摘要:

Class 1 clinical trials demonstrated that immunomodulatory treatments (interferonβ and glatiramer acetate) reduce the disease activity and the accumulation of disability in relapsing remitting multiple sclerosis. Moreover interferonβ-1b also had similar positive effects in secondary progressive multiple sclerosis. The magnitude of these clinical effects was modest, but the reduction of inflammatory activity, as revealed by magnetic resonance imaging, was marked. Converging evidence from new pathological studies and new magnetic resonance techniques, characterized by increased pathological specificity, has shown that already in the early phases of the disease inflammatory activity determines irreversible axonal damage. Moreover, the amount of inflammatory activity at the clinical presentation of the disease has some value in predicting long-term disability. Taken together, these data indicate that patients may benefit from early treatment; the positive results of the Controlled High Risk Subjects Avonex Multiple Sclerosis Prevention Study support this conclusion.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Multiple sclerosis is a complex trait of unknown etiology. Epidemiological data have shown that susceptibility to multiple sclerosis is determined by both genetic and environmental factors. It is unknown whether the clinical subcategories of multiple sclerosis are separate diseases with separate etiologies and causes. Recent theories of the pathogenesis of multiple sclerosis and candidate genes are discussed. Other potential nonchromosomal factors involved in multiple sclerosis susceptibility such as mitochondrial DNA and viral factors such as Chlamydia pneumoniae are reviewed.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Cell-specific magnetic resonance imaging, magnetization transfer imaging, proton magnetic resonance spectroscopy and diffusion-weighted imaging have all recently been applied to the study of multiple sclerosis. These techniques can give more accurate and pathologically specific estimates of the multiple sclerosis lesion burden than conventional magnetic resonance. Their extensive application should improve the understanding of the mechanisms leading to multiple sclerosis-related irreversible disability and help in the diagnostic work-out of patients with suspected multiple sclerosis.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The advent of magnetic resonance imaging techniques has greatly reduced the diagnostic value of neurophysiological tests, particularly evoked potentials, in multiple sclerosis patients, because of the higher sensitivity in revealing subclinical involvement of the central nervous system. Technical progress and new methods of investigating afferent and efferent nervous pathways would seem to increase the sensitivity in detecting neural dysfunction, but the ‘clinical gain’ is modest at best. More promising is the utilization of neurophysiological tests to quantify the severity of white matter involvement. Transversal and longitudinal studies have demonstrated good correlations between neurophysiological parameters and disability measures, indicating that a battery of neurophysiological tests could be useful in monitoring the disease evolution in single patients and as surrogate endpoints in clinical trials. Further studies are needed for a better definition of the applications of evoked potentials and other neurophysiological techniques. Finally, event-related potentials and advanced electroencephalogram techniques, such as coherence analysis, could provide useful information on the pathophysiology of cognitive dysfunction, so common in multiple sclerosis patients, and with a strong impact on the quality of life.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The management of individuals with multiple sclerosis must be considered under the following headings: administration and follow-up of adequate disease-modifying treatment, symptomatic relief and neurorehabilitation. Neurorehabilitation deserves a four-step strategy: multidisciplinary assessment, identification of areas of potential functional improvement, setting of goals of short/long-term duration, and measurement of outcomes. The patient's perspective is important to evaluate through questionnaires about quality of life. Well organized disability services with multidisciplinary specialists are probably cost effective and efficient. Determining the actual economic impact of multiple sclerosis and defining the most cost-effective type of care for persons with multiple sclerosis is a need in all countries faced with the limitation of healthcare resources. In persons with multiple sclerosis the range of main symptoms includes the loss of mobility and spasticity, pain, tremor, abnormal eye movements, paroxysmal symptoms, bladder and bowel dysfunction, sexual disturbances, fatigue and depression. Current palliative treatments, which are reviewed, are partly successful depending on the type of symptoms under consideration.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We currently conceive of a migraine attack as originating in the brain. Triggers of an attack initiate a depolarizing neuroelectric and metabolic event likened to the spreading depression of Leao. This event activates the headache and associated features of the attack by mechanisms that remain to be determined, but appear to involve either peripheral trigeminovascular or brainstem pathways, or both. The excitability of cell membranes, perhaps partly genetically determined, is the brain's susceptibility to attacks. Factors that increase or decrease neuronal excitability constitute the threshold for triggering attacks. Using a model of visual stress-induced migraine or by studying spontaneous attacks and applying advanced imaging and neurophysiological methods, results have been obtained that support spreading neuronal inhibition as the basis of aura. This neuroelectric event is accompanied by hyperoxia of the brain, possibly associated with vasodilation. Evidence has also been obtained that the spreading cortical event can activate the subcortical centers possibly involved in nociception and associated symptoms of the migraine attack. Susceptibility to migraine attacks appears to be related to brain hyperexcitability. These newer techniques of functional neuroimaging have confirmed the primary neural basis of the migraine attack with secondary vascular changes, reconciling previous theories into a neurovascular mechanism.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Primary chronic daily headache can be subclassified into disorders of short duration (<4 h/attack) including chronic cluster and disorders of long duration (⩾4 h/attack). Primary chronic daily headache disorders of long duration include chronic tension-type headache, chronic daily migraine (previously called transformed migraine), new daily persistent headache, and hemicrania continua. Four to 5% of the general population have primary chronic daily headache. Most chronic daily headache patients overuse analgesics or ergots. This article will consider recent insights into specific disorders, then psychiatric comorbidity, epidemiology, pathophysiology, and treatment.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Tension-type headache represents one of the most costly diseases in modern society because of its very high prevalence. Very little research on this disease has actually been carried out, and knowledge about key pathophysiological issues such as the nature and site of the noxious stimulus is surprisingly limited. As a result of this and the lack of scientific interest from the medical field, treatment is widely non-specific, very often ineffective and consists mainly of simple analgesics. The only new strategy is the pericranial injection of botulinum toxin. If current progress in our understanding of the mechanisms of tension-type headache continues, this may lead to greater scientific interest and the development of more specific and more effective drugs in the future.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Facial pain is a debilitating disorder if left untreated. Too often patients are labelled as having psychopathology when face pain etiology is unclear. These patients are categorized as ‘atypical’, ‘idiopathic’ or ‘psychogenic’. Idiopathic, when referring to a medical problem suggests that there is something unknown, and does not define the problem. The same applies to terms incorporating the word ‘atypical’. It is postulated that the most commonly undiagnosed facial pain conditions include neuropathic and myofascial pains because their pathophysiologies are not well understood. Peripheral and central mechanisms associated with these disorders are used to provide an update of these frequently seen clinical conditions.

ISSN:1350-7540    

出版商:OVID    

年代:2000

数据来源: OVID