scholarly journals COEXISTENCE OF MULTIPLE SCLEROSIS AND ALZHEIMER DISEASE: WHAT WE KNOW SO FAR?

2021 ◽  
Author(s):  
Igor Santiago ◽  
Victor Elias ◽  
Ivna Nóbrega ◽  
Gabriela Martins ◽  
José Artur D’Almeida ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Alzheimer Disease ◽  
Brain Mri ◽  
Poor Response ◽  
Executive Dysfunction ◽  
Oligoclonal Bands ◽  
Retrospective Case ◽  
Csf Analysis ◽  
Age Related ◽  
Pet Ct

Background: Multiple sclerosis (MS) and Alzheimer disease (AD) are neurodegenerative diseases with distinct pathophysiology but similar burdens. Early cognitive impairment in MS is unusual but, due to disease modifying therapies (DMT) advancements and bigger life expectancy, its coexistence with AD has become more common. Objective: To report a coexistence case of MS and AD. Methods: Retrospective case report and literature review. Results: 58-year-old patient presented with work issues, behavioral changes, gait disturbance and unbalance. It was disclosed an impairment of attention span, multitasking, executive dysfunction, and loss of memory for recent events. A PET/CT showed hypometabolism in frontal lobes and CSF analysis disclosed oligoclonal bands and increased TAU protein levels. The patient was initially treated with donepezil, with poor response. A later brain MRI showed typical demyelinating MS lesions. The patient was treated with Natalizumab due to high lesion load and functional impairment. Conclusion: As MS patients live longer, it’s important to recognize age-related comorbidities such as AD. In our patient a poor relapse perception contributed for a late MS diagnosis. The evaluation with PET/CT and increased TAU levels in CSF highly suggests a coexistence with AD. There are no peer-reviewed studies regarding coexisting MS and AD. Further research is necessary to better understand the clinical, demographic, and neuropathological features of the coexistence of both diseases.

Distinguishing neurosarcoidosis from multiple sclerosis based on CSF analysis

Neurology ◽  
2020 ◽  
Vol 94 (24) ◽  
pp. e2545-e2554
Author(s):  
Tarunya Arun ◽  
Laura Pattison ◽  
Jacqueline Palace
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Total Protein ◽  
White Cell Count ◽  
Binary Logistic Regression ◽  
White Cell ◽  
Oligoclonal Bands ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Oligoclonal Igg

ObjectiveTo characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS).MethodsThis retrospective cohort study enrolled 85 patients with a diagnosis of neurosarcoidosis (possible, probable, or definite). CSF total protein, white cell count, and angiotensin-converting enzyme levels were measured. CSF and serum oligoclonal immunoglobulin G (IgG) patterns were analyzed with the use of odds ratios and binary logistic regression.ResultsEighty patients had a probable (nonneural positive histology) or definite (neural positive histology) diagnosis of neurosarcoidosis. Most frequent findings on MRI were leptomeningeal enhancement (35%) and white matter and spinal cord involvement (30% and 23%). PET scan showed avid areas in 74% of cases. CSF analysis frequently showed lymphocytosis (63%) and elevated protein (62%), but CSF-selective oligoclonal bands were rare (3%). Serum ACE levels were elevated in 51% of patients but in only 14% of those with isolated neurosarcoidosis. Elevated CSF ACE was not found in any patient.ConclusionsLarge elevations in total protein, white cell count, and serum ACE occur in neurosarcoidosis but are rare in MS. The diagnostic use of these tests is, however, limited because minimal changes may occur in both. MS clinical mimics in neurosarcoidosis are not common, and intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is rare in neurosarcoidosis but occurs in 95% to 98% cases of MS. We suggest caution in making a diagnosis of neurosarcoidosis when intrathecal oligoclonal IgG synthesis is found.

Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study

2008 ◽  
Vol 14 (4) ◽  
pp. 485-493 ◽  
Author(s):  
MA Leone ◽  
S. Bonissoni ◽  
L. Collimedaglia ◽  
F. Tesser ◽  
S. Calzoni ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Mri ◽  
Total Duration ◽  
Oligoclonal Bands ◽  
Relapsing Remitting ◽  
Environmental Background ◽  
Maximum Improvement ◽  
A Prospective Study ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Speed Of Onset

Objective To prospectively evaluate predictors of incomplete recovery after the first attacks in a cohort of patients with clinically isolated syndrome or relapsing—remitting multiple sclerosis. Methods Seventy-two consecutive patients recruited from January 2001 to December 2003, evaluated every six months or at any relapse up to 31 July 2005. Relapse intervals were calculated from the date of onset, nadir, onset of improvement and maximum improvement. Predictive factors analysed were relapse-related (age at relapse onset, season and severity of the relapse, type of symptoms, speed of onset, plateau and total duration, number of affected Functional systems, preceding infections) and individual-related (gender, age at first attack, season of birth and first attack, characteristics of first brain MRI and cerebrospinal fluid oligoclonal bands, Link Index, IgG). Results We counted 209 attacks: 44 (21%) left mild sequelae, and 27 (13%) severe. The highest probability of sequelae was associated with sphincteric symptoms (9/20; 45%), followed by sensitive (38/113; 34%), motor (20/84; 24%), visual (13/61; 21%), cerebellar (4/24; 17%), brainstem (5/44; 11%) and others (0/6) ( P 0.005). Four variables were still relevant to predict sequelae after multivariate analysis: mild, moderate or severe relapses versus very mild (Odds ratio = 17.2, 95% confidence limits = 2.2—136.4), intermediate or long relapses versus short (3.2, 1.5—6.9), age ≥ 30 at relapse onset (2.9, 1.5—5.7) and bi-polysymptomatic versus monosymptomatic (2.2, 1.1—4.3). Conclusions Factors predicting incomplete recovery are more closely linked to the characteristics of the single relapse (extension and duration of tissue damage) than to the patient's genetic and environmental background. Multiple Sclerosis 2008; 14: 485—493. http://msj.sagepub.com

Foreign accent syndrome as a first sign of multiple sclerosis

2009 ◽  
Vol 15 (9) ◽  
pp. 1123-1125 ◽  
Author(s):  
JB Chanson ◽  
S Kremer ◽  
F Blanc ◽  
C Marescaux ◽  
IJ Namer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Right Hemisphere ◽  
Brain Mri ◽  
Photon Emission ◽  
Brain Magnetic Resonance Imaging ◽  
Foreign Accent ◽  
Oligoclonal Bands ◽  
Emission Computed Tomography ◽  
Initial Symptom ◽  
Foreign Accent Syndrome

Background Foreign accent syndrome (FAS) consists of a speech rhythm disorder different from dysarthia or aphasia. It is unusually met in multiple sclerosis (MS). Objective We report a case of FAS as an initial symptom of a MS. Methods A right-handed French woman developed an isolated German foreign accent. Brain magnetic resonance imaging (MRI), SPECT and analysis of CSF were performed. Results Brain MRI revealed a large hypersignal on T2-weighted images in the left prerolandic white matter. Single photon emission computed tomography showed a right prerolandic hypoperfusion. Unmatched oligoclonal bands in cerebrospinal fluid and occurrence of new abnormal hypersignals on the following MRI led us to diagnose MS. Conclusion FAS may be the first symptom of MS. It could result from extensive disturbances of brain function involving the right hemisphere.

Is Devic's neuromyelitis optica a separate disease? A comparative study with multiple sclerosis

2003 ◽  
Vol 9 (5) ◽  
pp. 521-525 ◽  
Author(s):  
J de Seze ◽  
C Lebrun ◽  
T Stojkovic ◽  
D Ferriby ◽  
M Chatel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Brain Mri ◽  
Oligoclonal Bands ◽  
Time And Space ◽  
Laboratory Findings ◽  
Therapeutic Trials ◽  
The Difference ◽  
Devic’S Neuromyelitis Optica

Devic's neuromyelitis optica (NMO) associates optic neuritis and myelopathy without other neurological signs. Many patients with NMO may be diagnosed as having multiple sclerosis (MS). However, there have been no previous studies comparing these two patho logies and it is still unclear if NMO is a separate entity or a subtype of MS. In the present study, we compared a series of NMO patients with a series of MS patients for whom optic neuritis or myelopathy was the presenting symptom, in order to determine the place of NMO in the spectrum of MS. We retrospectively studied 30 patients diagnosed with NMO and we compared these patients with 50 consecutive MS cases revealed by optic neuritis or acute myelopathy. MS patients were only included if a relapse occurred demonstrating time and space dissemination. We compared the two groups in terms of clinical presentatio n, laboratory findings (MRI and C SF) and clinical outcome. NMO patients were older and more frequently women than MS patients but the difference was not significant. C SF and MRI data were clearly different: oligoclonal bands (O C B) were found in 23% of NMO cases and 88% of MS (P B/0.001), abnormal brain MRI data were observed in 10% of NMO cases and 66% of MS (P B/0.001) and a large spinal cord lesion was observed in 67% of NMO cases and 7.4% of MS cases (P B/0.001). C linical outcome was evaluated as more severe in the NMO group (P B/0.001). O n the basis of clinical data, all NMO patients but three had dissemination in time and space. When we included MRI parameters, only two of the NMO patients met criteria for MS and one of the MS patients met criteria for NMO. O ur study demonstrates that NMO and MS should be considered as two different entities. The respective criteria for NMO and MS were able to distinguish these two patho logies but only when MRI data were applied. This finding could have implications for future therapeutic trials.

scholarly journals Cerebrospinal fluid features in COVID-19 patients with neurologic manifestations: correlation with brain MRI findings in 58 patients

2020 ◽  
Author(s):  
François Lersy ◽  
Ilies Benotmane ◽  
Julie Helms ◽  
Olivier Collange ◽  
Maleka Schenck ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Laboratory ◽  
Brain Mri ◽  
Oligoclonal Bands ◽  
Neurologic Manifestations ◽  
Neurological Manifestations ◽  
Rt Pcr ◽  
Mri Findings ◽  
Leptomeningeal Enhancement ◽  
Csf Analysis

Abstract Background Neurological manifestations are common in patients with COVID-19, but little is known about pathophysiological mechanisms. In this single-center study, we describe neurological manifestations of 58 patients, regarding cerebrospinal fluid (CSF) analysis and neuroimaging findings. Methods 58 COVID-19 patients with neurologic manifestations and SARS-CoV-2 RT-PCR screening on CSF analysis were included. Clinical, laboratory, and brain MRI data were retrospectively collected and analyzed. Results Patients were mostly men (66%) with a median age of 62 years. Encephalopathy was frequent (81%), followed by a pyramidal dysfunction (16%), seizures (10%), and headaches (5%). Protein and albumin levels in CSF were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient suggesting impaired blood-brain barrier integrity. CSF-specific IgG oligoclonal band was found in five (11%) cases, suggesting an intrathecal synthesis of IgG, and 26 (55%) patients presented identical oligoclonal bands in serum and CSF. Four (7%) patients harbored a positive SARS-CoV-2 RT-PCR in CSF. Regarding brain MRI, 20 (38%) patients presented leptomeningeal enhancement. Conclusions Brain MRI abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV 2 detection in CSF remained scanty.

scholarly journals AREA POSTREMA SYNDROME – A CHALLENGE FOR DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE SCLEROSIS AND NEUROMYELITIS OPTICA SPECTRUM DISORDERS

2017 ◽  
Vol 16 (4) ◽  
pp. 154-157
Keyword(s):  
Neuromyelitis Optica ◽  
Area Postrema ◽  
Brain Mri ◽  
Clinical Findings ◽  
The Body ◽  
Oligoclonal Bands ◽  
Neuromyelitis Optica Spectrum Disorders ◽  
Peripheral Facial Palsy ◽  
Csf Analysis ◽  
Spectrum Disorders

Area postrema syndrome (APS) manifested with hiccups, nausea and vomiting is one of the core clinical findings in neuromyelitis optica spectrum disorders (NMOSD). We report the case of a 41-year-old woman, with no significant prior medical history, who presented with left upper limb paresthesias. The patient revealed two prior episodes, one 5 years ago, with paresthesias and mild paresis on the right side of the body and the other a few month ago, with right peripheral facial palsy, right facial anesthesia, headache, nausea and emesis. This led us to suspect area postrema syndrome and, possibly, NMOSD. Brain MRI did not show typical lesions for NMOSD, apart from a left periaqueductal lesion. Other potential diagnoses were excluded through laboratory workup. Serum anti-AQP4 antibody were negative, while CSF analysis was positive for oligoclonal bands. Based on clinical and paraclinical findings, a diagnosis of MS was made. This case illustrated that APS may also be present in MS and not only in NMOSD.

scholarly journals Risk of Multiple Sclerosis after Idiopathic Optic Neuritis in a Pakistani Population

2010 ◽  
Vol 37 (2) ◽  
pp. 258-263 ◽  
Author(s):  
Syed Faraz Kazim ◽  
Muhammad Islam ◽  
Mustafa Khan ◽  
Bilal Hameed ◽  
Saad Shafqat
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Cumulative Probability ◽  
South Asian Population ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Csf Oligoclonal Bands

Background and objective:Optic neuritis (ON) is associated with a 38% ten-year risk of developing multiple sclerosis (MS) in Western populations, but the corresponding risk in non-Western populations is unclear. We conducted this study to estimate the risk of progression to MS after an episode of ON in a South Asian population.Methods:Two hundred and fifty-three patients with idiopathic ON were identified by reviewing records of visual evoked potentials and chart notes from a single academic center spanning the years 1990-2007. A structured telephone interview was then conducted to identify patients who had subsequently received a diagnosis of MS. The diagnosis was corroborated from chart notes, where possible. Cumulative probability of conversion to MS was calculated using Kaplan-Meier survival analysis.Results:The five-year risk of developing MS was 14.6% and the ten-year risk was 24%. Patients (N=218) who had one or more typical demyelinating lesions on baseline brain magnetic resonance imaging (MRI) had a 68% 10-year risk; those with no lesions or non-typical lesions had a 14% risk (p<0.001). Female gender, recurrent ON, and occurrence of ON in winter months were also associated with increased risk (p≤ 0.001). Severity of ON and likelihood of detecting cerebrospinal fluid (CSF) oligoclonal bands were higher in patients who developed MS.Conclusion:Idiopathic ON in Pakistan carries a lower risk of progression to MS compared with Western data. As in Western populations, however, presence of abnormal baseline brain MRI and CSF oligoclonal bands correlate with increased MS risk.

scholarly journals Cerebrospinal fluid oligoclonal immunoglobulin gamma bands and long-term disability progression in multiple sclerosis: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Virginija Danylaité Karrenbauer ◽  
Sahl Khalid Bedri ◽  
Jan Hillert ◽  
Ali Manouchehrinia
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Cox Regression ◽  
Brain Mri ◽  
Oligoclonal Bands ◽  
Positive Group ◽  
Mri Features ◽  
Modifying Effect ◽  
Immunoglobulin Gamma

AbstractMultiple sclerosis (MS) patients with immunoglobulin gamma (IgG) oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) have different genetic backgrounds and brain MRI features compared to those without. In this study, we aimed to determine whether CSF-OCB status is associated with long-term disability outcomes. We used Swedish MS register data on clinically definite MS patients with known OCB status. Date of birth, age at MS onset, and time to sustained Expanded Disability Status Scale (EDSS) milestones 3, 4, and 6; time to conversion to secondary progressive (SP) MS, sex, and immunomodulatory treatment (IMTs) duration were collected. Multivariate Cox regression models were used to investigate the association between OCB status and risk of reaching each milestone. The OCB-positive group reached disability milestones at an earlier time and younger age. OCB-positivity significantly increased the risk of reaching EDSS 3.0 (HR = 1.29, 95% CI 1.12 to 1.48, P < 0.001) and 4.0 (HR = 1.38, 95% CI 1.17 to 1.63, P < 0.001). The OCB-positive group had a 20% higher risk of conversion to SPMS. CSF-OCB presence is associated with higher risk of reaching EDSS milestones and conversion to SPMS. Our findings suggest higher disease modifying effect of OCB presence in the early inflammatory stages of MS.

scholarly journals Oligoclonal Immunoglobulin Gamma Bands and Long-Term Disability Progression in Multiple Sclerosis: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Virginija Danylaité Karrenbauer ◽  
Sahl Bedri ◽  
Jan Hillert ◽  
Ali Manochehrinia
Keyword(s):  
Multiple Sclerosis ◽  
Cox Regression ◽  
Brain Mri ◽  
Oligoclonal Bands ◽  
Clinical Aspects ◽  
Positive Group ◽  
Mri Features ◽  
Edss Score ◽  
Immunoglobulin Gamma

Abstract Background Multiple sclerosis (MS) patients without the typical oligoclonal bands (OCB) distribution of immunoglobulin gamma (IgG) in the cerebrospinal fluid (CSF) has a different genetic background and brain MRI features than OCB-positive MS patients. It is less clear if OCB presence indicates differences in clinical aspects of MS. Objective To determine whether CSF OCB status is associated with long-term disability outcomes. Methods We used Swedish MS register data on clinically definite MS patients with known OCB status. Date of birth, MS onset and date at sustained Expanded Disability Status Scale (EDSS) score milestones 3, 4, 6, date at conversion to secondary progressive (SP) MS, sex, and immunomodulatory treatment (IMTs) duration were collected. Multivariate Cox regression models were used to investigate the association between OCB status and risk of reaching each milestone. Results The OCB-positive group reached disability milestones at an earlier time and at younger age. OCB positivity significantly increased the risk of reaching EDSS score 3.0 (HR = 1.29, 95%CI: 1.12 to 1.48, P < 0.001) and 4.0 (HR = 1.38, 95%CI: 1.17 to 1.63, P < 0.001) but non-significantly for EDSS 6. The OCB-positive group had a 20 % higher risk to convert to SPMS. Conclusion Patients with or without CSF OCBs share a risk of long term progression and for conversion to SPMS. Presence of OCBs in the CSF is associated with higher risk to reach EDSS milestones and a higher risk to convert to SPMS. Our findings suggest higher disease modifying effect of OCB presence in the early inflammatory stages of MS.

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