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Archive for March, 2015

Spinal cord injury in multiple sclerosis: why is this important for MS clinical trials?

24 Mar, 15 | by Arun Krishnan, Web Editor

For patients with multiple sclerosis (MS), sustained long-term disability is a problem that elicits considerable concern. There is the impact on independence and the potential burden that it may lead to for caregivers. While treatments for MS seem to multiply by the year, established disability remains the one area that is still refractory to treatment. Most of the current medications are excellent for preventing relapses but it is important to remember there is still no good evidence that these medications prevent long-term disability. The trials have not been done and it seems unlikely that they ever will be. There are global efforts directed at progressive forms of MS,  such as The International Progressive MS alliance which is seeking to bring together groups of researchers who are committed to developing new methods for treating progressive MS (http://www.progressivemsalliance.org) .

The importance of such endeavours is underscored by a manuscript in this month’s issue of JNNP.  Lukas et al have explored the contribution of cervical spine cord damage to the development of disability in MS http://jnnp.bmj.com/content/86/4/410.abstract . They have assessed radiological parameters in a large cohort of patients and have demonstrated that there is a change in the dimensions of the spinal cord that appears to occur in all forms of MS. These changes also predicted disease progression. Critically, the thinning of the cord occurred not only in patients with progressive MS, but also in patients with relapsing-remitting MS (RRMS). A number of these RRMS patients were on treatment with immunomodulatory mechanisms and it is sobering to think that the changes in the spinal cord occurred despite the potential benefits of being on drug treatment. This study is of importance as it highlights the importance of spinal cord disease in the development of disability. The authors also make the valid point that measures of spinal cord injury need to be incorporated into MS drug trials.

Confused about encephalopathy? Here’s something that may help.

16 Mar, 15 | by Arun Krishnan, Web Editor

Confusion. Agitation. Irritability. A wander around any emergency department or neurology ward will yield an abundance of observations that can fall under these categories and yet these are not all due to long waiting times or general hospital mayhem. All these symptoms are common presentations of neurological dysfunction and they are features of that syndrome that neurologists call encephalopathy, which refers to a state of altered consciousness that is typically accompanied by changes in cognition or perception. Working out why someone has encephalopathy is challenging and can take time. While some diagnoses are easier to pick, such as systemic infection, in other cases symptoms can be so non-specific that finding a unifying diagnosis can be very hard despite the wonders of modern medical technology.

In this month’s issue of JNNP, Sutter and Kaplan have published an outstanding review that addresses neuroimaging in acute encephalopathy http://jnnp.bmj.com/content/86/4/446.abstract . Their paper provides an excellent outline of changes in MRI and CT which occur in various conditions that result in encephalopathy. They have gone through common and even rare causes of encephalopathy, indulging those related to immune and infectious mechanisms, and have complied useful lists of specific changes in brain areas that are characteristically involved in each condition.

This review will prove to be a very useful resource, for neurologists, emergency specialists and general physicians, all of whom will be called upon to manage these patients at one time or another.

Latest from JNNP

Latest from JNNP