Showing papers on "Poser criteria published in 2006"

Diagnosis and treatment of multiple sclerosis

Abstract: Multiple sclerosis is the most common disabling neurological disease in young adults. Recent advances in understanding the underlying mechanisms and the development of new therapies have increased hope for doctors and their patients. New therapies are available and many other agents are undergoing clinical trials. New information does reveal some disturbing aspects of the disease however. Evidence from several sources suggests that the disease is present long before the first symptom. The disease is also more widespread and continuous than previously thought, with changes in grey as well as white matter and changes in normal appearing white matter. Multiple sclerosis has long been regarded as a demyelinating disease, but evidence now suggests widespread damage to axons that may be more closely correlated with progression of disability. Better understanding of the underlying mechanisms of the disease is allowing more focused development of new therapies. This review is based on the conclusions of recent randomised clinical trials, the 15 Cochrane reviews of multiple sclerosis therapy, and guidelines of the American Academy of Neurology. Since the early 1980s the Poser criteria was used to classify multiple sclerosis. This relied on evidence of at least two relapses typical of multiple sclerosis and evidence of involvement of white matter in more than one site in the central nervous system, the concept of “lesions scattered in time and space.” A new system of classification, the McDonald criteria (see bmj.com), incorporates clinical and laboratory elements, allowing an earlier confirmation of the diagnosis and thus enabling earlier decisions about starting disease modifying therapies.1 2 Multiple sclerosis is a clinical diagnosis on the basis of two episodes involving two or more areas of the central nervous system over time, but the McDonald criteria incorporate magnetic resonance imaging to demonstrate multiple areas of involvement and also involvement over time …

Effects of pregnancy and childbirth on the incidence of urinary disorders in multiple sclerosis.

Abstract: Objective: Women with multiple sclerosis frequently pose questions to physicians regarding the potential negative impact of pregnancy, especially on urinary disorders. About 50 to 80% of patients suffer from urinary disorders during the course of the disease. Trauma to the pelvic floor and the urethral sphincter during vaginal delivery may lead to the development of stress urinary incontinence. The purpose of this work was to study the consequences of pregnancy and childbirth on urinary problems. Study Design: An inception cohort of 368 consecutive women suffering from multiple sclerosis (MS), according to the Poser criteria, were included in the study between June 1999 and June 2000. For each patient a full urological and obstetrical record was obtained. Results: Two hundred and seventy-three women (74%) had had at least one pregnancy. The parous women were older at the time of the study (mean age: 45.5 years vs 35.5 years), and were older at MS onset (mean age: 32.8 years vs 25.7 years). The nulliparous women were more rapidly disabled, with a shorter time to reach an EDSS score of 3 from MS onset (mean time of 5.9 years versus 8.2 years in parous women). In parous women, 259 (95%) had had at least one vaginal delivery and 14 (5%) had had a caesarean only. Delivery modalities had no influence on urinary disorder frequency or the type of problems. Conclusion: On the basis of these data, there is actually no clear argument for systematically performing caesarean section in MS women. Urinary disorders in these women were mostly linked to the duration and the severity of the disease but not to pregnancy or delivery modalities. From our point of view, caesarean section must be decided only on classic obstetrical criteria as for healthy women independently of multiple sclerosis. However our data were open and retrospective.

Low sensitivity of McDonald MRI criteria in the diagnosis of multiple sclerosis among Asians

Abstract: Background: Multiple sclerosis (MS) in Asia manifests differently with lower prevalence, higher female preponderance, fewer cortical lesions but more severe spinal cord disease. Methods: We retrospectively reviewed the first brain and spinal cord MRI in patients with clinical or laboratory-supported definite MS under the Poser criteria across Asia to ascertain the sensitivity of the Barkhof and McDonald MRI dissemination in space criteria. Results: The Barkhof criteria were only 49% sensitive in 101 patients, classical MS 62%, optic-spinal MS 35%. Similarly, revised McDonald MRI criteria have a sensitivity of only 52%, classical MS 67%, optic-spinal MS 37% in 101 patients. Conclusion: The sensitivity of McDonald MRI criteria in the diagnosis of multiple sclerosis among Asians is low.

Gender change and its impact on the course of multiple sclerosis.

Abstract: We report the case of a 22-years old genotypic women suffering from a relapsing-remitting multiple sclerosis (MS) according to the Poser criteria. In this patient, a gender change had been performed by androgen-supplementation and surgical intervention. During gender change, the patient experienced further relapses. Different immunomodulatory and immunosuppressive treatment strategies did not stabilise the course of MS in this patient. Actually, an escalating therapy with mitoxantrone has been initiated. During the observation period the patient received long-term testosterone-supplementation. Testosterone levels were elevated in the serum of this genotypic female MS patient under such a hormonal treatment compared to normal ranges before. The clinical course of the patient is presented in this case. As there are several studies investigating an immunomodulatory impact of hormones on the course of MS or experimental allergic encephalomyelitis, we discuss the presented case and a possible influence of androgens in this patient.