New Multiple Sclerosis Cure
Multiple sclerosis is a demyelinating disease of the CNS in which certain myelinated pathways, such as the optic nerve, dorsal columns, corticospinal tract, and medial longitudinal fasciculus (MLF) are affected. The illness is characterized by episodes of focal neurologic deficits that are separated in place and in time. The disease course is characterized by exacerbations and remissions. Patients may develop the following symptoms
Normal voiding is accomplished by activation of the micturition reflex. ' This is a coordinated event characterized by relaxation of the striated urethral sphincter, contraction of the detrusor, opening of the vesical neck and urethra and the onset of urine flow (20). The micturition reflex is integrated in the pontine micturition center, which is located in the rostral brain stem (20,21,22). Interruption of the neural pathways connecting the pontine micturition center to the sacral micturition center usually results in detrusor external sphincter dyssynergia (23,20,24). Detrusor external sphincter dyssynergia is characterized by simultaneous involuntary contractions of the detrusor and the external sphincter. The involuntary detrusor contractions cause incontinence the involuntary sphincter contractions result in bladder outlet obstruction. Detrasorexternal sphincter dyssynergia is commonly seen in patients with spinal cord involvement because of the demyelinating plaques, which are...
Urodynamic technique range from simple eyeball urodynamics to sophisticated multichannel synchronous video pressure flow EMG studies. We believe that synchronous multichannel videourodynamics offers the most comprehensive, artifact free means of arriving at a precise diagnosis and we perform them routinely in patients with multiple sclerosis.
Pars planitis has been associated with HLA-DR2 split products, in particular HLA-DR15 86, 92, 107 , as well as HLA-B*51 and HLA-B*8 62 , although not in all studies 33 . Similarly HLA-DR15 and HLA-DR2 have been associated with multiple sclerosis and optic neuritis, but also with differences in different studies and populations 62,114 .
Hyperreflexia (owing to multiple sclerosis) from detrusor instability (owing to prostatic obstruction). Logic dictates that detrusor overactivity is more likely to be because of multiple sclerosis if the patient is unaware of the involuntary detrusor contractions, cannot abort them, and is incontinent. Our experience defies this logic, and we do not believe that we can reliably make the necessary. The practical consequence of this is that we are unable to predict whether or not a man will be incontinent after transurethral incision or resection. Accordingly, if this form of therapy is chosen, it must be done so with informed consent and contingency plans for managing postoperative urinary incontinence because of persistent detrusor overactivity.
Coagulation and bleeding time increased. LP CSF normal. No evidence of multiple sclerosis on evoked-potential testing AST and ALT moderately increased. Discussion Trigeminal neuralgia is sometimes seen in association with multiple sclerosis, primarily in younger patients. Carbamazepine is chemically similar to imipramine and has been used for trigeminal neuralgia as well as for the treatment of partial and tonoclonic seizures.
Multiple sclerosis affects only axons in the CNS that have myelin sheaths formed by oligodendrocytes. The optic nerve is a direct outgrowth of the CNS and is the only nerve that falls into this category. All other nerves are in the PNS and have their myelin sheaths formed by Schwann cells.
The difficulties in sorting out what is cost effective have to do with the fact that schizophrenia is in many ways similar to other chronic central nervous system (CNS) disorders of unknown aetiology. Like multiple sclerosis and epilepsy, schizophrenia is a syndrome rather than a discrete disease entity. As a result, it is not possible to predict with any degree of certainty the course of, or the response to, treatment. Some patients, after an acute episode, recover quickly and remain well for extended periods others relapse repeatedly but remit quickly still others require repeated and extensive hospitalization.
Horizontal gaze is controlled by two interconnected gaze centers. One control center is in the frontal lobe, the frontal eye field (Brodmann area 8). This area acts as a center for contralateral horizontal gaze. In the pons is a second gaze center, known as the pontine gaze center or the PPRF, the paramedial pontine reticular formation. This is a center for ipsilateral horizontal gaze. When activated by neurons in the frontal eye field, the pontine gaze center neurons send axons to synapse with cell bodies in the abducens nucleus, which is actually contained within the pontine gaze center. The pontine gaze center also sends axons that cross immediately and course in the contralateral MLF to reach the contralateral oculomotor nucleus. The net effect of stimulation of the left frontal eye field, therefore, is activation of the pontine gaze center on the right and a saccadic horizontal eye movement of both eyes to the right. Horizontal gaze to the right results from activation of the...
Multiple sclerosis and Parkinson's disease are associated with abnormal latency periods. Lesions of the optic nerve, optic tract, and cerebral cortex visual center(s) can be identified with a visual-evoked response exam. Visual field defects due to retinal damage, macular degeneration, and glaucoma may be detected by VER. Variations from Normal. Auditory disorders of low-birthweight newborns are identified by auditory brain stem-evoked response studies. Abnormal latency responses are associated with brain stem tumors, acoustic neuromas, and lesions of the brain stem or auditory nerves. Brain stem and nerve lesions can be caused by a variety of neurological and or demyelinating diseases, such as multiple sclerosis. Variations from Normal. Multiple sclerosis, Guillain-Barre syndrome, and spinal cord injuries are identified by somatosensory-evoked response studies. Abnormal latency responses are associated with cerebrovascular accident and cervical myelopathy.
The presence or absence, increase or decrease, of each of these substances assists the health practitioner with disease identification. Indications for this type of CSF analysis range from suspected multiple sclerosis to diagnosing various intracranial hemorrhages or neoplastic conditions. Table 8-1 summarizes the normal ranges for the physical, chemical, and microscopic CSF tests. Elevated lymphocyte cell levels can help identify multiple sclerosis, syphilis of the central nervous system, and many varieties of meningitis. Viral, aseptic, fungal, parasitic, and atypical meningitis cause an increase in lymphocytes. Partially treated bacterial meningitis or the recuperatory phase also shows increased lymphocytes. Variations from Normal. Increased cerebrospinal fluid protein levels are consistent with infectious or inflammatory disease processes. Specific diseases are meningitis, encephalitis, or myelitis. Multiple sclerosis, neurosyphilis,
DESCRIPTION OF THE STUDY This 18-channel EEG was obtained on a 32-year-old female with a history of multiple sclerosis and cognitive difficulties. Her medications include Tegretol. She is awake and cooperative. CLINICAL DIAGNOSIS This EEG is consistent with moderately severe, diffuse disturbance in cortical neuronal function that is of nonspecific etiology. Such changes can be seen in the setting of a toxic metabolic encephalopathy and certainly could be related to the patient's history of severe demyelinating disease. The slight left-sided predominance of the slowing might predict more involvement of multiple sclerosis in the left hemisphere. No epileptiform abnormalities.
Detrusor hyperreflexia in a 54 year old woman with exacerbating & remitting multiple sclerosis. (A) Urodynamic tracing. At a bladder volume of 165 ml there was an involuntary detrusor contraction (arrow) which reached a maximum of 100 cm H20 (during sphincter contraction). Qmax 13 ml S and 25 cm H20. Throughout the detrusor contraction, there was increased EMG activity as she tried to abort the detrusor contraction. When she relaxed, (at Qmax) there was complete EMG silence. Unintubated uroflow (far right) was normal (19 ml S). Flow uroflow Pves vesical pressure Pabd abdominal pressure Pdet detrusor pressure (Pves-Pabd) EMG EMG of the pelvic floor (surface electrodes). (B) X-ray obtained at Qmax show a normal urethra. Courtesy of Jerry G. Blaivas, MD, with permission Fig. 1. Detrusor hyperreflexia in a 54 year old woman with exacerbating & remitting multiple sclerosis. (A) Urodynamic tracing. At a bladder volume of 165 ml there was an involuntary detrusor contraction (arrow)...
Congenital toxoplasmosis must be differentiated from other possible causes of the classic clinical acronym 'TORCH' for a series of etiologies that share similar signs and symptoms. The acronym includes Toxoplasma, rubella, cytomegalovirus, syphilis, and herpes simplex virus. However, emerging pathogens such as West Nile Virus must be considered as part of any differential in known congenital infection (Alpert et al., 2003). Recurrent toxoplasmosis with its unilateral active lesion associated with multiple adjacent chori-oretinal scars with the appropriate clinical history is virtually pathognomonic. However, clinical syndromes such as serpiginous chorioretinitis, and other infectious etiologies such as cytomegalovirus, may occasionally be considered. For the many other possible and unusual manifestations of ocular toxoplasmosis, such as pars plani-tis, the differential diagnosis is even broader, and includes autoimmune disorders such as multiple sclerosis and infections such as Lyme...
Best clinical results were found among patients who maintained some degree of bladder sensation and emptied the bladder by micturition. Most of these patients had incomplete spinal-cord lesions caused by multiple sclerosis, trauma or infectious diseases. After an initial period of 2 weeks during which urinary symptoms worsened, complete continence or satisfactory improvement was reported by 70-90 of
Multiple sclerosis is a chronic relapsing-remitting disorder of probable autoimmune origin characterized by recurrent episodes of demyelination (causing plaques ) and defective remyelination in the brain (including optic nerves) and spinal cord, which results in progressive (but variable in time and from person to person) neurological deficits (visual changes, sensation changes, motor changes, neuropsychiatry disturbances). Central pontine myelinosis is a rare, potentially fatal, focal demyelination of the basis pontis possibly related to over-rapid correction of hyponatremia in malnourished patients and alcoholics.
SSPE is thought to be caused by a measles-related virus present in the central nervous system. Most SSPE patients show elevated measles virus antibodies in serum and CSF. In patients with multiple sclerosis (MS), lower CSF antibody titers have been observed, suggesting a possible etio-logic role for measles virus in MS.
Although MRI is effective with any organ or system, this technology is most often used in association with the nervous system and the musculoskeletal system. Magnetic resonance imaging is often used to diagnose multiple sclerosis, and to evaluate pathology involving the brain and liver.
Histologically, there is microglial proliferation, slight glial scarring, and perivascular infiltration of lymphocytes, neutrophils and plasma cells. The site most commonly affected is the brainstem, followed by isolated hemispherical involvement in a subgroup of patients usually presenting with hemiparesis and or pyramidal signs, and spinal cord involvement in 4-20 of all cases (only 18 being isolated). A special, although fortunately rare, form of cerebral involvement in BD is the demyelinating variant, which does not have signs of active vasculitis in MRI or cerebrospinal fluid (except elevated protein levels), but nevertheless leads to progressive mental deterioration and dementia 127 . In the other forms, cerebrospinal fluid analysis mostly reveals neutrophilic pleocytosis, but lymphocytic pleocytosis is also common. Elevated protein concentrations with an increased IgG index are usually found, and oligoclonal bands similar to those in multiple sclerosis (MS) may occur and...
While abnormal test results of any type can be traumatic and emotionally devastating, variations from normal in many of the fluids discussed in this chapter often affect some of the most personal aspects of an individual's life. Amniotic fluid tests can reveal irreversible fetal abnormalities and cerebrospinal fluid analysis can identify extremely challenging diseases such as multiple sclerosis.
Head and brain magnetic resonance imaging reveals brain tumors, both primary and metastatic, and tumors involving the optic nerve, pituitary gland, and benign meningioma. Multiple sclerosis, causes of cerebrovascular accidents, and localization of the area of cerebral hemorrhage can be identified via MRI. Figure 10-7 shows an MRI of the brain with the area of a bleed visible on the lower right.
Pupillary constriction (miosis) results from contraction of the constrictor muscle of the iris. A smaller aperture gives the optic apparatus a greater depth of field. With Argyll Robertson pupds, both direct and consensual light reflexes are lost, but the accommodation-convergence reaction remains intact. This type of pupil is often seen in cases of neurosyphilis however, it is sometimes seen in patients with multiple sclerosis, pineal tumors, or tabes dorsalis. The lesion site is believed to occur near the pretectal nuclei just rostral to the superior colliculi.
Lower urinary tract symptoms may be classified as storage symptoms, emptying symptoms or mixed storage, and emptying (25). Storage symptoms include urinary frequency, urgency, incontinence, nocturia, and pain. Emptying symptoms include hesitancy, difficulty starting, weak stream, and a feeling of incomplete bladder emptying. About three fourths of patients with multiple sclerosis complain primarily of storage symptoms. The remainder has emptying or mixed symptoms. Many studies have found that there is no correlation between urologic symptoms, neurologic findings, and urodynamic findings. Blaivas performed prospective urodynamic study in 67 consecutive patients with MS and urinary bladder symptoms (19). Treatment was individualized on the basis of the underlying pathophysiology and consisted of intermittent catheterization (21 ), observation (27 ), surgical (12 ), drugs (9 ), voiding training (6 ), and external condom drainage (6 ). In 18 patients (27 ), lesser forms of treatment were...
Both cognitive and behavioral interventions have been found to improve well-being in a variety of GMCs, including cardiovascular illness, chronic pain, AIDS, cancer, and asthma 141, 142 . However, few studies use CT to reduce depression coexisting with GMCs 142 . Larcombe and Wilson 143 , in a controlled study, showed CBT to improve depression in patients with multiple sclerosis. Kelly et al 144 demonstrated the effectiveness of group CBT and social support for depressed HIV-infected patients.
When other features of the cauda equina syndrome are present it is easy to suspect lumbar disc prolapse as the cause of voiding dysfunction. It is a more difficult diagnostic dilemma when other signs, in particular pain, are absent. One's suspicion should be aroused when faced with a woman who is straining to void or having difficulty emptying her bladder as outlet obstruction is unusual in females. A thorough history and physical examination with a focused neurological evaluation is mandatory. In the male, prostatic obstruction or urethral stricture disease may cause similar findings and should be excluded. Other disease states such as diabetes mellitus (DM), multiple sclerosis (MS), vitamin B12
The other most prevalent use of botulinum toxin is for the management of spasticity in both adults and children. Spasticity is a very significant cause of disability in people with a variety of neurological disorders, particularly stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury. It is also a major problem in children and adults with cerebral palsy. It has been defined 46 as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone) with exaggerated tendon jerks, resulting in hyperexcitability of the stretch reflex, as one component of the upper motor neurone syndrome.
Discussion Trigeminal neuralgia is also known as tic douloureux. If present in a young individual, multiple sclerosis should be suspected. Although imaging studies usually yield 110 positive findings, surgical exploration of the posterior fossa in patients who do not respond to medical therapy frequently reveals aberrant blood vessels pressing on nerve root (amenable to decompression).
A 25-year-old woman with a prior history of visual loss in the left eye and a spastic gait develops impaired pain and temperature perception in her feet. She was diagnosed with multiple sclerosis (MS) shortly after her visual loss. Her left fundus reveals optic atrophy, and her facial movements are asymmetric. Chest x-ray reveals large hilar lymph nodes. Mammogram reveals no apparent carcinoma. (SELECT 1 CONDITION)
A young man with multiple sclerosis (MS) exhibits paradoxical dilation of the right pupil when a flashlight is redirected from the left eye into the right eye. Swinging the flashlight back to the left eye produces constriction of the right pupil. This patient apparently has
If present in a young individual, multiple sclerosis should be suspected. Although imaging studies usually yield no positive findings, surgical exploration of the posterior fossa in patients who do not respond to medical therapy frequendy reveals aberrant blood vessels pressing on nerve root amenable to decompression).
The answer is c. (Bradley, 3 e, p 1446.) This patient has a gradually progressive myelopathy. The differential diagnosis is broad, but multiple sclerosis (MS) is high on the list. A subset of patients with MS consists of middle-aged men with a progressive form of the disease. MRI of the spinal cord could show MS plaques in the cord or other abnormalities intrinsic to the spinal cord parenchyma, and could also exclude compressive lesions. Vascular malformations of the spinal cord can also be seen in this way, although sometimes spinal angiography is required for definitive diagnosis. Cerebral angiography would not be helpful except to evaluate for residual aneurysm, which is unlikely to be related to this patient's problem. Spinal cord biopsy is unwarranted in this case unless a specific indication is provided on neuroimaging. Visual evoked responses may be abnormal in MS, even without clinical evidence of disease, but would not account for this patient's spastic paraparesis....
A detailed history of known neurological diseases (e.g., stroke, Parkinson's disease, spinal cord injury, multiple sclerosis, myelodysplasia, and so on) is important because these diseases have the potential to affect bladder and sphincteric function. A history of medical diseases such as diabetes or congestive heart failure can cause LUTS by their effects on the lower urinary tract or fluid mobilization.
Myelin formation is produced in the peripheral nervous system by numerous Schwann cells, while a similar function in the central nervous system is carried out by an oligodendrocyte, which can wrap itself around numbers of neurons. Myelination in the nervous system allows for rapid conduction of action potentials by a process of saltatory conduction, in which the signals skip along openings in the myelin called nodes of Ranvier. Neurons that are myelinated (e.g., the pyramidal tracts and dorsal column-medial lemniscal system) are rapidly conducting, whereas those that are poorly or nonmyelinated (e.g., certain pain-afferent fibers to the spinal cord) are slowly conducting. Damage to such myelinated neurons typically disrupts the transmission of neural signals and is frequently seen in autoimmune diseases such as multiple sclerosis, in which sensory and motor functions are severely compromised.
Low fiber intake and poor diet can cause constipation. Medications also can lead to constipation (Table 21.1). Constipation is associated with many metabolic and endocrine disorders, including hypocalcemia, renal failure, hy-pothyroidism, hyperparathyroidism, and diabetes.1 Neurological disorders can impede normal GI movement multiple sclerosis, strokes, and spinal cord injury can cause constipation. Malfunction or anatomical abnormalities, including colitis, cancer, diverticular disease, and rectal prolapse, can cause constipation.
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