The History of Multiple Sclerosis

2016 ◽  
Author(s):  
T. Jock Murray
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
20Th Century ◽  
Clinical Disease ◽  
Resonance Imaging ◽  
History Of ◽  
Disease Modifying ◽  
Disease Modifying Agents

This chapter provides an introduction to the history of MS. It explores the observations of multiple sclerosis that were made even before the disease was more formally framed and named by Charcot in 1868. It reviews how description of the disease advanced through the 20th century, and how classification of clinical disease types, development of various tests, and the advent of magnetic resonance imaging improved diagnosis. Early attempts at therapy are discussed and contrasted with the modern disease modifying agents that were introduced in 1993.

Progressive Gait Difficulties

2021 ◽  
pp. 62-64
Author(s):  
I. Vanessa Marin Collazo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Resonance Imaging ◽  
Primary Progressive ◽  
Mcdonald Criteria ◽  
Mild Reduction ◽  
History Of

A 58-year-old, right-handed man with a medical history of nephrolithiasis, essential hypertension, and type 2 diabetes sought care for a 6-year history of gait impairment. Initially, he noted subtle left foot and ankle weakness with associated falls that progressed over time. Two to 3 years later he again noted progressive left leg weakness and new arm weakness. Subsequently, progressive pain developed on the soles of his feet in addition to edema with erythematous discoloration around the left ankle and foot. On neurologic examination, he was found to have mild upper motor neuron pattern weakness in the left arm and leg, most pronounced in the left hand finger extensor and left hip flexion and abduction. Left patellar reflex was brisk, and there was an extensor Babinski sign on the left. There was mild reduction in pinprick sensation in both feet. His gait was spastic with left leg circumduction. Magnetic resonance imaging of the brain showed left-sided predominant periventricular and subcortical T2 fluid-attenuated inversion recovery hyperintensities. Magnetic resonance imaging of the cervical and thoracic spinal cord showed intramedullary cord T2 signal hyperintensities, eccentrically located on the left at C3, C5, C6, on the right at C7 to T1, and centrally at T4/T5 and T8/T9. A diagnosis of primary progressive multiple sclerosis was made. The patient met the 2017 McDonald criteria for primary progressive multiple sclerosis. After the diagnosis was confirmed and comprehensive education about the disease and the role of disease-modifying therapy was discussed with the patient, he was started on ocrelizumab. Gabapentin was started for management of painful foot paresthesias. Vitamin D3 supplementation was started. Physical therapy was also initiated. Multiple sclerosis is a chronic immune-mediated demyelinating disease of the central nervous system and is the leading cause of disability in the young population. Approximately 1 million people in the United States currently have multiple sclerosis.

Progressive Spasticity With a Single Magnetic Resonance Imaging Lesion

2021 ◽  
pp. 20-21
Author(s):  
Samantha A. Banks ◽  
Eoin P. Flanagan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Fluid Analysis ◽  
Skin Cancers ◽  
Clinical Episode ◽  
History Of ◽  
The Right

A 59-year-old White man with a history of excised basal and squamous cell skin cancers was evaluated for gait difficulties. He had erectile dysfunction but no bowel or bladder dysfunction. He also reported fatigue. He began using a cane for ambulation 2 weeks before evaluation at our facility. His medications included vitamin D and sildenafil. He was a lifelong nonsmoker and had no family history of multiple sclerosis. Neurologic examination at the time of our evaluation 3 years after onset was notable for a positive Hoffman sign on the right and mild weakness of the right triceps but preserved strength elsewhere. He had a spastic gait with moderate spasticity in both lower extremities, hyperreflexic patellar and ankle jerks bilaterally, and bilateral positive Babinski sign. The remainder of the examination was essentially normal. Magnetic resonance imaging of the brain showed a single lesion at the cervicomedullary junction and medullary pyramids, more prominent on the right. There was also some accompanying atrophy that was also visible on cervical spine magnetic resonance imaging. Results of cerebrospinal fluid analysis showed a normal white blood cell count, increased protein concentration (108 mg/dL), and positive oligoclonal bands. The progressive nature of his symptoms, spinal fluid results, and lesion appearance were all consistent with a diagnosis of progressive solitary sclerosis. At the time this patient was seen, no immunomodulatory medications for progressive solitary sclerosis were approved, so no immunomodulatory medication was tried. Ongoing symptomatic management was recommended. Progressive solitary sclerosis is a rare variant of multiple sclerosis in which patients have a single central nervous system demyelinating lesion and development of motor progression attributable to that lesion. Patients can initially have a clinical episode followed by progression or can have a progressive course without an initial relapse.

Progressive Cerebellar Ataxia After Natalizumab Treatment

2021 ◽  
pp. 65-68
Author(s):  
Michel Toledano
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Polyoma Virus ◽  
Resonance Imaging ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

A 47-year-old woman with a history of relapsing-remitting multiple sclerosis (MS) receiving natalizumab therapy sought a second opinion regarding a recent diagnosis of secondary progressive disease. She was first diagnosed with multiple sclerosis 8 years earlier. While taking natalizumab, she was monitored for the development of antibodies to JC polyoma virus. Nine months before our evaluation, anti-JC polyoma virus antibodies became positive, with an increased index of 1.1. Given sustained remission, she was continued on natalizumab with increased surveillance and a plan to switch to a different disease-modifying therapy after 24 months. Five months later she noted subacute onset of slurred speech and right upper extremity incoordination. Over the next 4 months she continued to have clinical decline. On examination she had moderate ataxic dysarthria and right greater than left appendicular ataxia. She relied on a wheelchair for transportation and required 1-person assist to stand. Reflexes were brisk with bilateral Babinski sign. This patient with relapsing-remitting multiple sclerosis on natalizumab had a new subacute progressive cerebellar syndrome without radiographic evidence of disease activity. Repeated magnetic resonance imaging showed worsening cerebellar atrophy, right sided greater than left sided, and evolving T2 hyperintensity in the brainstem without enhancement or mass effect. JC polyoma virus polymerase chain reaction was positive. The patient was diagnosed with JC polyoma virus granule cell neuronopathy. Natalizumab was discontinued, and she was treated with 4 of 5 planned cycles of plasma exchange. After her 4th cycle, worsening symptoms developed. Magnetic resonance imaging showed gadolinium enhancement in the brainstem supportive of immune reconstitution inflammatory syndrome. She received high-dose intravenous methylprednisolone followed by a prednisone taper. Her disability progression stabilized. JC polyoma virus central nervous system infection, 1 of several infections reported among treated patients with multiple sclerosis, occurs almost exclusively in immunosuppressed patients, including those receiving disease-modifying therapy for multiple sclerosis.

scholarly journals Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis

2011 ◽  
Vol 17 (9) ◽  
pp. 1122-1129 ◽  
Author(s):  
Flavia Nelson ◽  
Sushmita Datta ◽  
Nereyda Garcia ◽  
Nigel L Rozario ◽  
Francisco Perez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Cognitive Status ◽  
Inversion Recovery ◽  
Cortical Lesions ◽  
Resonance Imaging

Background: Accurate classification of multiple sclerosis (MS) lesions in the brain cortex may be important in understanding their impact on cognitive impairment (CI). Improved accuracy in identification/classification of cortical lesions was demonstrated in a study combining two magnetic resonance imaging (MRI) sequences: double inversion recovery (DIR) and T1-weighted phase-sensitive inversion recovery (PSIR). Objective: To evaluate the role of intracortical lesions (IC) in MS-related CI and compare it with the role of mixed (MX), juxtacortical (JX), the sum of IC + MX and with total lesions as detected on DIR/PSIR images. Correlations between CI and brain atrophy, disease severity and disease duration were also sought. Methods: A total of 39 patients underwent extensive neuropsychological testing and were classified into normal and impaired groups. Images were obtained on a 3T scanner and cortical lesions were assessed blind to the cognitive status of the subjects. Results: Some 238 cortical lesions were identified (130 IC, 108 MX) in 82% of the patients; 39 JX lesions were also identified. Correlations between CI and MX lesions alone ( p = 0.010) and with the sum of IC + MX lesions ( p = 0.030) were found. A correlation between severity of CI and Expanded Disability Status Scale was also seen ( p = 0.009). Conclusion: Cortical lesions play an important role in CI. However, our results suggest that lesions that remain contained within the cortical ribbon do not play a more important role than ones extending into the adjacent white matter; furthermore, the size of the cortical lesion, and not the tissue-specific location, may better explain their correlation with CI.

Radiologically isolated syndrome – incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review

2012 ◽  
Vol 19 (3) ◽  
pp. 271-280 ◽  
Author(s):  
Tobias Granberg ◽  
Juha Martola ◽  
Maria Kristoffersen-Wiberg ◽  
Peter Aspelin ◽  
Sten Fredrikson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Disease Modifying Therapy ◽  
Radiologically Isolated Syndrome ◽  
Disease Modifying ◽  
Magnetic Resonance Imaging Mri

With increasing availability of magnetic resonance imaging (MRI), there is also an increase in incidental abnormal findings. MRI findings suggestive of multiple sclerosis in persons without typical multiple sclerosis symptoms and with normal neurological findings are defined as radiologically isolated syndrome (RIS). Half of the persons with RIS have their initial MRI because of headache, and some have a subclinical cognitive impairment similar to that seen in multiple sclerosis. Radiological measurements also show a similarity between RIS and multiple sclerosis. Approximately two-thirds of persons with RIS show radiological progression and one-third develop neurological symptoms during mean follow-up times of up to five years. Cervical cord lesions are important predictors of clinical conversion. Management has to be individualised, but initiation of disease modifying therapy is controversial and not recommended outside of clinical trials since its effects have not been studied in RIS. Future studies should try to establish the prevalence and long-term prognosis of RIS, its impact on quality of life, and define the role of disease modifying therapy in RIS.

Multiple sclerosis lesion formation and early evolution revisited: A weekly high-resolution magnetic resonance imaging study

2015 ◽  
Vol 22 (6) ◽  
pp. 761-769 ◽  
Author(s):  
Charles RG Guttmann ◽  
Matthieu Rousset ◽  
Jean A Roch ◽  
Salem Hannoun ◽  
Françoise Durand-Dubief ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Natural History ◽  
Contrast Enhancement ◽  
Blood Brain Barrier ◽  
Resonance Imaging ◽  
Lesion Formation ◽  
History Of

Background: Several magnetic resonance imaging (MRI) studies investigated the evolution of multiple sclerosis (MS) lesions to understand the pathophysiological mechanisms leading to blood-brain barrier breakdown and lesion formation. Only a few assessed the early natural history of MS lesions using short-interval longitudinal MRI. Objective: The purpose of this study was to characterize MS lesion occurrence and early evolution on high-resolution MRI acquired at weekly intervals. Methods: Active lesions were characterized on 3D fluid attenuation inversion recovery (FLAIR) and gadolinium-enhanced 3D T1-weighted MRI performed weekly (seven weeks) on five untreated patients with relapsing–remitting MS (RRMS). Results: Active lesions ( n=212) were detected in all patients. All showed contrast-enhancement on at least one time-point. Most new lesions (83.5%) were visible on FLAIR and post-contrast T1-weighted images at first detection; 11.2% showed activity on FLAIR images, one or more weeks before the appearance of contrast-enhancement; 12.5% enhanced before being apparent on FLAIR. Conclusion: Blood brain barrier disruption is a constant step in the natural history of active MS lesions, but does not always constitute the initial event. These findings are consistent with the existence of a subpopulation of lesions with an ‘inside-out’ genesis, where neurodegenerative processes might precede microglial activation, and a subsequent adaptive immune response.

Lesions Found by Chance

2021 ◽  
pp. 29-31
Author(s):  
Dean M. Wingerchuk
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Episodic Migraine ◽  
Periventricular White Matter ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Migraine Headaches ◽  
Radiologically Isolated Syndrome ◽  
History Of

A healthy 26-year-old woman with a history of episodic migraine without aura since age 12 years had a first-ever event of transient visual impairment. She reported to her neurologist that she “lost vision” for 15 minutes and described a “black blob” with a bright jagged border that moved across her binocular visual field and resolved without sequelae. Minutes later, one of her typical migraine headaches developed. Given the patient’s history of typical episodic migraine, the new visual event’s clinical characteristics were highly consistent with a migraine aura. Because of the new transient visual symptoms, the neurologist ordered brain magnetic resonance imaging, which showed several periventricular white matter lesions, including some that involved the corpus callosum and were oriented perpendicular to the septocallosal surface. The patient was counseled about the magnetic resonance imaging findings and expressed the desire to fully evaluate her risk of multiple sclerosis. The patient was diagnosed with radiologically isolated syndrome. The patient was counseled regarding the relevance of the magnetic resonance imaging findings and risk of future development of multiple sclerosis. She was not prescribed a disease-modifying therapy for multiple sclerosis. This patient has radiologically isolated syndrome —incidentally found magnetic resonance imaging lesions consistent with demyelination in a patient with no symptoms or signs suggestive of multiple sclerosis.

scholarly journals Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course

2012 ◽  
Vol 14 (3) ◽  
pp. 105-114 ◽  
Author(s):  
Stuart D. Cook ◽  
Suhayl Dhib-Jalbut ◽  
Peter Dowling ◽  
Luca Durelli ◽  
Corey Ford ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Consensus Conference ◽  
Disease Course ◽  
Clinical Classification ◽  
Resonance Imaging ◽  
International Consensus ◽  
Magnetic Resonance Imaging Mri

It has recently been suggested that the Lublin-Reingold clinical classification of multiple sclerosis (MS) be modified to include the use of magnetic resonance imaging (MRI). An international consensus conference sponsored by the Consortium of Multiple Sclerosis Centers (CMSC) was held from March 5 to 7, 2010, to review the available evidence on the need for such modification of the Lublin-Reingold criteria and whether the addition of MRI or other biomarkers might lead to a better understanding of MS pathophysiology and disease course over time. The conference participants concluded that evidence of new MRI gadolinium-enhancing (Gd+) T1-weighted lesions and unequivocally new or enlarging T2-weighted lesions (subclinical activity, subclinical relapses) should be added to the clinical classification of MS in distinguishing relapsing inflammatory from progressive forms of the disease. The consensus was that these changes to the classification system would provide more rigorous definitions and categorization of MS course, leading to better insights as to the evolution and treatment of MS.

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