scholarly journals A Multiple Sclerosis Patient Benefitting from CSF Flow Enhancement Had Imaging Signs of "Glymphatic-Lymphatic System Disease." Case Report

2021 ◽  
Author(s):  
Antonio Scollato ◽  
Francesco Lolli ◽  
Giancarlo Lastrucci ◽  
Anna Repice ◽  
Giuseppe De Santis ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lymphatic System ◽  
Immune Surveillance ◽  
Csf Shunt ◽  
Perivascular Spaces ◽  
Primary Progressive Multiple Sclerosis ◽  
Imaging Features ◽  
Csf Flow ◽  
Disease Case ◽  
Flow Enhancement

Abstract Background The derangement of CSF circulation impacts the functions of glymphatic-lymphatic system (G-Ls), which regulates solute trafficking and immune surveillance in the CNS. The imaging features of dilated perivascular spaces imply the substantial impairment of the G-Ls and can be easily estimated It has been proposed that multiple sclerosis can be viewed as a disease involving a failure component and therapeutically could be targeted as such.Case presentationWe report the case of a female patient diagnosed with primary progressive multiple sclerosis, also presenting perivascular spaces dilatation, who transiently improved after CSF shunt diversions. ConclusionsThe G-Ls failure leads to dysregulation of waste molecule clearance in the brain and an altered CNS immune response, potentially in many diseases. The clinical improvement observed in our patient may relate to an increased clearance of inflammatory mediators following the G-Ls reestablishment obtained by CSF flow enhancement.

Overview of primary progressive multiple sclerosis (PPMS): similarities and differences from other forms of MS, diagnostic criteria, pros and cons of progressive diagnosis

2004 ◽  
Vol 10 (3_suppl) ◽  
pp. S2-S7 ◽  
Author(s):  
Alan Thompson
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Criteria ◽  
Disease Process ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Imaging Features ◽  
Primary Progressive ◽  
Relapsing Remitting ◽  
Diagnostic Difficulties ◽  
Pros And Cons

Patients with the primary progressive form of multiple sclerosis (PPMS) have a unique clinical course and demonstrate additional demographic and imaging features, which separate them from the relapsing/remitting form of the condition. Whether these features indicate a fundamental difference in the underlying patho genesis of the condition or simply reflect opposite ends of a clinical spectrum is unclear. What is clear, however, is that this form of MS provides a valuable model of progression, which has the potential to explain this most disabling component of the disease process. The lack of the hallmark relapses and remissions in PPMS poses diagnostic difficulties, some of which have been addressed by recently published diagnostic criteria. Following diagnosis, the need for information, specific to this form of MS, must be recognized and addressed.

Blood-flow Restriction Training for a Person With Primary Progressive Multiple Sclerosis: A Case Report

2020 ◽  
Author(s):  
Evan T Cohen ◽  
Nicole Cleffi ◽  
Marianne Ingersoll ◽  
Herb I Karpatkin
Keyword(s):  
Multiple Sclerosis ◽  
Blood Flow ◽  
Case Report ◽  
Physical Therapist ◽  
Blood Flow Restriction ◽  
Patient Specific ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
Flow Restriction ◽  
Strength Tests

Abstract Objective Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-intensity resistance training (LIRT) has resulted in gains comparable to traditional progressive resistive exercise in healthy populations. The use of BFR with LIRT may enable people with multiple sclerosis (MS) to improve strength without an increase in fatigue. The purpose of this case report is to describe the use of a BFR/LIRT program for a person with MS. Methods (Case Description) The patient was a 54-year-old woman with a 13-year history of primary progressive MS with an Extended Disability Severity Score of 3.0 out of 10. She received a BFR/LIRT program for both lower extremities (LE) biweekly for 12 weeks. Outcomes measured at baseline and at 6 and 12 weeks included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale (FSS), Patient-Specific Functional Scale (PSFS) (goals: running for exercise and pleasure for 45 minutes, 100% confidence in negotiating a flight of stairs, confidently and safely drive without restriction), and 14 LE strength tests. Results The intervention was well tolerated without adverse events. After 6 weeks, the MSWS-12 score improved; however, it did not exceed minimum detectable change (MDC). FSS was unchanged. All PSFS goals improved beyond MDC, and improvements in strength exceeded MDC in 2 out of 14 tests. After 12 weeks, MSWS-12 improvements persisted and the FSS score improved, but neither exceeded MDC. The PSFS improvements persisted. There were improvements exceeding MDC for 8 out of 14 strength tests. The remaining 6 strength tests improved but did not exceed MDC. Conclusion The patient had measurable improvements following the use of a BFR/LIRT program. BFR/LIRT may be an option for strength training in people with MS; however, research is needed to determine its safety and effectiveness across the population of people with MS. Impact Traditional physical therapist interventions for people with MS have been shown to be beneficial; however, their usefulness has been limited by fatigue. A growing body of literature has demonstrated the effects of a BFR/LIRT program on strength and other measures of physical function in healthy populations and those with chronic disease. This case report adds missing information to the existing literature and suggests directions for research on the effectiveness of BFR/LIRT in people with primary progressive MS.

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