Clinical Neuroscience

[Possible involvement of superantigens of the etiology in multiple sclerosis and other autoimmune diseases]

KÁLMÁN Bernadett1, LUBLIN D. Fred2

SEPTEMBER 20, 1993

Clinical Neuroscience - 1993;46(09-10)

[The superantigens are bacterial and viral protein products, which differ from conventional antigens, since they activate and ultimately delete lymphocytes in a T cell receptor Vb chain specific manner. As the activation may involve 30% of the total T cell population, it is possible that autoimmune clones are also included. Restricted heterogeneity of T cells has been described in several autoimmune diseases including multiple sclerosis. Thus, the possible triggering role of superantigens has stimulated new investigations. Although the data implicating superantigens in the etiology of these diseases are indirect, recent experimental results suggest their therapeutic applicability, using the long lasting deletion effect.]

AFFILIATIONS

  1. Országos Ideg- és Elmegyógyászati Intézet, Budapest
  2. Thomas Jefferson University, Philadelphia

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Pharmaco-EEG investigation on sedative effect of antiallergic drugs. Setastin is a non-sedative antihistamina]

RAJNA Péter, VERES Judit

[Effect of setastine on pharmaco-EEG was investigated in a double blind placebo controlled study in ten healthy volunteers. Changes caused by setastine were compared with those of two referent antihistamine drugs (chloropyramine and hismanal) having great differences in their sedative side effect. The themporo-occipital alpha per theta ratio was the most sensitive EEG marker in differentiating the two referent drugs. The EEG effect showed by setastine was very similar to that to hismanal and opposite to that of chloropyramine. In addition an increase of the total power and the power of beta was also measured. The latter changes might refer to an inherent EEG effect of setastine. EEG changes of setastine cannot be evaluated as signs of hypovigilance and the similarity of EEG effect of hismanal and setastine also supports the non-sedative nature of setastine estabilished by clinical studies. The pharmaco-EEG method utilized gives possibility for an objective investigation of psychotropic side effects of the particular drugs. ]

Clinical Neuroscience

[Efficacy of cinolazepam on insomnia generated under shift-work conditions]

KÖVES Péter

[The efficacy of cinolazepam (a benzodiazepine with middle half life time and light pharmacological potential) on insomnia generated under shift-work conditions was investigated, and shown to be an efficent hypnotic. Cinolazepam (daytime dose 20 mg, night dose 40 mg) improved significantly both sleep and awakening quality: there were no hangover effects, drug provoked intrasleep or early morning insomnia. During the time cinolazepam was administered drug tolerance was not observed. The structure of cinolazepam-induced sleep could be characterised by shortened sleep latency, increase of deep slow wave sleep, improvment of sleep continuity and unchange of REM sleep parameters both during night- and daytime.]

Clinical Neuroscience

[Observation of embolic events during carotis constructive surgery]

RÓZSA András, ENZT László, JÁRÁNYI Zsuzsa

[The changes of middle cerebral artery circulation during carotid artery surgery in 65 patients were monitored, and the observed embolic events are discussed. Of the 65 patients, 37 were operated with shunt protection (group A) and 28 without (group B). In 31 of all cases 55 embolic events were noted. In 22 of the group A patients 37 embolic events were observed, one of them occured during the declamping of the external caruiid circulation. Eighteen emboli were observed in 9 of the Group B cases. There were embolic events in 5 cases due to external declamping. All the above mentioned embolic events occured without postoperative clinical sings.]

Clinical Neuroscience

[Experiences with carotid-doppler examinations on patients with arterial bypass operation on the lower extremities]

OLÁH László, FÜLESDI Béla, VALIKOVICS Atilla, CSIBA László, OLVASZTÓ Sándor, BÁNFI Csaba, KOZLOVSZKI Bertalan

[Carotis-Doppler examinations were performed on 83 patients with severe, obliterative disease of the arteries of the lower extremities and on 96 age-matched controls without signs and symptoms. In the group with obliterative arterial disease, severe or moderate stenosis of the carotid arteries was found in 20 and 40% of the patients, respectively, whereas in the control group the proportion of moderate carotid-stenosis was 2% and no case of severe stenosis was found. The role of risk factors was also studied. Based on their results the authors suggest, that because patients with obliterative disease on the arteries of the lower extremities have higher risk for stenosis, ultrasound investigations and regular follow up of the carotid arteries are needed.]

Clinical Neuroscience

[Brachioradial syndrome: superficial radial neuropathy]

KISS Gábor

[Damage of the superficial branch of the radial nerve represents a rare, and rarely recognized, mononeuropathy. The first three cases in the Hungarian literature are presented. The essential role of electrodiagnosis in detecting of the disease is stressed. Special attention should be paid to avoid any lesion which might result from improper patient-care.]

All articles in the issue

Related contents

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

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

[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

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.