses on cerebral circulation disorders are based on the fundamental causes of the disorders. Evoking factors are hypotheses, consequently therapies are directed to hypotheses. The mathematical model of cerebral microcircualtion is mondeterministic. The interactions between vascular factors and blood fluidity can be roughly estimated. Judging the therapeutic efficacy is hindered by the nondeterministic disease model, the indefinite clinical clues, their individual variations, heterogenous diagnostic groups, and tendency of spontaneous restoration of symptoms. Non-specific drugs are used to treat cerebral ischemia, and trials making use of monotherapies have failed to change the life expectancy or the clinical course of ischemic patients. The acute stage of the disease cannot be defined and because of the incompleteness of clinical indicators „stroke prevention" appeares to be ambiguious. Therefore, the nature of the treatment of ischemic cerebrovascular disease is at present based on trial and error.]

Clinical Neuroscience

[Molecular characterization of the T cell receptor in experimental allergic encephalomyelitis and multiple sclerosis - new therapeutical approaches]

KÁLMÁN Bernadett, LUBLIN D. Fred

[The authors review here the most recent literature on experimental allergic encephalomyelitis and multiple sclerosis, focusing on the efferent branch of the immune response. They attempt to describe the molecular characteristics of the myelin antigen specific T cell receptors. Identification of the most distinct properties of the disease mediating cells may not only provide clues to the etiology of MS, but also opens new avenues to specific therapeutical approaches.]

Clinical Neuroscience

[Transcranial doppler of extracranial stenosis in internal carotid artery]

NAGY Valéria, BEDŐ György

[Endeavours were made to determine why mean velocity and pulsatility index changes in middle and anterior cerebral artery are caused by the unilateral occlusion of the internal carotid artery or by severe stenosis. The transcranial Doppler method is suitable for judgingre pathologic intracranial blood flow conditions, especially when data are compared to those of healthy conditions.]

Clinical Neuroscience

[Imaging of the lumbar synoval cysts]

PATAY Zoltán, TOURNADE Alain, BALÉRIAUX Danielle, TAJAHMADY Taghy, BERKY Mihály

[Lumbar synovial cysts are infrequent but characteristic manifestations of the commonly encountered but rather complex degenerative disorders affecting the lumbar zygapophyseal joints. The anatomical disposition of the different components of the lumbar motion segment, their sensory innervation and their topographic relationship with the neighbouring nerve structures explain why the neurogical manifestations of these affections, as well as of other articular disorders, cannot always be distinguished from those of discal origin. However, modern imaging methods allow the resolution of the radiological and consequently of the clinical differential diagnostic problems. The systematic use of computed tomography and magnetic resonance imaging in the evaluation of low back pain syndromes has resulted in the recognition and precise description of the practically pathognomonic „radiological syndrome” of the synovial cysts of the lumbar zygapophyseal joints.]

All articles in the issue

Related contents

Clinical Neuroscience

Matrix metalloproteinases and their tissue inhibitors in relapsing remitting multiple sclerosis: Possible markers and treatment agents

SANLI Arzu, OZTURK Musa, SOYSAL Aysun, DOVENTAS Yasemin, BASOGLU Fulya, GOZUBATIK-CELIK R. Gokcen, BAYBAS Sevim

Matrix metalloproteinases (MMPs), which are synthesized by many cell groups and responsible for the destruction of matrix proteins, and endogen tissue inhibitors of MMPs (TIMPs) have a role in the pathogenesis of Multiple Sclerosis (MS) by affecting the blood-brain barrier. We aimed to investigate the role of MMPs and TIMPs in the immunopathogenesis and in the course of multiple sclerosis (MS). We enrolled 25 relapsing remitting MS patients, who had a definite MS diagnosis according to McDonald criteria and 25 healthy subjects similar for age and gender as control group. MMP-9- and TIMP-1 levels were measured twice in patient group (one time during an attack and one in remission) and once in healthy subjects. MMP-9- and TIMP-levels of patients during attack and remission period and MMP-9/TIMP-1 ratio were found significantly higher than in the control subjects. In patient group MMP-9 and TIMP-1 levels and MMP-9/TIMP-1 ratio during attacks were not significantly different than during remission period. However, when subdivided according to their number of attacks, patients with 2 attacks had significantly higher levels during attack period comparing to remission period (p<0.05); in case of patients with more than 2 attacks did not have a statistically significant difference in attack and remission periods. Matrix metalloproteinases are important actors in MS immunopathogenesis, particularly in the early period and inhibitor agents for these enzymes can be used as a treatment option.

Clinical Neuroscience

[Effective therapy in highly active pediatric multiple sclerosis ]

MERÔ Gabriella, MÓSER Judit, LIPTAI Zoltán, DIÓSZEGHY Péter, BESSENYEI Mónika, CSÉPÁNY Tünde

[Multiple sclerosis (MS) is typically a disease of young adults. Childhood MS can be defined in patients under 18 years of age, although some authors set the limit un­der the age of 16 formerly known as “early-onset multiple sclerosis” or “juvenile multiple sclerosis”, seen in 3-5% of all MS patients. Nowadays, owing to ever-evolving, better diagnostic tools and well-traced, strictly defined diagnostic criteria, childhood MS is showing an increasing incidence worldwide (0.05-2.85/100 000). MS is characterized by recurrent episodes of the central nervous system with demyelination separated in space and time. In childhood almost exclusively the relapsing-remitting (RR) type of MS occurs. Based on experience in adults, the goal in the pediatric population is also the early diagnosis, to initiate adequate DMT as soon as possible and to achieve symptom relief and good quality of life. Based on efficacy and safety studies in the adult population, inter­feron β-1a and glatiramer acetate were first approved by the FDA and EMA for the treatment of childhood MS also. The increased relapse rate and rapid progression of childhood MS and unfavorable therapeutic response to nearly 45% of the first DMT necessitated the testing of more effective and second-line drugs in the population under 18 years of age (PARADIGMS, CONNECT). Although natalizumab was reported to be effective and well-tolerated in highly active RRMS in childhood, evidence based studies were not yet available when our patients’ treatment started. In this article, we report on the successful treatment of three active RRMS patients with individually authorized off-label use of natalizumab.]

Clinical Neuroscience

Lymphopenia and tuberculous lymphadenitis under immunomodulatory agents in a multiple sclerosis patient: Follow-up of a challenging case

KOSEAHMET Basoglu Fulya, OZTURK Musa , CELIK R. Gokcen Gozubatik

Interferon-beta (IFN-β) 1a and glatiramer acetate (GA) are first-line therapies for multiple sclerosis (MS) with immunomodulatory effects. We present a patient who developed lymphopenia and tuberculous lymphadenitis under treatment with these agents. The female patient who at present 65 year old is followed at our MS outpatient clinics had received GA (20 mg/day, subcutaneous injection) and later IFN-β 1a (44 µg, thrice weekly, subcutaneous injection). During the course of her treatment, she developed mild to severe lymphopenia. A follow up thoracic spinal MRI (when lymphocyte count was 800/µl) showed multiple enlarged lymph nodes in the posterior mediastinum incidentally. Further investigation revealed tuberculous lymphadenitis. She received anti-tuberculosis (TB) treatment for nine months and her condition resolved. Although immunomodulatory treatments are considered safe with regard to opportunistic infections, and lymphopenia under these treatments are generally accepted as mild and asymptomatic, our experience was different with this patient. Further studies on the management of patients with lymphopenia and assessment of the risk of TB under immunomodulatory agents are needed.

Clinical Neuroscience

[Controversies in neurology: Diagnosis, follow up and therapy of multiple sclerosis with pathomechanismal approach]

VÉCSEI László

[The clinical boundaries between the relapsing and progressive course of multiple sclerosis are often indistinct. Despite the variable patterns of evolution, there are no biological reasons for discerning different multiple sclerosis phenotypes. Indeed, both primary progressive and secondary forms of the disease share similar pathological features in respect of the extent of inflammatory infiltrates, axonal damage, and cortical demyelination. The data indicating that primary progressive multiple sclerosis is preceded by an asymptomatic relapsing remitting phase. The proposed definition of secondary progressive multiple slcerosis, the attainment of at least EDSS of 4 is required to mark the transition to the progressive phase. Therefore, the clinical progress can be uncovered in the early phase of the disease. Furthermore, a continuous progression independent of relapsing activity is commonly observed during the relapsing remitting phase. A continuous smouldering process underpins the subtle clinical deterioration, which stands out as an important unmet treatment target. Concerning cognitive dysfunction of the patients pro-inflammatory cytokines have been associated with worse cognition in active multiple sclerosis, and this inflammatory milieu could also contribute to altered mentation during relapses. Therefore, long before people with multiple sclerosis become physically disabled, they have usually acquired hidden disabilities related to cognitive impairment. Silent progression appears during the relapsing remitting phase and it associates with brain atrophy. This suggests that the same process that underlies secondary progressive multiple sclerosis likely begins far earlier than is generally recognized. This supports a unitary view of multiple sclerosis biology. ]

Clinical Neuroscience

[Diagnosis of multiple sclerosis: A review of the 2017 revisions of the McDonald criteria]

CSÉPÁNY Tünde

[The revolutionary progress of research in neuroimmu­nology has led to the introduction of disease modifying therapies in multiple sclerosis at the end of the last century. The International Panel on Diagnosis of Multiple Sclerosis originally proposed the 2001 McDonald criteria to facilitate the diagnosis of MS in patients with the first objective neurological symptom(s) suggesting demyelinating event, when magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. New terms have been introduced to substitute clinical information by MRI: dissemination in space - indicating a multifocal central demyelinating process and dissemination in time - indicating the development of new CNS lesions over time. The criteria for diagnosis of Multiple Sclerosis have continuously evolved, they were modified in 2005 and 2010 allowing for an earlier and more accurate diagnosis of MS over time, and they provided the most up-to-date guidance for clinicians and researchers. The last recommended revisions relied entirely on available evidence, and not on expert opinion thereby reducing the risk of the misdiagnosis. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical, clinically isolated syndrome. In this review, we provide an overview of the recent 2017 revisions to the criteria of dissemination in space and time with the importance of the presence of CSF-specific oligoclonal bands; keeping fully in mind that there is no better explanation for symptoms than diagnosis of MS. In the future, validation of the 2017 McDonald criteria will be needed in diverse populations. Further investigations are required on the value of new MRI approaches, on optic nerve involvement, on evoked potential and optical coherence tomography, in order to assess their possible contribution to diagnostic criteria.]