More MS news articles for Jan 2002

28 Review Abstracts from Revue Neurologique (Paris)

http://www.e2med.com/index.cfm?fuseaction=Revue&idxRevue=115&&Random=13956&cfid=665898&cftoken=18411956

[These are a collect of review abstracts from Revue Neurologique. They do not appear to represent new research.]

Disease-modifying treatments in multiple sclerosis
The natural history of multiple sclerosis and optic neuritis
MRI vs EPs
A review on the use of evoked potentials in multiple sclerosis
Analysis of CSF in MS
Diagnosing Multiple Sclerosis
Border forms of multiple sclerosis
Borderline forms of multiple sclerosis
The diagnosis of MS
The doctor-patient relationship in MS
Economic assessments for multiple sclerosis
Quality of life in multiple sclerosis
Pregnancy, vaccinations and Stress in MS
Quantitative methods used for assessing neurological status in multiple sclerosis
New immunomodulatory treatments of Multiple Sclerosis
Diagnostic criteria of multiple sclerosis
The clinical assessment of the evolution of Multiple Sclerosis
Cognitive impairment and psychiatric disorders in Multiple Sclerosis
Tremor and movement disorders in multiple sclerosis
Pain in Multiple Sclerosis
Fatigue in multiple sclerosis
Bladder and bowel dysfunction in multiple sclerosis
Symptomatic bladder dysfunction in multiple sclerosis
Spasticity in multiple sclerosis
Exercise programs and physiotherapy for multiple sclerosis
Available treatment for relapsing-remitting and secondary progressive multiple sclerosis
Rapidly worsening Multiple Sclerosis
Treatment in secondary or primary progressive multiple sclerosis


Disease-modifying treatments in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787366&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):996-1000
Lubetzki C.
Federation de Neurologie, INSERM U-495, Hopital de la Salpetriere, 75013 Paris.

Disease-modifying treatments in multiple sclerosis emerged during the last few years, concerning mainly relapsing-remitting forms of the disease. They are essentially represented by beta-interferons. beta-interferons reduce relapse rate, achieving about 30 p. cent, and have an effect on brain lesions detected on MRI. They are indicated for use in ambulatory patients with relapsing-remitting multiple sclerosis characterized by at least 2 attacks of neurological dysfunction over the preceding 2 (or 3)-year period. Questions and controversies still remain concerning dose-response effect, early initiation and duration of treatment. Copolymer, which has a different mechanism of action, also decreases frequency of relapses, and the magnitude of the clinical effect is similar to beta-interferon. Copolymer is indicated for use in patients with relapsing-remitting multiple sclerosis, having either an intolerance or a contra-indication to beta-interferon.


The natural history of multiple sclerosis and optic neuritis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787365&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):988-95
Brochet B.
Federation des Neurosciences Cliniques, Hopital Pellegrin, CHU de Bordeaux & Laboratoire de Neurobiologie des Affections de la Myeline (EA 2966), Universite Victor Segalen, Bordeaux.

The natural history of multiple sclerosis (MS) exacerbations is characterized by a poor outcome in about 70 p. cent of cases. By contrast, the outcome of a first episode of acute optic neuritis (ON) is usually good. However the disability associated with MS bouts and ON requires the use of a specific treatment. Nine randomized controlled clinical trials against placebo performed exclusively for MS exacerbations or acute ON were identified. Corticosteroids or ACTH produced a significant improvement in disability or vision at 30 days and shortened the duration of exacerbations. Longer follow-up clinical trials performed in MS exacerbation were not able to clearly demonstrate a significant effect. In acute ON clinical trials the long term visual outcome was not significantly different after steroid treatment than after placebo but this outcome is usually good. There is some evidence that high doses of intravenous methylprednisolone delay the occurrence of the next relapse, and have a dose-dependent effect on the rate of new lesion formation. There is no convincing evidence of the effectiveness of oral steroids in MS exacerbations but this treatment is associated with an increase relapse rate in ON. Side effects with intravenous methylprednisolone are less severe than with oral mega doses or ACTH.


MRI vs EPs

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787364&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):981-6
Dimitri D.
Federation de Neurologie, Prs. Y. Agid et O. Lyon-Caen, Centre Hospitalier Universitaire Pitie-Salpetriere, 47, boulevard de l'Hopital, 75013 Paris.

Visual and somatosensory evoked potentials are useful to identify patients at increased risk for developing Multiple sclerosis (MS). However Magnetic Resonance Imaging (MRI) is more sensitive and predictive. More studies are needed to determine the optimal sequence of evoked potentials and MRI that best predict the development of MS especially in monosymptomatic manifestations and in primary progressive MS.


A review on the use of evoked potentials in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787363&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):974-80
Fischer C, Andre-Obadia N, Mauguiere F.
Service de Neurologie Fonctionnelle et Epileptologie, Hopital Neurologique, BP Lyon Montchat, 69394 Lyon-France.

We have made a review on the use of evoked potentials in multiple sclerosis (MS) for the past 30 years, in the diagnosis of MS, to disclose subclinical lesions or to assess atypical symptoms. Yet the role of evoked potentials in evaluation of multiple sclerosis has been changed since MRI is now widely and easily used for the diagnosis of MS. Evoked potentials are useful when symptoms are atypical without any objective impairment and when symptoms have already recovered at the time of clinical examination. Visual evoked potentials and somatosensory evoked potentials are widely used thanks to their diagnostic value and their ability to disclose spatial dissemination of multiple sclerosis. Evoked potentials have to be recorded in validated technical conditions such as to ensure reliability of data and have to be interpreted in reference to a population of healthy people recorded in the same conditions and in the same age range as MS patients.


Analysis of CSF in MS

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787362&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):968-73
Dimitri D.
Federation de Neurologie, Prs. Y. Agid et O. Lyon-Caen, Centre Hospitalier Universitaire Pitie-Salpetriere, 47, boulevard de l'Hopital, 75013 Paris.

The clinical diagnosis of multiple sclerosis (MS) can be supported by the analysis of the cerebrospinal fluid (CSF) by the detection of an inflammatory reaction in central nervous system. The most sensitive method for the detection of oligoclonal IgG bands is isoelectric focusing. However magnetic resonance imaging (MRI) is more sensitive and predictive. Nevertheless CSF study is useful in monosymptomatic manifestation when MRI is normal, and primordial in primary progressive MS diagnosis. More studies are needed to determine the optimal sequence of CSF study, MRI and evoked potentials in the diagnosis of different presentation of MS.


Diagnosing Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787360&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):949-62
Dupel-Pottier C.
Service de Neurologie, Centre hospitalier d'Aix-en-Provence.

To date, there is no biological test available with enough confidence to make alone a diagnosis of Multiple Sclerosis (MS). MS diagnosis criteria are then an association of clinical and para clinical criteria that allow an objective demonstration of dissemination of lesions in both time and space. Adapted MRI criteria from Barkhof have a good sensitivity and the best specificity to evaluate MS. 3 of 4 criteria are necessary: 1 gadolinium enhancing lesion or 9 T2 hyper intense lesions; at least 1 infratentorial lesion; at least 1 juxtacortical lesion; at least four periventricular lesions; NB: 1 spinal cord lesion can substitute for 1 brain lesion. News methods as spectroscopy, magnetization transfer, diffusion MRI and functional MRI complete results of conventional MRI and give new informations about physiopathology of MS demyelinating lesions.


Border forms of multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787358&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):935-43
Dupel-Pottier C.
Service de Neurologie, Centre hospitalier d'Aix-en-Provence.

Border forms of multiple sclerosis (MS) can be separated in two groups: either they are variants of MS or they are distinct from MS but they share several characteristics with MS thus representing for some of them a continuum with MS. All these entities are central nervous system demyelinating diseases. Here we describe, for the first group, MS in childhood, MS in elderly subjects, Balo's concentric sclerosis, Schilder's myelinoclastic diffuse sclerosis and MS simulating a mass lesion, and for the second group, acute disseminated encephalomyelitis and Devic's neuromyelitis optica.


Borderline forms of multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787357&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):929-34
Fontaine B.
Federation de Neurologie, INSERM U546, Groupe Hospitalier, Faculte de Medecine Pitie-Salpetriere, Paris.

Multiple sclerosis (MS) has been described for more than a century, but its cause remains unknown and no simple diagnostic marker is available. Therefore, it is not surprising that numerous articles were written on closely related diseases, borderline forms of multiple sclerosis. Different forms have been distinguished: a clinical form of MS (Devic's neuromyelitis optica), pathological forms (Balo, Schilder, Maburg), forms associated with MS (peripheral neuropathy, autoantibodies) and closely related disorders (acute disseminated encephalomyelitis).


The diagnosis of MS

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787355&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):907-13
Confavreux C, Vukusic S, Achiti J.
Centre de Coordination Europeen EDMUS (European Database for MUltiple Sclerosis) sur la Sclerose en Plaques, Service de Neurologie A, Hopital Neurologique, 59, bd Pinel, 69003 Lyon, France.

Multiple sclerosis (MS) is a disease of unknown origin and for which there is no specific diagnostic test. The diagnosis of MS is always the result of a more or less simple procedure, depending on the cases, and it remains uncertain until evidence of anatomo-pathological signs have been brought forward. An almost unanimous consensus does exist regarding several points. In the presence of suggestive or, at least, compatible neurological signs and in the absence of any alternative diagnosis according to a neurologist expert in MS, the diagnosis of MS is based on three criteria: the evidence of at least two different lesions in the white matter of the central nervous system, which is called the "space dissemination" criterion; the evidence of at least two different episodes in the disease course, which is called "time dissemination"; the evidence of a chronic inflammation of the central nervous system revealed through the analysis of the cerebrospinal fluid, i.e. the "infammatory" criterion. The observation of one or several of these criteria allows to establish the diagnosis of MS with more or less certainly, likely to be reassessed according to the subsequent course of the disease. There is a wide consensus today with Poser's classification (Poser et al., 1983) which combines the three criteria and distinguishes five different categories. According to Poser et al., space dissemination may be proved on clinical examination, but also with the brain MRI and, failing that, with the evoked potentials. Time dissemination is based only on clinical signs and the inflammatory criterion is as significant as the two other criteria. This classification has just been revised by an expert committee (McDonald et al., 2001) who wish to simplify it into two different categories (MS vs possible MS). It has been suggested that time dissemination should be proven by the observation of MRI signs three months at least after the previous clinical episode or the previous MRI. It has been suggested also to use the inflammatory criterion in second position in replacement of the space criterion when the latter is missing on the clinical and paraclinical levels. Time will say whether this new classification will replace the previous one.


The doctor-patient relationship in MS

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787353&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1175-83
Barroso B.
Service de Neurologie A, CHU Pellegrin, place Amelie Raba Leon, 33076 Bordeaux.

Multiple sclerosis (MS) is the most common neurological disease disabling young adults. Patients with MS experience symptoms in an unpredictable pattern over years or decades. The doctor/patient relationship in MS, beginning with the announcement of the diagnosis has to grow stronger with a clear structured information following from the many available studies of the medical literature. This is all the more welcome since the introduction of a new generation of disease-modifying agents which has a radical effect on the management of the condition. This management of MS must also concentrate on symptom relief, palliative care and complementary therapies including rehabilitation when a disability occurs. Nowadays, a quality health service for people with MS need to be intimately involved in the long-term care of a disease which has frequently a social and occupational impact. Physicians of several disciplines, primary medical care, social service and nurses should work as an integrated medical network model focusing on the patient and his family.


Economic assessments for multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787352&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1169-74
Tissot E, Woronoff-Lemsi MC.
CHU Besancon, Boulevard Fleming, 25030 Besancon.

Economic assessments for multiple sclerosis (MS) first appeared in the nineties. Drug costs were initially marginal before the recent introduction of interferon-beta. To evaluate the burden of MS, economic studies were carried out in addition to specific cost-of-illness studies. Like other chronic illnesses, MS patients can have mild to moderate or severe disabilities. This led to the need for indirect cost analysis. We interrogated the Medline database from 1985 to 2001 to select cost-of-illness studies. We present our findings here by type of methodology used, health care system and level of disability. We found that indirect costs are related to patient age at symptom onset (20-40 years). In most counties, excepting the United Kingdom, hospital costs dominate direct costs. Finally, MS costs are related to the stage of the disease.


Quality of life in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787351&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1163-8
Vermersch P, Marissal JP.
Clinique Neurologique, Hopital Roger Salengro, F-59037 CHU de Lille.

On a daily basis the quality of life of patients suffering from multiple sclerosis (MS) partially depends on social measures. These are not specific to MS. Patients often need to be helped by hospital or town social services for the numerous and complicated administrative steps to be taken. The information given to a patient is of prime importance concerning his rights, particularly his occupational rights. Many organisations have to be contacted to obtain financial and material aids, even if the latter are considered insufficient in many fields especially for improvements in accommodation. An invalidity card may entitle its holder to certain tax reductions. The competences of the COTOREP are wide-ranging and include the recognition of the handicapped worker, his training and his regarding at work, his orientation and admission into a specialised structure, the degree of his invalidity rate and should his handicap justify it, benefits such as the handicapped adults allowance and the compensatory third person's allowance. It is essential to adopt a multidisciplinary way when dealing with MS in order to provide a better care, experiments in specialised structures and networks are being undertaken. Numerous partners are taking part in these new approaches and patient associations may find their place there. Social aspects have to be taken into account as well in the way the cost of the disease is evaluated in terms of money and humanity.


Pregnancy, vaccinations and Stress in MS

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787350&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1157-62
Moreau T.
Centre Hospitalier Universitaire, Service de Neurologie, 3, rue du Faubourg Raines, BP 1519, 21033 Dijon.

The onset of Multiple Sclerosis usually concerns young adults who are making plans for their life. The personal, familial, professional plans must be adapted to the course of the disease. This adapted daily life must be as normal as possible to prevent the social loneliness which is the principal complication of Multiple Sclerosis. Three frequent situations of daily life have recently been studied in Multiple Sclerosis. Pregnancy is permitted. There is a dramatic decrease of the relapse rate during pregnancy but an obvious increase after delivery. Pregnancy has no influence on disability. Vaccinations do not favor the onset or the worsening of Multiple Sclerosis according to studies with large number of patients (in particular hepatitis B vaccination). Stress is not able to trigger the onset or relapses of Multiple Sclerosis. Stress could even protect against relapses. The Multiple Sclerosis daily life does not need to take specific precautions which would expose to the marginalization of patients.


Quantitative methods used for assessing neurological status in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787348&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1143-51
Couvreur G.
Service de Neurologie, Hopital General, CHRU de Dijon, 21000 Dijon.

The aim of this paper is to review the quantitative methods used for assessing neurological status in multiple sclerosis patients. The Expanded Disability Status Scale (EDSS) is the most wide used. Its psychometric properties, validity, and inter- and intra-rater reliability are modest and responsiveness is weak. Similar results are obtained with the other scales used. The recently developed Multiple Sclerosis Functional Composite (MSFC) scale for clinical trials satisfies this requirement, but is not suitable for individual evaluation. There is no scale in French for assessment of cognitive disturbances and only one, the SEP-90, for quality of life. Brain and spinal cord abnormalities with conventional magnetic resonance imaging parameters (T1, T2-weighted and gadolinium enhanced images) have a weak relationship with disability. New magnetic resonance techniques (magnetic resonance spectroscopy and magnetized transfer imaging) would be more sensitive and should be further investigated.


New immunomodulatory treatments of Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787346&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1135-8
Borgel F.

New immunomodulatory treatments of Multiple Sclerosis lead to considerable changes in the doctor-patient relationship. Today the neurologist must become involved in comprehensive management of MS patients. He/She must become familiar with the specific methodology of assessment in rehabilitation, and especially with the measurement of disability. Some specific measures have been developed in this field, i.g. the Functional Independence Measure (FIM). Although no significant change was demonstrable on neurological status decline as measured by EDSS in progressive phase, several recent controlled studies have demonstrated the efficacy of inpatient or outpatient rehabilitation programs, when assessment was based on disability, handicap and quality of life measurement. We emphasized the neurologist's role in determining adequate timing for rehabilitation according to the course of disease and therapeutic choices, but also in the setting of patient-centered functional goals for rehabilitation program.


Diagnostic criteria of multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787344&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1124-7
Tourbah A.
Federation de Neurologie, Hopital de la Salpetriere, INSERM U546-Affections de la Myeline et des canaux ioniques musculaires, Faculte de Medecine Pitie-Salpetriere, Service de Neuroimagerie, CHNO des XV-XX, Paris.

Diagnosis criteria of multiple sclerosis (MS) have been recently reconsidered, introducing the possibility to validate temporal dissemination with the use of MRI. In fact, MRI parameters may be considered as reflecting the biological activity of MS. MRI is used to monitor treatment in clinical trials. However, and except for particular circumstances, its use in routine follow-up of patients with MS is not recommended, because of weak correlations with clinical disability and technical difficulties of such follow-up.



The clinical assessment of the evolution of Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787343&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1121-3
Roullet E.
Service de Neurologie, Hopital Tenon, 4, rue de la Chine, 75970 Paris.

The clinical assessment of the evolution of Multiple Sclerosis (MS) is based on international criteria. For the definition of relapse and progression, the so-called Schumacher criteria (1965) may be chosen. For the definition of clinical subtypes (relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing), the criteria issued from a survey conducted by the group of Lublin (1996) are mandatory. One may be cautious to apply such research-driven sets of criteria to clinical practice. Many scales have been elaborated for the evaluation of the handicap caused by MS (i.e. neurological deficit, impairment, and "handicap"). None is perfect, but the Expanded Disability Status Scale (EDSS, Kurtzke, 1983) is widely used. Recent development in the elaboration process of scales ("scalology") may soon lead to the validation of new composite outcome measures.


Cognitive impairment and psychiatric disorders in Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787341&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1085-90
Lebrun C.
Service de Neurologie, Hopital Pasteur, 30, Voie Romaine, BP69, 06002 Nice.

Cognitive impairment and psychiatric disorders occur in about 60 p. cent of multiple sclerosis patients. In general, impairment develops in established cases, although it can present early in the disease course. The pattern of neuropsychological deficits is characterized by deficits in attention, memory and executive functions; No specific treatment seems to be effective in cognitive impairment but appropriate strategies could limit the negative impact on this disease. Depressive states are twice frequent and usual antidepressant drugs seems to demonstrate some efficacy.


Tremor and movement disorders in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787340&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1079-84
Viallet F, Witjas T, Gayraud D, Pelletier J, Regis J.
Service de Neurologie, CH du Pays d'Aix, Avenue des Tamaris, 13616 Aix-en-Provence.

Tremor and movement disorders in multiple sclerosis (MS) patients cause a severe functional impairment. The different types of tremor observed in MS are: cerebellor tremor with a dominant intention component, Holmes tremor characterized by the addition of rest and postural components and palatal tremor. When no medication can improve the functional status, it is acceptable to discuss the deep brain stimulation in the VIM thalamus, thus making possible a partial attenuation of the rest and postural component, mainly affecting the proximal part of the affected limb. Among the movement disorders, paroxysmal dyskinesias are not rare and a good therapeutic response is obtained with carbamazepine: dystonia and parkinsonism are usually coincidental features during MS.


Pain in Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787339&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1072-8
Chatel M, Lanteri-Minet M, Lebrun-Frenay C.
Service de Neurologie, Hopital Pasteur, CHRU Nice.

Pain is a major issue in the care of Multiple Sclerosis patients. It is present in more than half of the cases and it adopts many aspects, which frequently ruin the patients quality of life. Most of them do not receive appropriate treatments, as clinicians are more oriented towards controlling the immuno-pathogenic process of the disease than coping with symptomatic consequences of the lesions. Any clinical form of the disease may include pain and no clinical criteria have been correlated with the occurrence of pain: neither age, nor gender, nor MS subtypes nor severity of the handicap; almost all MS cases will complain of pain at a time or another of their evolution. A key issue is to make a precise diagnosis of the type or types of pain that any patient reports: is pain due to a central neuropathic or a nociceptive pathogenesis. Treatments will depend upon these two main pain mechanisms and will use different agents according to each type: antispastic, antiepileptic, anti-inflammatory, opioids.... Pain has to be taken in consideration in every MS patient and adapted treatment strategy must be prescribed.


Fatigue in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787338&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1066-71
Waubant E.
Centre d'Investigation Clinique, Federation de Neurologie, Hopital Pitie-Salpetriere, Paris.

Fatigue is a common complaint in patients affected by multiple sclerosis. Its mechanisms are poorly understood and are likely diverse. The term "fatigue" has been used for asthenia at rest but also for fatigability during exercise. Amantadine is the only drug that has a proven therapeutic benefit in randomized, double blind, controlled trials. Inhibitors of serotonin re-uptake are used pragmatically because of the relationship between fatigue and depression. Aminopyridins may improve fatigability, mainly at the level of lower limbs.


Bladder and bowel dysfunction in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787337&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1060-5
Lebrun C.
Service de Neurologie, Hopital Pasteur, 30, Voie Romaine, BP69, 06002 Nice.

Bladder and bowel dysfunction is common in multiple sclerosis. After accurate diagnosis of dysfunction, a management program with anticholinergic or alphabloquers drugs is mandatory. Intermittent catheterization, surgical treatment, or electrostimulation are proposed in most severe cases. Therapies for intestinal disorders are more limited. Management of symptoms and different therapies are reviewed.


Symptomatic bladder dysfunction in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787336&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1051-9
Joseph PA, de Seze M.
Unites de Reeducation Neurologique, Service de Medecine Physique et de Readaptation, CHU Pellegrin, 33076 Bordeaux.

Symptomatic bladder dysfunction occurs at some time in most patients with multiple sclerosis. Detrusor hypereflexia and sphincter dyssynergia are the main dysfunctions. Anticholinergic medication is currently the most effective and the most common treatment of overactive bladder with reduced bladder capacity and uninhibited detrusor contractions. Desmopressin, surgery, permanent indwelling catheter or external device are used in some cases. Nevertheless essential to bladder management is understanding to what extent the patient has incomplete emptying while complaining predominantly of symptoms of detrusor overactivity: frequency and urgency, with or without urge incontinence. Intravesical capsaicin and botulinum toxin injected into the detrusor seems promising means of treating intractable bladder hyperreflexia. If the post-micturition residual volume is raised, intermittent self-catheterization is the most adequate method to achieve bladder emptying of patients with MS. Physical and cognitive disability as well as patients motivation can reduce their ability to perform catheterization. In such situation, alphablockers show moderate efficacy and botulinum toxin urethral sphincter injection or surgical solution may be discussed. Disturbed anorectal physiology is common in MS, but there are as yet few specific treatments. The efficacy of oral sildenafil for treatment of neurogenic erectile failure increases the range of treatment available for men with sexual dysfunction. In women, mechanical remedies, treatment of motor and sensory loss are effective for dyspareunia. Patients of both sexes are likely to welcome to discuss their problem, and counselling or psychotherapy may be of use.


Spasticity in multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787335&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1045-50
Lebrun C.
Service de Neurologie, Hopital Pasteur, 30 Voie Romaine, BP69, 06002 Nice.

Spasticity is reported in 90 p. 100 of multiple sclerosis patients causing pain, spasms, loss of function and difficulties in nursing care. A variety of oral and parenteral medications are available. Review of comparative efficacy and tolerability of anti-spastic agents is performed in order to guide rational prescribing.


Exercise programs and physiotherapy for multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787333&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1030-40
Pelissier J, Benaim C, Petiot S.
Unite de Reeducation Neurologique, Departement de Medecine Physique et de Readaptation, CHU, 30240 le Grau du Roi.

Multiple Sclerosis (MS) is a disabling chronic neurological disorder with multiple motor impairments and its progressive course leads to severe disability. The question of the value of exercises program and physiotherapy to reduce these motor disorders and their consequences was raised. This literature overview is based on data from common database: Medline, Embase, Cochrane Library. Were selected articles corresponding to open studies and especially clinical controlled randomised trials. To be analysed, each article should correspond with inclusion criteria: confirmed diagnosis according to Poser's criteria, secondary or primary progressive form of MS without relapse for the study period, randomisation according to severity assessed by the Expanded Disability Status Scale (EDSS), no change in symptomatic drugs along the study period, and a simple blind assessor. Impairment, disabilities, handicap and quality of life had to be measured. Five clinical controlled randomised trials were consistent with these criteria. They demonstrated the effectiveness of comprehensive programs on motor function in the less severe forms of MS, but also their inability to change the course of the most severely affected forms. However, the effects on disability, handicap and quality of life were significant in comparison with control patients. These trials emphasised the value of multidisciplinary programs including physiotherapy and occupational therapy, carried out daily or 3 times a week by specialised staffs. The effects lasted only few weeks or months, requiring to propose them again after this period. Other controlled randomised studies also stressed the value of specific programs: temporary alleviation of spasticity and fatigue with cooling techniques; aerobic endurance training for less severely affected patients to prevent disuse consequences and improve fitness and quality of life; expiratory training to enhance coughing capacity and prevent pulmonary infections in very disabled patients. From this overview study, it seems that multidisciplinary comprehensive programs clearly provide benefits to those patients and contribute to reduce disability and improve quality of life at each stage of MS.


Available treatment for relapsing-remitting and secondary progressive multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787332&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1014-28
Brassat D.
Federation de Neurologie, Hopital Purpan, place du Dr Baylac, 31059 Toulouse.

On the subject of the treatment of Multiple Sclerosis, JM Charcot stated in 1877 that "the time has not yet come when such a subject can be seriously considered". Fortunately such point of view is no more up to date. This chapter will review the available treatment for relapsing-remitting and secondary progressive Multiple Sclerosis. The immunosuppressive drugs and steroids have been used for many years. Immunomodulation appeared more recently. A review of the evidence on the use of those drugs will be performed.


Rapidly worsening Multiple Sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787331&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1008-13
Edan G.
Service de Neurologie, CHU Rennes.

There is not a standardized definition of rapidly worsening Multiple Sclerosis (MS). Arbitrary, we have designed under this term patients having a very active MS (patients having more than 2 relapses within the last 12 months) or rapid progression of handicap (more than 2 points EDSS progression within the last 12 months). The design of most previous studies using azathioprine, cyclophosphamide, methotrexate do not fulfill criteria to draw final conclusions as to the efficacy of these drugs as an immunoprophylactic agent in Multiple Sclerosis (MS). During the last five years, efficacy of immunomodulatory and immunosuppressive agents was provided by some well-designed randomized control clinical trials: among the immunosuppressors, mitoxantrone deserves special consideration as there were three controlled trials in Europe during the two last years that demonstrated strong efficacy both on clinical and MRI criteria. Due to its potentially cardiotoxicity, related to total cumulative dose, mitoxantrone should presently only be used in selected patients with a very high relapse rate and incomplete remission or in those who do not respond to INF beta treatment. The immunomodulatory agents (interferon beta 1a or 1b, copolymer 1) demonstrated a significant effect on the reduction of relapse rate (about 30 p. cent reduction), on progression of handicap and on MRI. In secondary progressive MS, an effect on progression is demonstrated only on patients still having relapses. No trial devoted to worsening patients as defined above have been yet designed with immunomodulatory agents.


Treatment in secondary or primary progressive multiple sclerosis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11787330&dopt=Abstract

Rev Neurol (Paris) 2001 Sep;157(8-9 Pt 2):1001-7
Rumbach L.

Service deNeurologie, Centre Hospitalier, 25030 Besancon.

The indication for a long-term treatment in secondary or primary progressive multiple sclerosis is raised in more than half of the patients with MS. The fact that the pathogenic mechanisms involved in these two entities are unknown makes it difficult to predict the clinical course. The still insufficient knowledge of the MRI parameters is another obstacle to overcome. Nevertheless, the results of a certain number of clinical trials have, despite the methodological inadequacies, provided some insight. Immunomodulators, such as interferon-beta, have shown some efficacy, particularly in patients with a still inflammatory form of secondary progressive MS. Massive short-term immunosuppression does not appear to affect the course of progression but prolonged immunosuppression appears to be able to retard progression, at least in certain patients. This points out the importance of starting treatment as early as possible, before the development of irreversible damage. A better analysis of results already published, and most importantly, of results currently under way, should be most helpful in terms of therapeutic management if not in terms of our understanding of the pathophysiological processes involved.