Primary progressive MS (PPMS) is the least frequent but possibly the most devastating of the MS phenotypes. The rate of progression and disability accumulation in PPMS has been a matter of debate. In an upcoming issue of JNNP 9Published as first online), Koch and colleagues address the issue of factors governing disability progression. Importantly, older […]
Month: August 2014
Cortical thickness: A biomarker of upper motor neuron dysfunction?
Thinning of the motor cortex has been suggested as a biomarker of cortical dysfunction in ALS, although the specificity of the finding remains to be determined. In an upcoming issue of JNNP Walhout and colleagues report on the fact that cortical thinning was a specific feature in ALS, related to pathology of upper motor neurons. […]
Cervical sensory axonal dysfunction in radiculopathy: A novel concept!
Cervical radiculopathy is a common issue for neurologists. While motor dysfunction has been traditionally assessing using needle EMG techniques, thereby confirming the diagnosis, frequently only sensory symptoms may be evident. In such cases, the diagnostic time may be protracted. In an upcoming issue of JNNP (ON-LINE FIRST) Lin and colleagues tackle this issue in a […]
Calling Dr Google: where to from here for the poor old clinician?
Recently, I was talking to a young man in my clinic whom I had recently diagnosed with MS. We went over the potential options for treatment and he said that he would think it over and get back to me. A few weeks later I received an email from him stating that he wanted to […]
Lamotrigine safer in pregnancy after all!
The risk of fetal malformations is a considerable therapeutic consideration in pregnant patients that suffer epilepsy. the need to control seizures effectively is counterbalanced by toxicity of medications. While lamotrigine was considered as a safer option than other anti-epiletics, doubt was cast upon this assertion. In this issue of JNNP, an important study conducted by […]
Is FOSMN syndrome a form of ALS?
Facial onset sensory and motor neuronopathy (FOSMN syndrome) is a rare neurodegnerative disorder of unknown etiology. Clinically it may resemble ALS, albeit only in the motor component. The marked sensory abnormalities, which dominate the phenotype in the early stages of the disease process, and the prolonged survival, clearly argue against an ALS phenotype. In this […]
Stopping Tysabri treatment in multiple sclerosis: disease on the rebound.
Many moons ago it would have been unthinkable that MS treatment would take about 2-3 hours a month. It would have been impossible to imagine that you could simply turn up to your local hospital, have an infusion while you read a book and then tell the ward staff that you would see them again […]
Sudden changes in cognition in MS: the isolated cognitive relapse.
Of all the types of functional difficulties that a patient with multiple sclerosis (MS) can experience, cognitive change remains the area that is hardest to delineate. MS patients may experience changes in memory, attention, reasoning and executive function that can be subtle and therefore hard to detect clinically, but significant enough to compromise their daily […]
Dystonia and the inspired sensory tricks
Sensory tricks, also called geste antagoniste, is a typical feature of primary and secondary dystonias. The sensory tricks may take many forms and if not recognized, may lead to misdiagnosis and mislabeling as “psychogenic”. Importantly, the sensory tricks are associated with neurophysiological changes, including normalization of TMS parameters such as intracortical facilitation as well as […]
Glutamate and memory: A novel paradigm in MS
Glutamate is a major excitatory neurotransmitter in the human brain vital for multiple functions, including memory and cognition. Importantly, excessive glutamate activity may be harmful to the CNS, leading to neurodegeneration. In this issue of JNNP, Muhlert and colleagues report a link between glutamate levels and memory, a unique link in MS. Given that forgetfulness […]