Temporal and Clinical Course of Multiple Sclerosis

2016 ◽  
Author(s):  
Erica Grazioli ◽  
Channa Kolb ◽  
Bianca Weinstock-Guttman
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Characteristics ◽  
Progressive Disease ◽  
Clinical Course ◽  
Disease Classification ◽  
Clinical Relapse ◽  
Resonance Imaging ◽  
Genetic Biomarkers ◽  
Active Disease ◽  
Over Time

The temporal and clinical course of multiple sclerosis is heterogeneous, varying among patients as well as over time in the same individual. Greater specificity in describing disease classification and course is important for conduct of clinical trials as well as prognosis for individual patients. This chapter reviews the results of recent consensus panels that have further defined the relapsing and progressive forms of multiple sclerosis through clarification of clinical relapse, subclinical relapse, active disease, and progressive disease. Clinical characteristics, conventional and nonconventional magnetic resonance imaging metrics, and immunologic and genetic biomarkers that can be used to predict disease severity and course are also discussed.

2010 McDonald criteria in a pediatric cohort: is positivity at onset associated with a more aggressive multiple sclerosis course?

2013 ◽  
Vol 19 (10) ◽  
pp. 1359-1362 ◽  
Author(s):  
Sandra Bigi ◽  
Ruth A Marrie ◽  
Leonard Verhey ◽  
E Ann Yeh ◽  
Brenda Banwell
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Course ◽  
Expanded Disability Status Scale ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Disability Status ◽  
Annualized Relapse Rate ◽  
Magnetic Resonance Imaging Mri ◽  
Aggressive Clinical Course ◽  
Over Time

The 2010 McDonald criteria allow the diagnosis of multiple sclerosis (MS) at first attack in children and adults provided that the first attack symptoms are typical of MS and that the magnetic resonance imaging (MRI) conforms to prescribed features. We evaluate whether meeting the 2010 McDonald criteria at onset correlates with a more aggressive clinical course in a cohort of pediatric MS patients. The Expanded Disability Status Scale (EDSS) and annualized relapse rate were not associated with positivity for 2010 McDonald criteria at onset. The 2010 McDonald criteria identify children with similar MS features to those identified by clinical or MRI evidence of dissemination over time.

Mild gray matter atrophy in patients with long-standing multiple sclerosis and favorable clinical course

2021 ◽  
pp. 135245852110196
Author(s):  
Rosa Cortese ◽  
Marco Battaglini ◽  
Francesca Parodi ◽  
Maria Laura Stromillo ◽  
Emilio Portaccio ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Gray Matter ◽  
Clinical Course ◽  
Resonance Imaging ◽  
Volume Changes ◽  
Magnetic Resonance Imaging Mri ◽  
Global Brain ◽  
Diffuse Brain

The mechanisms responsible for the favorable clinical course in multiple sclerosis (MS) remain unclear. In this longitudinal study, we assessed whether magnetic resonance imaging (MRI)-based changes in focal and diffuse brain damage are associated with a long-term favorable MS diseases course. We found that global brain and gray matter (GM) atrophy changes were milder in MS patients with long-standing disease (⩾30 years from onset) and favorable (no/minimal disability) clinical course than in sex-age-matched disable MS patients, independently of lesions accumulation. Data showed that different trajectories of volume changes, as reflected by mild GM atrophy, may characterize patients with long-term favorable evolution.

At the heart of primary progressive multiple sclerosis: three cases with diffuse MRI abnormalities only

2008 ◽  
Vol 14 (3) ◽  
pp. 428-430 ◽  
Author(s):  
JNP Zwemmer ◽  
JCJ Bot ◽  
B. Jelles ◽  
F. Barkhof ◽  
CH Polman
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Course ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Resonance Imaging ◽  
Focal Lesions ◽  
Primary Progressive ◽  
Magnetic Resonance Imaging Mri ◽  
Brain And Spinal Cord ◽  
Made In

We present three patients with a clinical course and cerebrospinal fluid findings consistent with a diagnosis of primary progressive multiple sclerosis (PPMS). Extensive and repeated magnetic resonance imaging (MRI) examinations showed only diffuse abnormality in brain and spinal cord, but no focal lesions. We propose that these cases represent the most pure form of PPMS, even though according to currently applied criteria this diagnosis can not be made in the absence of focal lesions on MRI. Multiple Sclerosis 2008; 14: 428—430. http://msj.sagepub.com

Clinical course in multiple sclerosis patients presenting with a history of progressive disease

2014 ◽  
Vol 3 (1) ◽  
pp. 67-71 ◽  
Author(s):  
K.S. Pandey ◽  
S.C. Krieger ◽  
C. Farrell ◽  
C. Hannigan ◽  
T. DeAngelis ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Disease ◽  
Clinical Course ◽  
History Of ◽  
Multiple Sclerosis Patients

Baló's disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese

2008 ◽  
Vol 14 (3) ◽  
pp. 418-424 ◽  
Author(s):  
Chaodong Wang ◽  
Kun-Nan Zhang ◽  
Xiao-Mu Wu ◽  
Gang Huang ◽  
Xu-Fang Xie ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Clinical Course ◽  
Demyelinating Disorder ◽  
Baló’S Concentric Sclerosis ◽  
Chinese Subjects ◽  
Over Time

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder usually considered a variant of multiple sclerosis (MS). However, its pathogenesis and its correlation with MS remains unclear and controversial. This report presents seven Hans Chinese subjects diagnosed as BCS on the basis of the pathognomonic MR (magnetic resonance) findings. Upon diagnosis, all the cases displayed good responses to corticosteroids and showed an overall benign prognosis during a follow-up period of 4—13.5 years, although three relapsed later. MR findings suggest that the characteristic concentric lesions of BCS frequently (5/7) coexist with multiple sclerosis-like lesions. During follow-up, the Baló-like lesions may either dissolve over time or transform into an MS-like lesion. Moreover, the Balóand MS-like lesions occurred one after another at the onset and relapse phases of the same patient in two cases. These clinical features suggest that Baló's disease showing benign clinical course and co-existence of multiple sclerosis (MS)-like lesion is not rare among the Chinese, and strengthens the notion that BCS correlates intrinsically with MS. Multiple Sclerosis 2008; 14: 418—424. http://msj.sagepub.com

Demographics and clinical characteristics of episodic hypothermia in multiple sclerosis

2018 ◽  
Vol 25 (5) ◽  
pp. 709-714 ◽  
Author(s):  
Michel Toledano ◽  
Brian G Weinshenker ◽  
Timothy J Kaufmann ◽  
Joseph E Parisi ◽  
M Mateo Paz Soldán
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Disease ◽  
Expanded Disability Status Scale ◽  
Resonance Imaging ◽  
Altered Consciousness ◽  
Hypothalamic Lesions ◽  
Search Terms ◽  
Disability Status ◽  
Magnetic Resonance Imaging Mri ◽  
Putative Mechanism

Background: Episodic hypothermia (EH) can occur in multiple sclerosis (MS). The putative mechanism is impairment of thermoregulation due to a presumed demyelinating hypothalamic lesion. Objective: To describe a cohort of patients with MS, who developed EH. Methods: Patients were identified through review of the Mayo Clinic electronic medical record (1996 to July 2015). Search terms were [multiple sclerosis] or [MS] within the diagnoses field and [hypothermia] within any field. We reviewed records for accuracy of diagnoses and abstracted relevant data. Magnetic resonance imaging (MRI) was reviewed for presence of hypothalamic lesions. Results: Of 156 patients, 34 had concurrent MS and hypothermia. Thirty-two (94%) had progressive disease at EH onset. Median MS duration was 19.9 years, and median expanded disability status scale (EDSS) was 8.0. Most patients presented with alterations in consciousness. Infection was suspected as the precipitating factor in 19 (56%), but clinically/laboratory supported in only 9 (28%). MRI lesions were evident within the hypothalamus in only 4 (14%). Conclusion: EH occurs predominantly in patients with advanced secondary progressive MS. The major manifestation is altered consciousness. Infection is often suspected as causal, but infrequently confirmed. Although commonly implicated, hypothalamic lesions were rarely evident on MRI and were absent in two post-mortem evaluations.

Therapy of highly active pediatric multiple sclerosis

2017 ◽  
Vol 25 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Peter Huppke ◽  
Brenda Huppke ◽  
David Ellenberger ◽  
Kevin Rostasy ◽  
Hannah Hummel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Relapse Rate ◽  
Clinical Course ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Childhood And Adolescence ◽  
Pediatric Multiple Sclerosis ◽  
Highly Active ◽  
The Impact ◽  
Active Disease

Objective: Study aims were to determine the frequency of highly active disease in pediatric multiple sclerosis (MS), the response to natalizumab (NTZ) and fingolimod (FTY) treatment, and the impact of current treatment modalities on the clinical course. Methods: Retrospective single-center study in the German Center for MS in Childhood and Adolescence. Results: Of 144 patients with first MS manifestation between 2011 and 2015, 41.6% fulfilled the criteria for highly active MS. In total, 55 patients treated with NTZ and 23 with FTY demonstrated a significant reduction in relapse rate (NTZ: 95.2%, FTY: 75%), new T2 lesions (NTZ: 97%, FTY: 81%), and contrast-enhancing lesions (NTZ: 97%, FTY: 93%). However, seven patients switched from NTZ to FTY experienced an increase in disease activity. Comparing pediatric MS patients treated in 2005 with those treated in 2015 showed a 46% reduction in relapse rate and a 44% reduction in mean Expanded Disability Status Scale (EDSS). Conclusion: The rate of highly active disease among pediatric MS patients is high; more than 40% in our cohort. Response to NTZ and FTY treatment is similar if not better than observed in adults. Current treatment modalities including earlier treatment initiation and the introduction of NTZ and FTY have significantly improved the clinical course of pediatric MS.

scholarly journals Demographic and Clinical Overview of Hospitalized COVID-19 Patients during the First 17 Months of the Pandemic in Poland

2021 ◽  
Vol 11 (1) ◽  
pp. 117
Author(s):  
Robert Flisiak ◽  
Piotr Rzymski ◽  
Dorota Zarębska-Michaluk ◽  
Magdalena Rogalska ◽  
Marta Rorat ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Course ◽  
Gastrointestinal Symptoms ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Medical Centers ◽  
Later Phase ◽  
Clinical Overview ◽  
Over Time

Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze the demographics, early symptoms of infection, laboratory parameters, and clinical manifestation of COVID-19 patients hospitalized during the first 17 months of the pandemic in Poland (March 2020–June 2021). The patients’ demographical and clinical data (n = 5199) were extracted from the national SARSTer database encompassing 30 medical centers in Poland and statistically assessed. Patients aged 50–64 were most commonly hospitalized due to COVID-19 regardless of the pandemic period. There was no shift in the age of admitted patients and patients who died throughout the studied period. Men had higher C-reactive protein and interleukin-6 levels and required oxygenation and mechanical ventilation more often. No gender difference in fatality rate was seen, although the age of males who died was significantly lower. A share of patients with baseline SpO2 < 91%, presenting respiratory, systemic and gastrointestinal symptoms was higher in the later phase of a pandemic than in the first three months. Cough, dyspnea and fever were more often presented in men, while women had a higher frequency of anosmia, diarrhea, nausea and vomiting. This study shows some shifts in SARS-CoV-2 pathogenicity between March 2020 and July 2021 in the Polish cohort of hospitalized patients and documents various gender-differences in this regard. The results represent a reference point for further analyses conducted under the dominance of different SARS-CoV-2 variants.

scholarly journals Histopathology and serial, multimodal magnetic resonance imaging in a multiple sclerosis variant

2007 ◽  
Vol 13 (4) ◽  
pp. 471-482 ◽  
Author(s):  
S. Lindquist ◽  
N. Bodammer ◽  
J. Kaufmann ◽  
F. König ◽  
H.-J. Heinze ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Diffusion Tensor Imaging ◽  
Magnetic Resonance ◽  
Clinical Course ◽  
Diffusion Tensor ◽  
Magnetization Transfer ◽  
Resonance Spectroscopy ◽  
Resonance Imaging ◽  
Baló’S Concentric Sclerosis

Defining tools in magnetic resonance imaging (MRI) representing specific pathological processes is needed to understand the complex relationship between inflammation, myelin breakdown, axonal injury and clinical symptoms in multiple sclerosis (MS) and its variants. Here, we describe a case of histologically-defined MS, in which the radiological appearance of the lesion and clinical course support the diagnosis of Balo's concentric sclerosis. Serial magnetization transfer, diffusion tensor imaging and 1H-magnetic resonance spectroscopy, from 14 days to 13 months after biopsy, allow the contextual interpretation of specific pathological changes. In our case, acute inflammation was sensitively traced by fractional anisotropy and increased lactate in spectroscopy. In contrast, magnetization transfer ratio and the apparent diffusion coefficient monitor the sequential loss of tissue in selected rings of the lesion. The delay from the peak of symptoms in a dramatic clinical course to the maximum tissue destruction indicated through MRI suggests that compromise of axonal function may be decisive for the acute clinical situation. This is the first report comparing 1Hmagnetic resonance spectroscopy, magnetization transfer and diffusion tensor imaging with histopathology in a patient with Balo's concentric sclerosis. Multiple Sclerosis 2007; 13: 471-482. http://msj.sagepub.com

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