Multimodal Evoked Potentials as Potential Biomarkers of Disease Activity in Patients With Clinically Isolated Syndrome

Objective

There is an ongoing search for markers useful in monitoring and predicting disease activity at the early stage of multiple sclerosis (MS). The goals of this study were to prospectively evaluate the changes in parameters of multimodal evoked potentials (EP) and cognition within a 3-year follow-up period in patients with clinically isolated syndrome (CIS), and to assess the prognostic value of baseline findings with regard to the disease outcomes.

Methods

In 29 patients (20 women, nine men, mean age 31.1) multimodal (visual, brainstem auditory, somatosensory, event-related) EP and neuropsychological tests (NT) were performed at baseline (T0) and after 1 (T1) and 3 (T3) years. Their results were compared longitudinally between baseline, T1, and T3. Baseline results confirmed conversion of CIS into multiple sclerosis (MS) and disability level at T1 and T3 using multiple comparisons and a logistic regression model.

Results

Apart from mean N13/P16 SEP (somatosensory evoked potentials) amplitude (lower at T1 and T3 than at baseline (T0 1.02 ± 0.37 μV, T1 0.90 ± 0.26 μV, T3 0.74 ± 0.32 μV, p < 0.05 for both comparisons), no significant changes of EP or NT parameters were found in longitudinal assessment. Baseline P300 Pz latency was longer for the patients with MS than for those with CIS at T1 (352.69 vs. 325.56 ms). No predictive value was shown for any of the analyzed baseline variables with regard to conversion from CIS into MS.

Significance

Baseline ERP abnormalities were associated with their short-term conversion into MS. ERP are worth considering in multimodal EP evaluation at the early stage of MS.

Symptoms after COVID-19 Infection in Individuals with Multiple Sclerosis in Poland

(1) Background: To report and analyze the presence of residual symptoms after SARS-CoV-2 infection among Polish patients with multiple sclerosis (MS) treated with different disease-modifying therapies (DMTs). (2) Methods: The study included 426 individuals with MS treated with DMTs and confirmed SARS-CoV-2 infection from 12 Polish MS centers. The data were collected through to 31 May 2021. The information included demographics, specific MS characteristics, course of SARS-CoV-2 infection, and residual (general and neurological) symptoms lasting more than four and 12 weeks after the initial infection. The results were obtained using maximum likelihood estimates for odds ratio and logistic regression. (3) Results: A total of 44.84% patients with MS reported symptoms lasting between four and 12 weeks after the initial infection; 24.41% people had symptoms that resolved up to 12 weeks, and 20.42% patients had symptoms that lasted over 12 weeks. The most common symptoms were: fatigue, disturbance of concentration, attention, and memory, cognitive complaints, and headache. None of the DMTs were predisposed to the development of residual symptoms after the initial infection. A total of 11.97% of patients had relapse three months prior or after SARS-CoV-2 infection. (4) Conclusion: Almost half of individuals with MS treated with different DMTs had residual symptoms after SARS-CoV-2 infection. None of the DMTs raised the probability of developing post-acute COVID symptoms.

Burden of COVID-19 Pandemic Perceived by Polish Patients with Multiple Sclerosis

People with multiple sclerosis (MS) were expected to be particularly affected by the COVID-19 pandemic. The purpose of the study was to evaluate the burden of pandemic, perceived by Polish MS patients, with regard to major contributing factors. The survey, conducted in August/September 2020, included: Perceived Stress Scale (PSS-10), Coping Orientations to Problems Experienced (Brief–COPE), questions on demographic data, MS characteristics, and health-related and social aspects of pandemic burden. Relationships were searched between PSS-10 and Mini-COPE results and other analyzed items, using U Mann–Whitney test, Kruskal–Wallis ANOVA rank test and Spearman rank correlation. The survey was answered by 287 MS patients (208 female, 79 male, aged 21–69 years). Since March 2020, 2.4% of respondents had been positive for COVID-19 and 5.2% had undergone a quarantine. Mean PSS-10 score was 19.99, with moderate or high level of stress in 83.3% of respondents. Problem-focused strategies were more frequently used than emotion-focused strategies (1.76 vs. 1.16). Higher PSS-10 score was associated with comorbidities (H = 4.28), increase in major MS symptoms during the pandemic (21.92 vs. 18.06), experience of healthcare limitations (21.12 vs. 17.98), work-related (22.58 vs. 18.69), financial (22.70 vs. 18.83) and family-related problems (22.54 vs. 17.73) due to pandemic restrictions. A coping model was associated with functional disability and limitations to daily activities (H = 7.81). During the first stage of the pandemic, MS patients reported increased level of stress and preferred problem-focused coping. The level of stress and coping showed more relationships with pandemic impact upon social issues than with MS-related variables.

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies - the Polish experience

INTRODUCTION

The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited.

MATERIALS AND METHODS

This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health.

RESULTS

There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Social participation of patients with multiple sclerosis

BACKGROUND

The effect multiple sclerosis (MS) has on the social functioning and integration of patients has been recently considered as an important factor of the disease.

OBJECTIVES

To assess social participation of MS patients with regard to demographic and disease-related variables.

MATERIAL AND METHODS

The study comprised 201 MS patients: 140 women, 61 men, aged 24-69 years. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was applied to assess the aspects of social functioning and the Beck Depression Inventory (BDI) was applied to evaluate the level of depression. Disease duration, degree of disability in Expanded Disability Status Scale (EDSS), most disabling symptoms and type of treatment were determined. WHODAS 2.0 scores (total and within particular domains) and their relationships with age, gender, disease-related variables and level of depression were analyzed.

RESULTS

The results of WHODAS 2.0 for 27.4% of patients exceeded the 90th percentile compared to the population norms (with the highest scores for "getting around" and "participation in society" domains). The results of BDI and WHODAS 2.0 were strongly correlated (p < 0.001; β = 0.73) and mobility impairment was related to both of them (p < 0.001; β = -0.12 and 0.25, respectively). Other disabling symptoms were associated with scores in domains "understanding and communicating", "getting around" and "participation in society".

CONCLUSIONS

Social participation of the MS patients is affected by the impact of disease and associated with depression. Particular symptoms of neurological deficit (motor and visual impairment, fatigue) influence social functioning more than general disease-related variables.

Internet Usage by Polish Patients With Multiple Sclerosis: A Multicenter Questionnaire Study

Background

The internet is a source of knowledge and medium widely used in services that facilitate access to information and networking. Multiple sclerosis (MS) patients find the possibility of acquiring information relating to their condition particularly rewarding.

Objective

We aimed to identify Polish MS patients’ preferences by analyzing a percentage of internet users and determining the most common search subjects and patients’ approach to information on the internet. Disability connected with the condition, its duration, and other factors that influence patients’ internet use were examined along with instances of relations established through the internet and their durability.

Methods

The study examined 1045 patients (731 women, 314 men) treated in 10 Polish MS centers, of whom 932 (89.19%) declared to be internet users. Their average age was 40.65 (SD 11.06) and average MS duration was 9.08 (SD 6.97) years. The study used a proprietary survey on information seeking, the range of searched subjects, and internet usage frequency.

Results

The majority of the patients (494/932, 53.0%) used the internet 6-7 times per week and 4.3% (40/932) declared they spent minimum 2 hours per day. The most commonly searched subjects were world news (604/932, 72.9% of patients using the internet); 60.8% (504/932) searched for information on their condition, particularly for new treatment methods (562/932, 67.8%) and the course of illness (520/932, 62.7%). One’s sex had no impact on internet usage (female vs male, odds ratio [OR] 1.13, 95% CI 0.72-1.77), although a patient’s age might, at varying degrees. We found several significant associations using a .05 significance level: a patient with higher education used the internet 9 times more often than one with primary education (OR 8.64, 95% CI 3.31-22.57); lasting relationships increased chances of internet usage by 10-fold compared to widowers (OR 0.12, 95% CI 0.05-0.31); living in a city with a population over 100,000 increased chances by nearly 6 times compared with the countryside (OR 5.59, 95% CI 2.72-11.48); the relapsing-remitting MS type saw a 2-fold increase compared with the primary progressive MS type (OR 0.47, 95% CI 0.29-0.75); and those needing assistance were 2 times less likely to use the internet than patients who could move independently (OR 0.53, 95% CI 0.31-0.89). More than half of the patients (489/932, 52.5%) did not discuss the information found on the internet with their neurologists; 15.9% (148/932) believed that relationships established through the internet can be stable.

Conclusions

The majority of Polish patients use the internet as a crucial information source on their condition and innovative treatment methods. The internet can be helpful in establishing new relationships, which are usually short-lived. Polish patients do not frequently discuss the information gathered on the internet with their doctors.

Cognitive impairment, event-related potentials and immunological status in patients with systemic lupus erythematosus

BACKGROUND

Cognitive impairment (CI) is a frequent problem in lupus patients, regardless of their overt neuropsychiatric (NP) involvement.

OBJECTIVES

The aim of our study was to test cognitive abilities in systemic lupus erythematosus (SLE) patients by means of neuropsychological testing and event-related potentials (ERPs), and to search for their cognitive abilities correlations with a wide range of auto-antibodies.

MATERIAL AND METHODS

A total of 37 SLE patients were subjected to a battery of neuropsychological tests, recommended by the American College of Rheumatology (ACR), and to ERPs. They were also tested for a wide range of auto-antibodies (anti-cardiolipin (aCL), anti-β2-glycoprotein I (anti-β2-GPI), lupus anticoagulant, anti-dsDNA, anti-nucleosome, anti-ribosomal P (anti-Rib-P), anti-ganglioside, anti-Ro/SS-A, and anti-La/SS-B.

RESULTS

Cognitive impairment was found in 35% of patients, mostly with NP SLE (NPSLE), and was associated with higher disease activity, measured by the SLE Disease Activity Index (SLEDAI), and with a longer duration of central nervous system (CNS) involvement. There were no differences in the immunological status between CI patients and those without cognitive decline, but some antibodies were correlated with worse results in certain neuropsychological tests (anti-dsDNA and worse results of Rey Complex Figure Test - RCFTc for copying and RCFTr for recall, and of verbal fluency test (VFT); aCL IgG and worse results in Digit Span (DS) and in RCFTc). Event-related potentials showed prolonged N200 and P300 latencies in SLE patients in comparison to controls, but no differences were found between SLE and NPSLE patients. Mean P300 latency was significantly longer in patients without anti-nucleosome antibodies.

CONCLUSIONS

Event-related potentials can be used as a complementary tool in assessing CI in SLE patients. The immunological status of patients with CI did not differ from that of patients without cognitive problems.

The relationship between epileptiform discharges and background activity in the visual analysis of electroencephalographic examinations in dogs with seizures of different etiologies

Electroencephalographic (EEG) recordings in 125 outpatient dogs with various epileptiform encephalopathies were acquired under medetomidine sedation using subdermal wire electrodes. The features of canine EEG (background activity [BGA] and epileptiform discharges [EDs]) were assessed, described and compared. The dogs included neurologically healthy controls (N, n = 19), dogs with portosystemic shunt (PSS, n = 9), dogs with intracranial pathologies (IP, n = 27) and dogs with idiopathic epilepsy (IE, n = 70). A visual EEG analysis revealed significantly more pronounced high voltage, low-frequency BGA in the PSS and IP groups in comparison to the N and IE groups (PSS vs. N, PSS vs. IE P <0.0001; IP vs. N, IP vs. IE P = 0.043). At least one ED in the recording was found in 47.37% (n = 9/19) of the individuals in the N group, 88.9% (n = 8/9) of the dogs in the PSS group, 77.78% (n = 21/27) of the dogs in the IP group and 61.43% (n = 43/70) of the dogs in the IE group. The presence of bilateral symmetric triphasic (BST) waves was significantly higher in the PSS group than in the remaining groups. There was a strong prevalence of spike-waves in dogs with idiopathic epilepsy and of BST waves in dogs with portosystemic shunt. None of the dogs in group N had spike-waves or BST activity. EDs were observed more frequently in high and very high voltage, low frequency BGA than in low voltage, high frequency BGA.

Cognitive performance, fatigue and event-related potentials in patients with clinically isolated syndrome

OBJECTIVES

Cognitive impairment and fatigue are regarded as important aspects of multiple sclerosis. The aim of this study was to evaluate cognitive performance, the level of fatigue and parameters of event-related potentials (ERP) in patients diagnosed with clinically isolated syndrome (CIS).

PATIENTS AND METHODS

The study comprised 44 patients with CIS and 45 healthy controls. Cognitive performance was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRBNT), fatigue - using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). Auditory ERP were performed and the parameters of N200 and P300 components were analyzed. Neuropsychological and electrophysiological measures were referred to clinical and radiological features of the disease activity.

RESULTS

Forty five% of patients failed in at least one test from BRBNT, mainly within the domains of memory and attention. In 18% of patients FSS corresponded with moderate or severe fatigue. The mean latency of N200 and P300 was significantly longer and amplitude of P300 was lower in those patients with CIS than in the controls. Significant correlations were found between the results of MFIS and tests evaluating verbal memory and attention, as well as between N200 latency and results of tests for verbal memory.

CONCLUSIONS

Cognitive performance and fatigue deserve attention from the earliest clinical stage of MS. Abnormalities of event-related potentials in CIS suggest early impact of the disease on functional neural networks.

Assessment of visual and auditory evoked potentials in multiple sclerosis patients with and without fatigue

The aim of the study was to evaluate visual and brainstem auditory evoked potentials (VEP, BAEP) in multiple sclerosis (MS) patients with regards to fatigue and disease-related variables. The study comprised 86 MS patients and 40 controls. Fatigue was assessed using the Fatigue Severity Scale (FSS/FSS-5) and the Modified Fatigue Impact Scale (MFIS). Latencies and amplitudes of the P100 component of VEP and the I–V components of BAEP were analyzed. The results of EP were compared between non-fatigued, moderately and severely fatigued MS patients and controls. P100 latency was increased and amplitude decreased in moderately and severely fatigued MS subjects. The latency of the V component of BAEP and interlatencies I-III-V were increased in severely fatigued patients. The amplitude of the V component was lowered in fatigued patients. VEP and BAEP abnormalities were usually one-sided. Interocular P100 latency difference tended to correlate with FSS/FSS-5. The parameters of VEP and BAEP correlated with functional system scores but not with MS duration, overall degree of disability or its progression over time. Significant, usually asymmetrical VEP and BAEP abnormalities were found in fatigued MS patients, with no relationships to disease-related variables. EP may be considered an electrophysiological marker of fatigue in MS patients.

In vivo evaluation of brain damage in the course of systemic lupus erythematosus using magnetic resonance spectroscopy, perfusion-weighted and diffusion-tensor imaging

Twenty-two neuropsychiatric (NPSLE) and 13 systemic lupus erythematosus (SLE) patients with a normal appearing brain on plain magnetic resonance (MR) as well as 20 age-matched healthy controls underwent MR spectroscopy (MRS), perfusion-weighted (PWI) and diffusion-tensor imaging (DTI). In MRS NAA/Cr, Cho/Cr and mI/Cr ratios were calculated from the posterior cingulate cortex and left parietal white matter. In PWI, values of cerebral blood volume (CBV) were assessed from 14 regions, including gray and white matter. In DTI fractional anisotropy (FA) values were obtained from 14 white matter tracts including projection, commissural and association fibers. All MR measurements were correlated with clinical data. SLE and NPSLE patients showed significantly (p < 0.05) lower NAA/Cr ratios within both evaluated regions and FA values within the cingulum, as well as a tendency to cortical hypoperfusion. Compared to SLE, NPSLE subjects revealed lower FA values within a wide range of association fibers and corpus callosum. Advanced MR techniques are capable of in vivo detection of complex microstructural brain damage in SLE and NPSLE subjects regarding neuronal loss, mild hypoperfusion and white matter disintegrity. MRS and DTI seem to show the highest usefulness in depicting early changes in normal appearing gray and white matter in SLE patients.

Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis

The prevalence of autoantibodies in multiple sclerosis (MS) patients and their clinical associations differ between various studies. This study investigated antiphospholipid and antinuclear antibodies in 85 patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) with regard to their association with demographic features, MS specific clinical features and symptoms of connective tissue diseases. Autoantibodies tested included antinuclear antibodies (ANA) with their specificities and anticardiolipin (aCL) and anti-beta-2-glycoprotein I (anti-β2GPI) antibodies. Antinuclear antibodies were more prevalent in MS patients than in controls (63.5% vs. 3.3%; p < 0.01) and in 19% of patients specific antinuclear antibodies were detected. Anti-β2GPI IgM antibodies were more frequent in MS patients than in the control group (20% vs. 3.3%; p < 0.05). The frequency of anticardiolipin antibodies did not differ between MS patients and controls. MS patients seropositive for ANA and extractable nuclear antigens (ENA) had significantly shorter disease duration than seronegative patients (p < 0.05) and a lower disability score (Expanded Disability Status Score; EDSS) (p < 0.05). Anti-β2GPI antibodies were more frequent in patients with secondary progressive MS (SP-MS) and specific ANA antibodies were more frequent in patients with clinically isolated syndrome (CIS) (p < 0.05). The presence of autoantibodies was not associated with the predominant site of neurological involvement or the clinical features of connective tissue diseases.

Secondary progressive multiple sclerosis - clinical course and potential predictive factors

BACKGROUND AND PURPOSE

To characterize the course of secondary progressive multiple sclerosis (SPMS), with an attempt to assess the predictive value of early clinical variables.

MATERIAL AND METHODS

Medical records of 100 patients with SPMS (40 men, 60 women, aged 34-73) were analyzed retrospectively. Age at onset of MS, first symptoms, annual exacerbation rate (AER), time to progressive phase (TTP), degree of disability at its beginning (Expanded Disability Status Scale; EDSS SP), and annual progression in disability in relapsing-remitting and progressive phases (APD RR and APD SP) were compared for the gender subgroups, and the relationships between them were analyzed.

RESULTS

Time to progressive phase range was 2-29 years (mean 11.51) and EDSS SP 2-7.5 (mean 5.55). Time to progressive phase in women was longer and EDSS SP was lower than in men. Age at onset of MS, AER and ADP RR correlated positively with TTP. Optic neuritis was the most common first symptom (49%; motor deficit and cerebellar/brainstem involvement 26% and 21%, respectively). Time to progressive phase in the former subgroup was shorter than in the latter, but no differences in ADP SP were found. Annual progression in disability in relapsing-remitting was higher than APD SP. Degree of disability at its beginning (EDSS SP) correlated negatively with ADP SP.

CONCLUSIONS

Older age at onset, male gender, frequent relapses and fast increase in disability in the relapsing-remitting phase are risk factors for conversion to SPMS. Increase in disability during the progressive phase is slower than in the relapsing-remitting phase and depends mainly on initial EDSS. Individual variability of the course of MS has to be considered.

[Clinical assessment of the course of relapsing-remitting multiple sclerosis in patients treated with interferon beta]

AIM OF THE STUDY

To analyse retrospectively course of the disease in the patients with relapsing-remitting multiple sclerosis (R-R MS), treated with interferon beta (IFN-beta), to compare clinical data within the periods before, during and after IFN-beta treatment and to refer these parameters to clinical state of patients at the beginning of treatment.

MATERIAL AND METHOD

The study comprised 40 patients (18 men, 22 women, aged 22-55 years) with R-R MS, treated with IFN-beta for at least 12 months, with documented follow-up before the treatment and for at least 12 months after it was discontinued. Annual exacerbation rate (AER) and annual rate of disability progression measured by means of expanded standard disability status scale (ap-EDSS) within the periods before, during and after the IFN-alpha treatment were compared for all the patients and referred to duration of the disease and EDSS score at the beginning of treatment. AER and ap-EDSS were also analyzed for subgroups of patients who were relapse-free or whose EDSS score improved during the treatment.

RESULTS

Mean values of AER and ap-EDSS were significantly lower during the IFN-beta treatment than before and after the treatment. AER during and after the treatment correlated positively with EDSS score at the beginning of the treatment. ap-EDSS during the treatment was significantly lower for the patients with EDSS <3 at the beginning of the treatment than for those with EDSS > or = 3. The patients who were relapse--free during the treatment had significantly lower EDSS score at the beginning of treatment and lower AER after the treatment in comparison with those who had relapses. The patients whose EDSS score improved during the treatment had significantly lower EDSS score at the beginning of treatment and lower AER after the treatment in comparison with those whose EDSS score worsened or remained unchanged. AER and ap-EDSS did not depend upon duration of IFN-beta treatment.

CONCLUSIONS

In patients with R-R MS IFN-beta has significant influence upon course of the disease: it causes decrease in exacerbation rate and slower progression of disability. However, improvement of these parameters persists only during the treatment. Clinical effect of treatment depends on initial stage of disability but does not depend on dynamics of the disease before the treatment. For optimal results of IFN-beta treatment, it should be introduced possibly early in the course of MS.

Lack of association between an exon 1 CTLA-4 gene polymorphism A(49)G and multiple sclerosis in a Polish population of the Lower Silesia region

Multiple sclerosis (MS) a chronic inflammatory demyelinating disease of the central nervous system is believed to have a T cell-mediated autoimmune etiology. The cytotoxic T lymphocyte antigen 4 (CTLA-4) gene is a strong candidate for the involvement in autoimmune diseases because CTLA-4 plays an important role in the downregulation of the early and late stages of T cell activation and the maintenance of peripheral T cell tolerance. To examine the genetic association of the CTLA-4 gene locus with MS, we analyzed an exon 1 CTLA-4 gene polymorphism A(49)G in 102 unrelated Polish MS patients in the Lower Silesia region and 101 age- and sex-matched healthy subjects. The distribution of CTLA-4 exon 1 A(49)G genotype, phenotype and allele frequencies did not differ between patients with MS and healthy subjects.

Fas expression on T cells and sFas in relapsing-remitting multiple sclerosis

OBJECTIVES

To investigate the proportions of peripheral blood CD4+/Fas+ and CD8+/Fas+ cells and serum sFas levels in relapsing-remitting multiple sclerosis (RRMS) patients with relapses (active RRMS), those without relapses (stable RRMS), and controls over 1 year.

MATERIAL AND METHODS

Sixteen RRMS patients and 10 controls were tested monthly. Cells were analyzed by dual immunofluorescence and the sFas levels by ELISA. There were 14 relapses which occurred 1223 days after the last control visits. The measurements performed at these visits in the active RRMS patients were considered as relapse-related, while the rest were regarded as relapse-unrelated.

RESULTS

In active RRMS patients the median of CD4+ Fas+ to total CD4+ and CD8+ Fas+ to total CD8+ from relapse-related measurements were higher than the median from relapse-unrelated measurements (P=0.003, 0.004, respectively). The median of CD4+ Fas+ to total CD4+ from relapse-unrelated measurements in active RRMS was higher compared with stable RRMS (P = 0.005) and controls (P = 0.004). The sFas level from relapse-unrelated measurements was also higher in active RRMS than in stable RRMS (P = 0.04) and in controls (P = 0.004).

CONCLUSIONS

We suggest that increased expression of Fas antigen on CD4+ subset and increased serum sFas level are valuable markers of clinical activity in MS.

Serum levels of sTNFR-1 and sFas in patients with relapsing-remitting multiple sclerosis

BACKGROUND

During the relapse of multiple sclerosis (MS), activated T cells, T cells autoreactive against myelin antigens as well as antigen-nonspecific lymphocytes and monocytes produce a number of proinflammatory cytokines such as TNF (Tumor Necrosis Factor). For a proinflammatory effect to take place TNF must bind together with appropriate receptors. The aim of the study was to assess value of serum sTNFR-1 and sFas levels with reference to clinical activation of disease.

MATERIAL/METHODS

Thirty-three patients with clinically documented diagnosis of relapsing-remitting MS and 22 healthy subjects were included in the study. In 15 patients the measurements of sTNFR-l and sFas levels were performed at the beginning of MS relapse and in 18 subjects--they were taken in MS remission. 'I'he levels of both soluble molecules were determined with the use of enzyme-linked immunosorbent assay (ELISA).

RESULTS

Mean serum sTNFR-1 levels in patients with MS relapse did not differ significantly from mean sTNFR-1 level in patients with MS remission and a control group. Mean serum sFas level in patients with MS relapse was significantly higher comparing with the results obtained in patients with MS remission and in control group.

CONCLUSIONS

The absence of changes in serum sTNFR-1 levels relative to clinical activation of the disease makes this measurement ineffective in the assessment of MS status. On the other hand, the measurement of serum sFas levels may be a valuable parameter for the monitoring of both MS clinical course and immune response to treatment when the symptoms of neurological deficit aggravate.

Expression of Fas antigen on T cell subpopulations in peripheral blood of patients with relapsing-remitting multiple sclerosis

BACKGROUND

During the relapse of multiple sclerosis, the activation of T cells, autoreactive to myelin antigens in blood, enhanced and maintained as a result of anomalous mechanisms of their earlier elimination, leads on para- and autocrine basis to the activation of antigen- non-specific cells of immune system. In consequence, activated cells secrete a range of proinflammatory cytokines and display activation antigen expression on their surface, which results in blood-brain barrier damage. The differentiation of lymphocytes into effector cells in blood during MS relapse is to increase the number of cells supporting inflammatory reactions and simultaneously to reduce the number of cells which play a role of suppressors. Fas antigen is present among activation antigens found on T cells. Once this antigen has been combined with the ligand, it transmits apoptic signal to the cell. The presence of Fas antigen on activated peripheral blood T cells may enable us to estimate their activation and it may also indicate a potential to eliminate those cells from blood. The aim of the study was to provide a quantitative assessment of the subpopulations of CD3, CD4 and CD8 lymphocytes in peripheral blood and to investigate Fas antigen expression on these subsets in patients with relapsing-remitting multiple sclerosis, in relation to clinical activation of the disease.

MATERIAL AND METHODS

Thirty-five patients participated in the study, including 14 patients finding themselves in clinical relapse of the disease and 21 patients in the state of remission. Additionally, 21 healthy subjects were included. Quantitative assessment of individual subpopulations and Fas co-expression was carried out with the use of monoclonal antibodies anti CD3, CD4 and CD8 as well as anti CD95 antibodies, and flow cytometer Pas/Dako Galaxy.

RESULTS

The differences in the percentage of particular lymphocytes between 3 groups proved insignificant. Patients in the relapse of the disease showed significantly greater Fas expression on subpopulations CD3 and CD4 when compared to the results obtained from remission patients and control subjects. This difference was not observed for Fas expression on subset CD8.

CONCLUSIONS

The investigation of Fas receptor expression may be useful in order to monitor clinical course of the disease, which is characterised by the periods of exacerbation and remission.

[The comparison of the effectiveness of treatment of multiple sclerosis relapse with high doses of methylprednisolone, alpha-24 corticotropin and cyclophosphamide]

The effectiveness of treatment was compared in groups of patients with definite multiple sclerosis (MS) given respectively: methylprednisolone, alpha-24 corticotropine and cyclophosphamide combined with corticotropine. Clinical improvement was assessed by means of the expanded disability status scale (EDSS). The significant results were noted in patients treated with methylprednisolon and corticotropine combined with cyclophosphamide (1.5 in EDSS) for the first time, when compared to subsequent treatment. Within the patients in a more advanced stage of the disease, undergoing subsequent treatment, those given corticotropine displayed the best improvement (1.5 in EDSS), but without statistical significance. The authors suggest methylprednisolone or corticotropine combined with cyclophosphamide are the most effective immunosuppressive treatment in the initial phase of MS.

[Evaluation of sweating function, changes in heart function and postural blood pressure in patients with multiple sclerosis]

The aim of the study was electrophysiologic assessment of sudomotor function and some aspects of cardiovascular system function in patients with multiple sclerosis and an attempt of referring assessed variables to duration of the disease and EDSS score. The study included 24 patients with clinically definite, relapsing-remitting multiple sclerosis and 22 healthy, age-matched controls. Autonomic functions were evaluated by means of clinical examination, heart rate variability tests, measures of blood pressure in supine and standing position and skin sympathetic response examination. Clinical symptoms in patients with multiple sclerosis were scarce. Electrophysiologic tests showed no abnormalities in heart rate variability and blood pressure response to standing in studied group. The majority of patients presented with subclinical dysfunction of sudomotor system, indicated by an abnormal sympathetic skin response, which did not correlate with duration of the disease or EDSS score. Sympathetic skin response examination proved to be a sensitive indicator of autonomic disturbances in patients with multiple sclerosis.

[Congenital defects of the spinal part of the neural tube]

The abnormal closure of the neural tube results in defects of the nervous system development, which are referred to as dysraphism. Considering successive steps of the development of the human foetus, it can be estimated that spinal cord malformations arise from pathologies of early foetal development between 17th and 28th day gestational age. This time period comprises a development of the neural plate and subsequently neural tube. The development is completed with a closure of a posterior aperture of the neural tube (caudal neuropore). Congenital malformations are often caused by defective closure of the caudal neuropore. The neural plate develops about 17th day gestational age, the cerebral vesicle appears about 21st day and the neural tube forms between 17th and 20th day. The rostral neuropore closes on the day 25th as does the caudal neuropore on the day 28th. The embryo is 2.5 mm long at the time. Noxious factors acting during that period can affect normal closure of the caudal neuropore and distort the process of spinal cord canalization. The resultant defect is called spina bifida. This is the most severe form of dysraphism-rachischisis. Meninges are also affected in this defect. They cannot cover the neural canal and on the margins of the lesion are replaced by epithelium. In milder types of the defect lack of a complete bony framework is concealed by soft tissues, forming a sac of variable size over the lesion. Spina bifida can be subdivided according to the sac structure: meningocoele, meningocysticoele, meningomyelocoele, meningomyelocystocoele. Central canal pathologies constitute another form of spinal cord malformations presenting as hydromyelia. Abnormal closure of the neural tube may affect development of the vertebral column and spinal cord along their entire length or only at a certain portion. Malformations are seen most frequently in the lumbo-sacral and then cervical regions.

[Sarcoidosis with involvement of the central nervous system]

Two cases of lungs and mediastinal lymph nodes sarcoidosis with involvement of central and peripheral nervous system were described. In one patient the vascular type of neurosarcoidosis was diagnosed, in another-the inflammatory type, with pyramidal and cerebellar symptoms and severe peripheral changes. Both cases were illustrated with MRI scans.

[Sleep disorders in patients with brain stem lesions]

In 10 patients with clinical symptoms of brainstem lesions of various aethiology and different localization within the brainstem polysomnographic records were performed. Patients were divided into two groups (according to age) and the results obtained in each group were compared with the results in control group. In all patients prolongation of I and III+IV phases and reduction of II and the REM phase were noted. In some patients REM was not observed at all. These results may confirm the theory of the localization of the sleep centre in the brainstem, specially the centre of induction of the REM.

[Paroxysmal EEG changes in patients with multiple sclerosis]

The electroencephalograms (EEG) and visual evoked potentials (VEP) were recorded in 100 multiple sclerosis patients treated from 1981 to 1989. In 35 cases the EEG records were pathological and in 12 of them they showed paroxysmal changes. Pathological EEG were mostly seen in young patients, during the first relapse, with high degree of Kurtzke's disability score. Patients with paroxysmal changes showed on physical examination brain stem lesions that could be responsible for paroxysmal activity in EEG. The latencies of P100 wave and amplitudes of P100/N120 complex were analysed in two groups of patients (with and without paroxysmal activity in EEG). There was no statistically important difference between two groups, although in the group with paroxysmal changes in EEG some prolongation of the latency of P100 wave and a little higher amplitude of P100/N120 complex were recorded.

[Results of treatment with plasmapheresis in myasthenic crisis and severe polyneuropathy]

Results of plasmapheresis on myasthenic crisis, Guillain-Barre syndrome (GBS) and paraneoplastic polyneuropathy are presented. In the cases of myasthenic crisis which did not respond to steroids addition of plasma exchange (PE) improved dramatically respiratory failure. Also good results were obtained in GBS treated with PE. In the case of paraneoplastic polyneuropathy PE did not influence the course of disease.

Dry drop of blood plasma--a new approach in the diagnosis of neoplastic diseases

The dried drop of blood plasma and serum was first described by Białowas in 1967. The dry drop as a method for diagnosis of neoplasms was introduced in 1984 by Hungarian authors from Cancer Research Group. The aim of our investigations was to estimate the usefulness of this method in diagnostic of central nervous system's tumours and lung cancers. We worked out our own modification of dry drop test, i.e., we used the blood plasma instead the blood serum. In 93% of neoplasms the result of test was positive (in 92% of neoplasms of central nervous system and in 83% of lung cancers). In the control group occurred the large number of falsely positive results, as well as in group of patients with lung tuberculosis (70%), multiple sclerosis (63%) and myasthenia (45%). The results of our investigations showed the usefulness of this method in the screening diagnostic of neoplasia. The further investigations are necessary, especially correlation of dry drop test results with erythrocyte sedimentation test and antibodies and fibrinogen's level in the blood.