scholarly journals MON-258 Hyperprolactinemia: An Unusual Initial Presenting Manifestation of Multiple Sclerosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
MaKenzie Hodge ◽  
Vijaya A Ganta ◽  
Gail Louise Nunlee-Bland ◽  
Wolali Akua-Sabia Odonkor ◽  
Anteneh Woldetensay Zenebe ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dopamine Agonist ◽  
Prolactin Level ◽  
Visual Fields ◽  
Nipple Discharge ◽  
Clinical Signs ◽  
Marijuana Use ◽  
Disease Marker ◽  
Regular Menses ◽  
Dopaminergic Agent

Abstract Hyperprolactinemia and multiple sclerosis (MS) have a direct relationship and hyperprolactinemia may precede clinical signs of MS as a heralding manifestation of disease. Prolactin has significant pro-inflammatory effects in addition to its lactotrophic properties and can also lower the body’s immune tolerance, inducing autoimmunity. High levels of prolactin have been thought to contribute to the inflammation of multiple sclerosis. However, elevated levels of prolactin, especially in pregnant women, can be protective for MS patients and induce remission. Prolactin is neuroregenerative and stimulates the precursors for oligodendrocytes, the cells responsible for myelination. Our hypothesis is that an elevated prolactin level detected during an MS flare should not be treated with dopamine agonist, but rather allowed to decrease as the MS improves with treatment. Case Presentation A 24 year old woman with a history of marijuana use is referred to our clinic for elevated prolactin levels associated with galactorrhea for 3 months duration. In addition to marijuana use, patient was also sexually active and having regular menses, with menarche at age 11 years old. On physical exam, the patient was found to have bilateral nipple discharge with stimulation, and visual fields were intact to confrontation. At the time of referral, the patient’s prolactin was 92.3 ng/dL (4.8−23.3 ng/mL) TSH was normal, and pregnancy test negative.An MRI showed multiple areas of enhancement compatible with active demyelination, concerning for multiple sclerosis. The pituitary gland was enlarged, without evidence of adenoma. A follow up prolactin level was 101 ng/dL and upon further discussion, patient also admitted to some “funny feeling” and weakness in her right hand and a feeling of being “off balance” diagnosed as a left ear infection. Patient was advised to seek urgent treatment for multiple sclerosis. She was admitted, where she was seen by neurology and diagnosed with relapsing remitting multiple sclerosis. She was initially treated with a course of IV methylprednisolone. She was discharged after this course and followed with neurology as an outpatient. For a few months our patient went into remission and her prolactin improved to 24 ng/dL. A few months later, she had a significant increase in her prolactin to 71.5 ng/dL accompanied by evidence of disease progression on MRI and symptoms of weakness and falls. Neurologists changed her medication from Copaxone to Tecfidera and patient improved clinically and has not had any further flares. Notably, she never received any dopaminergic agent to treat her prolactin level, which improved significantly.Our case illustrates that prolactin may be a disease marker in the acute phase of MS and can be restorative. Further more it will improve when the MS is treated and we should not use any dopamine agonist.

CRYAB modulates the activation of CD4+ T cells from relapsing–remitting multiple sclerosis patients

2013 ◽  
Vol 19 (14) ◽  
pp. 1867-1877 ◽  
Author(s):  
Que Lan Quach ◽  
Luanne M Metz ◽  
Jenna C Thomas ◽  
Jonathan B Rothbard ◽  
Lawrence Steinman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
T Cells ◽  
Cytokine Production ◽  
Clinical Signs ◽  
Healthy Controls ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Background: Suppression of activation of pathogenic CD4+ T cells is a potential therapeutic intervention in multiple sclerosis (MS). We previously showed that a small heat shock protein, CRYAB, reduced T cell proliferation, pro-inflammatory cytokine production and clinical signs of experimental allergic encephalomyelitis, a model of MS. Objective: We assessed whether the ability of CRYAB to reduce the activation of T cells translated to the human disease. Methods: CD4+ T cells from healthy controls and volunteers with MS were activated in vitro in the presence or absence of a CRYAB peptide (residues 73–92). Parameters of activation (proliferation rate, cytokine secretion) and tolerance (anergy, activation-induced cell death, microRNAs) were evaluated. Results: The secretion of pro-inflammatory cytokines by CD4+ T cells was decreased in the presence of CRYAB in a subset of relapsing–remitting multiple sclerosis (RRMS) participants with mild disease severity while no changes were observed in healthy controls. Further, there was a correlation for higher levels of miR181a microRNA, a marker upregulated in tolerant CD8+ T cells, in CD4+ T cells of MS patients that displayed suppressed cytokine production (responders). Conclusion: CRYAB may be capable of suppressing the activation of CD4+ T cells from a subset of RRMS patients who appear to have less disability but similar age and disease duration.

scholarly journals Metabolomic Signature in Sera of Multiple Sclerosis Patients during Pregnancy

2018 ◽  
Vol 19 (11) ◽  
pp. 3589 ◽  
Author(s):  
Claudia Rossi ◽  
Ilaria Cicalini ◽  
Mirco Zucchelli ◽  
Maria di Ioia ◽  
Marco Onofrj ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Signs ◽  
Female Gender ◽  
Epidemiological Studies ◽  
Mass Spectrometry Analysis ◽  
Spectrometry Analysis ◽  
Hormonal Fluctuations ◽  
The Central Nervous System ◽  
Multiple Sclerosis Patients

Multiple sclerosis (MuS) is an autoimmune disease of the central nervous system characterized by neuroinflammation, neurodegeneration, and degradation of the myelin sheath. Epidemiological studies have shown that the female gender is more susceptible than the male gender to MuS development, with a female-to-male ratio of 2:1. Despite this high onset, women have a better prognosis than men, and the frequency of the relapsing phase decreases during pregnancy, while it increases soon after birth. Therefore, it is interesting to investigate hormonal fluctuations during pregnancy and whether they correlate with metabolic signatures. To gain a deeper inside into the biochemical mechanism of such a multifactorial disease, we adopted targeted metabolomics approaches for the determination of many serum metabolites in 12 pregnant women affected by MuS by mass spectrometry analysis. Our data show a characteristic hormonal fluctuation for estrogens and progesterone, as expected. They also highlight other interesting hormonal alterations for cortisol, corticosterone, 11-deoxycortisol, 4-androstene-3,17-dione, testosterone, and 17α-hydroxyprogesterone. Furthermore, a negative correlation with progesterone levels was observed for amino acids and for acylcarnitines, while an imbalance of different sphingolipids pathways was found during pregnancy. In conclusion, these data are in agreement with the characteristic clinical signs of MuS patients during pregnancy and, if confirmed, they may add an important tessera in the complex mosaic of maternal neuroprotection.

scholarly journals Еvaluation data somatosensory evoked potentials and electromyography in patients with multiple sclerosis in the aspect comorbidity

2017 ◽  
pp. 22-29
Author(s):  
G. Chupryna ◽  
N. Svyrydova ◽  
T. Parnikoza
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Pathological Process ◽  
Psychological Status ◽  
Sensorimotor Polyneuropathy ◽  
Initial Stage ◽  
Prevalence Of Pain

The paper shows the results of electrophysiological methods of investigation in patients with multiple sclerosis (MS) in the aspect of comorbidity. The studies of somatosensory evoked potentials (SSEP) in 216 patients with MS and electroneuromyography in 158 patients with MS, together with the assessment of neurological and psychological status. It is shown that according SSEP increase latency peripheral response in a progressive course of MS compared to remitting associated with older age of patients with progressive MS, and due to involvement in the pathological process of the peripheral nervous system (PNS) and the prevalence of pain syndrome (PS) in patients MS with comorbidity. It is demonstrated, on the basis of electroneuromyographic that MS patients with comorbidity tends to be deeper shock PNS. The data electroneuromyographic clinically appropriate initial stage of sensory or sensorimotor polyneuropathy, which proceeded in 84.8% of patients with MS subclinical and 15.2% had a clear clinical signs.

scholarly journals Impact of Astrocyte Depletion upon Inflammation and Demyelination in a Murine Animal Model of Multiple Sclerosis

2019 ◽  
Vol 20 (16) ◽  
pp. 3922 ◽  
Author(s):  
Allnoch ◽  
Baumgärtner ◽  
Hansmann
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Calcium Binding ◽  
Performance Test ◽  
Intraperitoneal Administration ◽  
Clinical Signs ◽  
Aquaporin 4 ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
The Impact

Astrocytes play a key role in demyelinating diseases, like multiple sclerosis (MS), although many of their functions remain unknown. The aim of this study was to investigate the impact of astrocyte depletion upon de- and remyelination, inflammation, axonal damage, and virus distribution in Theiler`s murine encephalomyelitis (TME). Groups of two to six glial fibrillary acidic protein (GFAP)-thymidine-kinase transgenic SJL mice and SJL wildtype mice were infected with TME virus (TMEV) or mock (vehicle only). Astrocyte depletion was induced by the intraperitoneal administration of ganciclovir during the early and late phase of TME. The animals were clinically investigated while using a scoring system and a rotarod performance test. Necropsies were performed at 46 and 77 days post infection. Cervical and thoracic spinal cord segments were investigated using hematoxylin and eosin (H&E), luxol fast blue-cresyl violet (LFB), immunohistochemistry targeting Amigo2, aquaporin 4, CD3, CD34, GFAP, ionized calcium-binding adapter molecule 1 (Iba1), myelin basic protein (MBP), non-phosphorylated neurofilaments (np-NF), periaxin, S100A10, TMEV, and immunoelectron microscopy. The astrocyte depleted mice showed a deterioration of clinical signs, a downregulation and disorganization of aquaporin 4 in perivascular astrocytes accompanied by vascular leakage. Furthermore, astrocyte depleted mice showed reduced inflammation and lower numbers of TMEV positive cells in the spinal cord. The present study indicates that astrocyte depletion in virus triggered CNS diseases contributes to a deterioration of clinical signs that are mediated by a dysfunction of perivascular astrocytes.

scholarly journals Serial Assessment of Cardiac Function during and following Mitoxantrone Infusion in 30 Consecutive Patients with Multiple Sclerosis

2010 ◽  
Vol 2010 ◽  
pp. 1-4
Author(s):  
Damian Franzen ◽  
Angelika Haus ◽  
Martin Hellmich
Keyword(s):  
Multiple Sclerosis ◽  
Heart Failure ◽  
Cardiac Function ◽  
Low Dose ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Cardiac Effect ◽  
Left Ventricular ◽  
History Taking ◽  
Dose Dependent

Immunosuppressive therapy is an established therapeutic option in patients suffering from multiple sclerosis (MS). In an open nonrandomized study we serially assessed cardiac function in 30 consecutive patients with MS before, during, and after mitoxantrone therapy. Mitoxantrone (12 mg/m2) was administered intravenously at 3-month intervals. Before each infusion, cardiac function was assessed by history taking, resting electrocardiogram, and echocardiography. Whereas no patient experienced clinical signs of heart failure, left ventricular pump function decreased continuously during mitoxantrone therapy and did not recover after cessation. The presented data suggest a dose-dependent and long-lasting toxic cardiac effect of low-dose mitoxantrone therapy in MS.

Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations

2004 ◽  
Vol 10 (3) ◽  
pp. 316-321 ◽  
Author(s):  
D Alpini ◽  
L Pugnetti ◽  
D Caputo ◽  
F Cornelio ◽  
S Capobianco ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Vestibular Evoked Myogenic Potentials ◽  
Vestibular Disorders ◽  
Mri Findings ◽  
Mean Delay ◽  
Stance Control ◽  
Specific Skill ◽  
Prolonged Latency

Patients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinal involvement are posturography and vestibular evoked myogenic potentials (VEMPs). While posturography cannot be performed in every subject requiring minimal stance control, VEMPs do not require any specific skill on the part of the subjects and they may be investigated in all patients able to sit. VEMPs were recorded for 40 patients (17 men, 23 women; mean age 38 years, range 17-71 years) fulfilling diagnostic criteria of clinically defined MS, by means of rarefaction clicks, recording modulation of sterno-cleido-mastoideus tonic contraction saccule-mediated modulation. VEMPs were found to be abnormal in 28 of 40 patients. In 18 of the cases the VEMPs were asymmetric, i.e., had a prolonged latency on one side. In six cases latency was increased on both sides (mean delay 4.1 ms). In four subjects VEMPs were absent on one side. C oncordance with clinical findings of presence/absence of brainstem involvement was found in 55% and with MRI findings in 65% of the cases. A bnormal VEMPs indicated brainstem dysfunction in four patients (10%) with normal MRI and no specific clinical signs.

Bovine spastic syndrome: a review

2018 ◽  
Vol 182 (24) ◽  
pp. 693-693 ◽  
Author(s):  
Victoria Goeckmann ◽  
Sophie Rothammer ◽  
Ivica Medugorac
Keyword(s):  
Multiple Sclerosis ◽  
Physical Therapy ◽  
Clinical Signs ◽  
Hereditary Disease ◽  
Neuromuscular Disorder ◽  
Future Research ◽  
Interesting Aspect ◽  
Similar Disease ◽  
Spastic Paresis ◽  
First Time

Bovine spastic syndrome (BSS) was described for the first time in 1941. The disease occurs in various—maybe even all—cattle breeds and is a chronic-progressive neuromuscular disorder that commonly affects cattle of at least three years of age. Typical clinical signs of the disease are clonic-tonic cramps of the hindlimbs that occur in attacks. Since BSS does not recover, affected animals can only be treated symptomatically by improving welfare conditions and management factors, or with physical therapy or drugs. Although still not irrevocably proven, BSS is assumed to be a hereditary disease. Therefore, affected animals should be excluded from breeding, which negatively affects economics and breeding. Besides epidemiology, clinical signs, aetiopathogenesis, diagnosis and treatment, this review discusses genetic aspects and differences to the similar disease bovine spastic paresis. Furthermore, this review also picks up the discussion on possible parallels between human multiple sclerosis and BSS as a further interesting aspect, which might be of great interest for future research.

scholarly journals Atypical Multiple Sclerosis Presenting as Bilateral Optic Neuritis

2021 ◽  
Vol 20 (4) ◽  
pp. 182-188
Author(s):  
Sun Young Lee ◽  
Mi-Ra Park
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Oral Steroid ◽  
High Signal ◽  
High Dose ◽  
Color Test ◽  
Blurred Vision ◽  
Lower Extremity Weakness

Purpose: We report a case of multiple sclerosis with bilateral optic neuritis that was atypical in terms of both the clinical signs and symptoms.Case summary: A 34-year-old female visited the department of neurology with a complaint of sudden-onset, left lower extremity weakness and numbness that had developed 3 weeks prior, and bilateral blurred vision that had commenced 2 weeks prior. The patient was diagnosed with multiple sclerosis and prescribed high-dose intravenous methylprednisolone for 3 days, but the blurred vision did not improve. The patient was referred to the ophthalmology department. The initial best-corrected visual acuity was 0.04 in both eyes, and the relative afferent pupillary defect test was positive for the left eye. The Ishihara color test scores were 1/17 for both eyes. No optic disc swelling was evident on fundus examination. Brain and spine magnetic resonance imaging (T2-weighted) performed during the initial visit revealed lesions of high signal intensity in the frontal, subcortical white matter; the optic chiasm; the left retrobulbar optic segment; the medulla; and the spinal C2-5 processes. Aquaproin-4 immunogloblin G antibody (AQP4-IgG Ab) was not detected in serum. One month after prescription of the oral steroid, the vision improved to 1.0 in the right and 0.8 in the left eye. The patient was lost to follow-up after prescription of interferon-beta for 4 years, without recurrence.Conclusions: Binocular optic neuritis accompanied by severe visual loss is a rare form of multiple sclerosis. A thorough diagnosis (with a focus on exclusion) is required, as is appropriate treatment.

scholarly journals Comparative efficacy of various therapeutic protocols in the treatment of pyometra in bitches

2013 ◽  
Vol 58 (No. 5) ◽  
pp. 271-276 ◽  
Author(s):  
B. Jena ◽  
KS Rao ◽  
KCS Reddy ◽  
KBP Raghavender
Keyword(s):  
Dopamine Agonist ◽  
Biochemical Parameters ◽  
Clinical Signs ◽  
The Other ◽  
Control Group ◽  
Untreated Control Group ◽  
Comparative Efficacy ◽  
Open Type ◽  
Abdominal Palpation ◽  
Therapeutic Protocols

This study was undertaken on canine pyometra and consisted of 28 bitches of different breeds with known breeding history and open type of pyometra. The diagnosis of pyometra was made by correlating the history and clinical signs with the findings of abdominal palpation, radiography and ultrasonography. The physiological, haematological and biochemical parameters were evaluated before and at the end of therapy. The clinical cases were divided randomly into four different groups with each group consisting of seven bitches. One untreated control group in which bitches were given only supportive therapies was included. The bitches in the other three groups were treated using natural PGF<sub>2</sub>&alpha; or synthetic PGF<sub>2</sub>&alpha; or a combination of a dopamine agonist prolactin-inhibiting drug, i.e., cabergoline and lower dose of synthetic PGF<sub>2</sub>&alpha; (Cloprostenol) along with supportive therapies. Treatment of canine pyometra by the use of different drugs was found to be successful. Though a lower dose of cloprostenol was effective in treating pyometra, it is not recommended due to high rates of recurrence and lower conception rates. Treatment of canine pyometra using a combination of a dopamine agonist prolactin-inhibiting drug (Cabergoline) and a lower dose of synthetic PGF<sub>2</sub>&alpha; (Cloprostenol) was found to be the most effective method among the three therapeutic protocols used in the present study. &nbsp;

Relationship between clinical signs and hormonal analytical findings in bitches with lactatio sine graviditate

2021 ◽  
Vol 49 (03) ◽  
pp. 174-182
Author(s):  
Sebastian Ganz ◽  
Carla Olschewski ◽  
Klaus Failing ◽  
Hartwig Bostedt
Keyword(s):  
Peripheral Blood ◽  
Prolactin Level ◽  
Clinical Relevance ◽  
Reference Range ◽  
Clinical Signs ◽  
Hormone Profile ◽  
The Individual ◽  
Almost All ◽  
Estradiol 17Β

Abstract Objective Lactatio sine graviditate of the bitch can become clinically relevant in particularly severe manifestations. The aim of the study was to relate the hormone pattern consisting of progesterone (P4), estradiol 17β (E2) and prolactin to the time of occurrence of lactatio sine graviditate in the course of metoestrus and anoestrus as well as to its symptomatology. Material and methods Sixty-eight bitches with apparent lactatio sine graviditate were divided into 3 groups according to their cycle status. All bitches were examined for gynaecological findings. Furhtermore, their blood progesterone, oestrogen, and prolactin concentrations were determined and compared with the 133-day hormone profile of 7 control animals. Results Lactatio sine graviditate occurring in early metoestrus was characterised more by a shifted P4:E2 ratio than by hyperprolactinaemia. Overall, the prolactin concentration in the peripheral blood was significantly increased. Analysis of the individual cases revealed that hyperprolactinaemia was present to varying degrees. It could be detected in almost all bitches that showed full symptomatology at the end of metoestrus or at the beginning of anoestrus. Only then clinical signs correlated with an increased prolactin concentration in the peripheral blood. In most cases, the estradiol-17β concentration was within the reference range. Conclusion and clinical relevance The study indicates that the administration of prolactin inhibitors alone is not indicated in all cases of lactatio sine graviditate and that the timepoint of onset of the clinically relevant symptoms and the current prolactin level should be taken into account in the treatment of affected bitches.

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