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Franks C, Eylon A, Carrion A, Bassa R. An Atypical Presentation of Progressive Multiple Sclerosis in a Young Black Male. Cureus 2023; 15:e45496. [PMID: 37727844 PMCID: PMC10506862 DOI: 10.7759/cureus.45496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease primarily affecting the central nervous system, commonly diagnosed in women and individuals of European ancestry. It most commonly presents in the form of relapsing-remitting MS, which is characterized by exacerbations with partial to complete recovery. Far less common is the primary progressive form of MS, which involves the progression of neurological symptoms that gradually worsen with time. We present an atypical case of progressive MS in a 26-year-old incarcerated Black male. Initially diagnosed in 2019, he experienced bilateral upper extremity weakness and phasic spasticity, with subsequent worsening of symptoms including lower extremity spasticity, vision impairment, and difficulties with mobility and writing. With progressing symptoms, unintentional weight loss, and declining motor function, he was admitted to the hospital in March 2023. This case emphasizes the importance of considering MS as a differential diagnosis in any patient with progressive neurological dysfunction because, unlike the more prevalent relapsing-remitting type of MS, primary progressive MS has a more insidious onset with no recovery between exacerbations. It addresses the patient's symptom history, medication compliance challenges, and the need for improved education and awareness of MS in diverse patient populations.
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Affiliation(s)
- Charles Franks
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Adi Eylon
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Arturo Carrion
- Internal Medicine, Reception and Medical Center, Lake Butler, USA
| | - Ramon Bassa
- Internal Medicine, Reception and Medical Center, Lake Butler, USA
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García Cena CE, Gómez-Andrés D, Pulido-Valdeolivas I, Sánchez-Seco VG, Domingo-Santos A, Moreno-García S, Benito-León J. Toward an Automatic Assessment of Cognitive Dysfunction in Relapsing-Remitting Multiple Sclerosis Patients Using Eye Movement Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:8220. [PMID: 36365918 PMCID: PMC9657913 DOI: 10.3390/s22218220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Despite the importance of cognitive function in multiple sclerosis, it is poorly represented in the Expanded Disability Status Scale (EDSS), the commonly used clinical measure to assess disability, suggesting that an analysis of eye movement, which is generated by an extensive and well-coordinated functional network that is engaged in cognitive function, could have the potential to extend and complement this more conventional measure. We aimed to measure the eye movement of a case series of MS patients with relapsing−remitting MS to assess their cognitive status using a conventional gaze tracker. A total of 41 relapsing−remitting MS patients and 43 age-matched healthy controls were recruited for this study. Overall, we could not find a clear common pattern in the eye motor abnormalities. Vertical eye movement was more impaired in MS patients than horizontal movement. Increased latencies were found in the prosaccades and reflexive saccades of antisaccade tests. The smooth pursuit was impaired with more corrections (backup and catchup movements, p<0.01). No correlation was found between eye movement variables and EDSS or disease duration. Despite significant alterations in the behavior of the eye movements in MS patients, which are compatible with altered cognitive status, there is no common pattern of these alterations. We interpret this as a consequence of the patchy, heterogeneous distribution of white matter involvement in MS that provokes multiple combinations of impairment at different points in the different networks involved in eye motor control. Further studies are therefore required.
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Affiliation(s)
- Cecilia E. García Cena
- Escuela Técnica Superior de Ingeniería y Diseño Industrial, Centre for Automation and Robotics, ETSIDI-CAR, Universidad Politécnica de Madrid, 28012 Madrid, Spain
| | - David Gómez-Andrés
- Child Neurology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Euro-NMD and ERN-RND, 08035 Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Anatomy, Histology and Neuroscience Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | | | - Angela Domingo-Santos
- Department of Neurology, “La Mancha Centro” General Hospital, Alcázar de San Juan, 13600 Ciudad Real, Spain
| | - Sara Moreno-García
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Department of Medicine, Complutense University, 28040 Madrid, Spain
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Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:726-734. [PMID: 34836843 DOI: 10.1016/j.nrleng.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice. OBJECTIVE We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery. MATERIAL AND METHODS We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population. RESULTS The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity. CONCLUSION The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.
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Selective Cerebellar Atrophy Associates with Depression and Fatigue in the Early Phases of Relapse-Onset Multiple Sclerosis. THE CEREBELLUM 2020; 19:192-200. [PMID: 31898280 DOI: 10.1007/s12311-019-01096-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cerebellar dysfunctions have been associated to depressive disorders and cognitive impairment in neurodegenerative diseases. The objective is to analyze the associations between cerebellar atrophy, depression, and fatigue in the early phases of relapse-onset multiple sclerosis (RRMS). Sixty-one RRMS patients and 50 healthy controls (HC) were enrolled and clinically evaluated by means of expanded disability status scale (EDSS), Rao's brief repeatable battery of neuropsychological tests (BRB-NT), Delis-Kaplan executive function system sorting test, beck depression inventory II (BDI-II), and fatigue severity scale (FSS). The relationships between MRI variables and clinical scores were assessed. Depressed RRMS (dRRMS) had significantly lower Vermis Crus I volume compared with not depressed RRMS (ndRRMS) (p = 0.009). Vermis Crus I volume was lower in dRRMS suffering from fatigue than in ndRRMS without fatigue (p = 0.01). The hierarchical regression models which included demographic and clinical data (age, sex, and disease duration, FSS or BDI-II) and cerebellar volumes disclosed that cerebellar lobule right V atrophy explained an increase of 4% of the variability in FSS (p = 0.25) and Vermis Crus I atrophy explained an increase of 6% of variability in BDI-II (p = 0.049). Since clinical onset, atrophy of specific cerebellar lobules associates with important clinical aspects of RRMS. Cerebellar pathology may be one of the determinants of fatigue and depression that contribute to worsen disability in RRMS.
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Gómez-Moreno SM, Cuadrado ML, Cruz-Orduña I, Martínez-Acebes EM, Gordo-Mañas R, Fernández-Pérez C, García-Ramos R. Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis. Neurologia 2020; 37:S0213-4853(19)30149-5. [PMID: 31983477 DOI: 10.1016/j.nrl.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice. OBJECTIVE We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery. MATERIAL AND METHODS We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population. RESULTS The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity. CONCLUSION The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.
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Affiliation(s)
- S M Gómez-Moreno
- Sección de Neurología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - M L Cuadrado
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - I Cruz-Orduña
- Sección de Neurología, Hospital Universitario Infanta Leonor, Madrid, España
| | - E M Martínez-Acebes
- Sección de Neurología, Hospital Universitario Infanta Leonor, Madrid, España
| | - R Gordo-Mañas
- Sección de Neurología, Hospital Universitario Infanta Leonor, Madrid, España; La afiliación de R. Gordo-Mañas en el momento de la publicación de este artículo es: Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - C Fernández-Pérez
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - R García-Ramos
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Togrol RE, Demir S. Reliability, validity and validation of the CNS emotional lability scale for pseudobulbar affect on multiple sclerosis in Turkish patients. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1472905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rıfat Erdem Togrol
- Department of Neurology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Serkan Demir
- Department of Neurology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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7
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Zurawski J, Stankiewicz J. Multiple Sclerosis Re-Examined: Essential and Emerging Clinical Concepts. Am J Med 2018; 131:464-472. [PMID: 29274753 DOI: 10.1016/j.amjmed.2017.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by exacerbations of neurological dysfunction due to inflammatory demyelination. Neurologic symptoms typically present in young adulthood and vary based on the site of inflammation, although weakness, sensory impairment, brainstem dysfunction, and vision loss are common. MS occurs more frequently in women and its development is complex-genetics, hormones, geography, vitamin D, and viral exposure all play roles. Early MS is characterized by relapsing-remitting course and inflammation of the white matter, although as patients age, the disease often transitions to a pathologically distinct secondary progressive phase with gradual disability accrual affecting gait, coordination, and bladder function. A minority of patients (10%) have disease that is progressive at onset. In the past decade, there has been a remarkable expansion in disease-modifying therapy for MS, but treatment of progressive disease remains a challenge. This article reviews foundational concepts in MS and emerging work that has reshaped understanding of the disease, providing new insight for therapeutic advance.
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Affiliation(s)
- Jonathan Zurawski
- Partners MS Center, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - James Stankiewicz
- Partners MS Center, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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8
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Ozakbas S, Cinar BP, Gurkan MA, Ozturk O, Oz D, Kursun BB. Paced auditory serial addition test: National normative data. Clin Neurol Neurosurg 2016; 140:97-9. [DOI: 10.1016/j.clineuro.2015.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 11/30/2022]
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9
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Yildiz M, Tettenborn B, Radue EW, Bendfeldt K, Borgwardt S. Association of cognitive impairment and lesion volumes in multiple sclerosis – A MRI study. Clin Neurol Neurosurg 2014; 127:54-8. [DOI: 10.1016/j.clineuro.2014.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 08/18/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
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Ranieri M, Putignano P, Fiore P, Santamato A, Megna G, Bellomo R, Cristella G, Saggini R, Megna M. Associated with Intrathecal Baclofen Treatment and Duloxetine in Patients with Multiple Sclerosis. Int J Immunopathol Pharmacol 2012; 25:51S-56S. [DOI: 10.1177/03946320120250s108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M. Ranieri
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Moro” University — Italy
| | - P. Putignano
- St Agostino Institute Rehabilitation Center Noicattaro (Ba) Italy
| | - P. Fiore
- Department of Physical Medicine And Rehabilitation University of Foggia Oo Rr
| | - A. Santamato
- Department of Physical Medicine And Rehabilitation University of Foggia Oo Rr
| | - G. Megna
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Moro” University — Italy
| | - R.G. Bellomo
- Department Of Physical Medicine And Rehabilitation “G. D'annunzio” University — Chieti, Italy
| | - G. Cristella
- Osmairm Neuropsychomotor Rehabilitation Center Laterza (Ta) Italy
| | - R. Saggini
- Department Of Physical Medicine And Rehabilitation “G. D'annunzio” University — Chieti, Italy
| | - M. Megna
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Moro” University — Italy
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Gold R, Wolinsky JS, Amato MP, Comi G. Evolving expectations around early management of multiple sclerosis. Ther Adv Neurol Disord 2011; 3:351-67. [PMID: 21179596 DOI: 10.1177/1756285610385608] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Multiple sclerosis is a progressive inflammatory disease of the central nervous system. With prevention or at least delay of disease progression as a key target in the management of multiple sclerosis, current opinion on treatment encourages early intervention with well-tolerated disease-modifying treatments in order to optimize long-term clinical outcomes. Patients presenting with a clinically isolated syndrome (CIS) may progress to clinically definite multiple sclerosis, and clinical trials have demonstrated that early treatment with interferon beta can reduce the conversion rate. Cognitive impairment may already be present in patients with CISs. Today there is evolving evidence that cognitive impairment may be relevant for prognosis and that early treatment with interferon beta may also have a protective effect on the cognitive function. As an accumulation of neuronal loss is now considered to underlie the development of persistent disability in multiple sclerosis, it is crucial that treatment can protect against neuronal damage. In addition to its anti-inflammatory activity, interferon beta may have direct and indirect neuroprotective effects, and several studies have explored the role of interferon beta in regulating neuroprotective factors. With over 15 years of clinical experience as evidence, the long-term safety and efficacy of interferon beta treatment is unquestionable. Results from the CIS studies have demonstrated the high percentage of patients converting to clinically definite multiple sclerosis without treatment and the short- and long-term benefits of an early use of disease-modifying treatments. These findings support starting disease-modifying treatment as soon as the diagnosis of MS is reasonably formulated.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital/Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Mangiardi M, Crawford DK, Xia X, Du S, Simon-Freeman R, Voskuhl RR, Tiwari-Woodruff SK. An animal model of cortical and callosal pathology in multiple sclerosis. Brain Pathol 2010; 21:263-78. [PMID: 21029240 DOI: 10.1111/j.1750-3639.2010.00444.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The pathological and radiological hallmarks of multiple sclerosis (MS) include multiple demyelinated lesions disseminated throughout the white matter of the central nervous system (CNS). More recently, the cerebral cortex has been shown to be affected in MS, but the elucidation of events causing cortical demyelination has been hampered by the lack of animal models reflecting such human cortical pathology. In this report, we have described the presence of cortical gray matter and callosal white matter demyelinating lesions in the chronic experimental autoimmune encephalomyelitis (EAE) mouse model of MS. Similar to the pathological lesions of MS patients, EAE lesions have been classified as type I-leukocortical, type II-intracortical and type III-subpial. All of these lesions had varying degrees of demyelination, inflammatory cells and reactive astrocytes. Similar to MS, cortical layers during EAE showed demyelination, microglia activation, synaptic protein alterations and apoptotic cells. In addition, the callosal white matter during EAE had many inflammatory demyelinating lesions and axon degeneration. Functional electrophysiological conduction analysis showed deficits in both myelinated and unmyelinated callosal axons during early and late EAE. The chronic EAE mouse model has features that mimic cortical and callosal pathology of MS, and can be potentially used to screen agents to prevent these features of disease.
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Affiliation(s)
- Mario Mangiardi
- Multiple Sclerosis Program, Department of Neurology, School of Medicine, University of California, Los Angeles, CA 90095-1769, USA
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Douzenis A, Michalopoulou PG, Voumvourakis C, Typaldou M, Michopoulos I, Lykouras L. Obsessive-compulsive disorder associated with parietal white matter multiple sclerosis plaques. World J Biol Psychiatry 2010; 10:956-60. [PMID: 19995223 DOI: 10.1080/15622970701762528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the case of a patient who developed obsessive-compulsive symptoms after being diagnosed with multiple sclerosis. In this patient, obsessive-compulsive symptoms deteriorated with the emergence of a right parietal white matter multiple sclerosis plaque. The involvement of parietal white matter abnormalities in the pathophysiology of obsessive-compulsive disorder remains largely unexplored. Our case report raises the possibility that parietal lobe white matter microstructure plays a role in mediating obsessions and compulsions through disruptions of the functional connectivity between cortical-cortical and/or cortical-subcortical brain regions implicated in the pathophysiology of obsessive-compulsive disorder.
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Affiliation(s)
- Athanassios Douzenis
- National and Kapodistrian University of Athens, Medical School, Second Department of Psychiatry, Attikon General Hospital, Athens, Greece
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Reuter F, Audoin B, Rico A, Malikova I, Ranjeva JP, Pelletier J. [Cognitive impairment]. Rev Neurol (Paris) 2009; 165 Suppl 4:S113-22. [PMID: 19361675 DOI: 10.1016/s0035-3787(09)72122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), occurring at all stages of the disease, even at the earliest, and can be a major source of disability, social impairment, and impoverished quality of life. Cognitive dysfunction is mainly focused on working memory, conceptual reasoning, verbal fluency, speed of information processing, attention and executive function. Measures of information-processing speed appear to be the most robust and sensitive markers of cognitive impairment in MS patients. Cognitive testing in MS patients is complex and cognitive screening tests are time- and cost-saving test instruments. A comprehensive and sensitive cognitive test procedure should be administered to detect cognitive dysfunction, and recent studies demonstrate that single, predominantly speed-related cognitive tests may be superior to extensive and time-consuming test batteries in screening cognitive decline. Additional clinical factors, including disease course, fatigue, and affective disturbance, can impact the degree of MS-related cognitive impairment. Despite weak correlation with disease duration and physical disability status, the degree of cognitive impairment in MS has been related to the extent of topographically specific neuronal tissue damage and loss. Numerous studies have applied conventional and quantitative magnetic resonance imaging (MRI) techniques to correlate the profile and degree of cognitive impairment with various MRI-detectable abnormalities. The burden of MRI-visible lesions does not fully account for the degree of MS-related cognitive impairment. Nonconventional MRI findings suggest the extent of subtle tissue damage in normal-appearing white and grey matter to correlate best with the severity of cognitive impairment in MS patients. Structural MRI approaches have recently been extended by functional MRI studies scrutinizing the brain's ability for adaptive functional reorganization in the presence of widespread tissue damage. Cognitive impairment in MS seems to be not simply the result of tissue destruction, but also a balance between tissue destruction, tissue repair, and adaptive functional reorganization. These findings highlight the need to screen for cognitive deficits in MS patients to conduct potential cognitive rehabilitation intervention.
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Affiliation(s)
- F Reuter
- Pôle de Neurosciences Cliniques, Service de Neurologie, CHU Timone, Rue Saint Pierre, 13385 Marseille cedex 5, France
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15
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Servis ME. PSYCHIATRIC COMORBIDITY IN PARKINSON'S DISEASE, MULTIPLE SCLEROSIS, AND SEIZURE DISORDERS. Continuum (Minneap Minn) 2006. [DOI: 10.1212/01.con.0000290502.96516.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Lana-Peixoto MA, Teixeira AL, Haase VG. Interferon beta-1a-induced depression and suicidal ideation in multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:721-4. [PMID: 12364937 DOI: 10.1590/s0004-282x2002000500007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Depression and suicide have been reported in association with multiple sclerosis (MS). Some studies show that interferon beta may increase the depression rate. We report a case of depression and suicidal ideation in coincidence with the start of increased doses of interferon beta-1a and their complete reversal following the drug withdrawal. The patient was a 21-year-old man with MS and no past history of affective disorders who was given interferon beta-1a in the dose of 11 microgram three times per week. As a new relapse occurred the dose of interferon beta-1a was increased to 22 microgram three times a week. The patient then observed increased worry, irritability and a sense of discouragement as well as recurring suicidal thoughts. His mood was rapidly restored following interferon beta-1a withdrawal. This case suggests that patients with MS may develop depression and suicidal thoughts when treated with high doses of interferon beta-1a.
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Affiliation(s)
- Marco Aurélio Lana-Peixoto
- Minas Gerais Center for Investigation of Multiple Sclerosis, Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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Berg D, Supprian T, Thomae J, Warmuth-Metz M, Horowski A, Zeiler B, Magnus T, Rieckmann P, Becker G. Lesion pattern in patients with multiple sclerosis and depression. Mult Scler 2000; 6:156-62. [PMID: 10871826 DOI: 10.1177/135245850000600304] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To assess if a specific lesion pattern or changes of the basal limbic system as seen in primary depression and depression associated with neurodegenerative disorders might be identified in depressive multiple sclerosis (MS) patients, we submitted 78 MS patients to a MRI examination consisting of a quantitative measurement of lesions and of hyperintense signals from the pontomesencephalic midline (raphe). Furthermore relaxometry of the pontomesencephalic midline, a transcranial ultrasound examination rating its echogenicity semiquantitatively and a standardized neurological, neuropsychiatric and neuropsychological assessment were obtained. Thirty-one patients fulfilled the DSM-IV criteria for depression. Depressed MS patients had a significantly larger temporal lesion load than non-depressed MS patients, especially on the right side. A trend of difference was detected for lesions of the right parietal lobe, the right frontal lobe, the cerebellum and the total lesion load. Neither hyperintense signals or relaxometry nor echogenicity of the region at the level of the pontomesencephalic midline were significantly different between the groups. We conclude that depression in MS patients is not associated with an alteration of the basal limbic system at the brainstem as seen in Parkinson's disease or unipolar depression but with an increased lesion load of the projection areas of the basal limbic system.
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Affiliation(s)
- D Berg
- Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, Germany
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Blinkenberg M, Rune K, Jønsson A, Holm S, Jensen CV, Paulson OB, Sørensen PS. Cerebral metabolism in a case of multiple sclerosis with acute mental disorder. Acta Neurol Scand 1996; 94:310-3. [PMID: 8947281 DOI: 10.1111/j.1600-0404.1996.tb07071.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute mental disorder in early Multiple Sclerosis (MS) is rare and little is known about the structural and metabolic changes in this relation. We present an MS patient with discrete motor and sensory deficits, who developed severe behavioral changes over a period of nine months during the initial course of the disease. The cerebral metabolic rate of glucose (CMRglc) was measured using positron emission tomography (PET), and the patient underwent MRI as well as a comprehensive battery of neuropsychological tests. Significantly reduced values of CMRglc were found bilaterally in the frontal and temporal cortex, the putamen, the thalamus and the hippocampus. The MRI revealed progression of MS lesions in the frontal lobes during the development of mental symptoms. Neuropsychological examination showed wide spread cognitive dysfunction, and a pronounced frontal lobe syndrome. The study demonstrates the remote metabolic effects of lesions affecting subcortical neural connections in an MS patient with severe cognitive dysfunction.
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Affiliation(s)
- M Blinkenberg
- Department of Neurology, National Hospital (Rigshospitalet), Copenhagen, Denmark
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Rodgers J, Bland R. Psychiatric manifestations of multiple sclerosis: a review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1996; 41:441-5. [PMID: 8884033 DOI: 10.1177/070674379604100709] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the occurrence, type, causes, and management of psychiatric manifestations in multiple sclerosis (MS). METHOD Review of recent, relevant literature. RESULTS Psychiatric illness, especially depression, occurs much more frequently than expected in patients with MS, is frequently unrecognized or ignored, and is treatable using standard methods, although patients with MS may be unusually sensitive to side effects of tricyclic antidepressants. CONCLUSIONS Research is needed to better define the causes of psychiatric syndromes in patients with MS. Those treating MS should increase their awareness of and sensitivity to the likelihood of psychiatric disorder in these patients.
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Affiliation(s)
- J Rodgers
- Department of Psychiatry, University of Alberta, Edmonton
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