Research progress on risk factors for radiologically isolated syndrome conversion and its clinical management / 中华神经科杂志

Radiologically isolated syndrome (RIS) is considered as an imaging marker of the prodromal stage of multiple sclerosis (MS), and approximately one-third of patients might convert to clinically isolated syndrome or clinically definite multiple sclerosis within 5 years after diagnosis. Although it still remains inconclusive whether or not disease-modifying therapies for RIS need to be initiated, effective identification of prognostic factors for conversion would be of great benefit for early screening of high-risk patients and subsequent clinical precision management. Combined with the latest research progress at home and abroad, this review summarizes the prognostic factors for conversion of RIS to MS from the aspects of demographic characteristics, clinical presentations, imaging manifestations, cerebrospinal fluid and ophthalmological examinations. Given that disease-modifying therapies for RIS are still in clinical research stage and there are no definite recommendations to date, this article expounds the research progress on clinical monitoring, therapeutics and prevention of disease progression, which aims to provide neurologists with reference suggestions on clinical management of RIS.

Software for cerebrospinal fluid diagnostics and statistics / Software para el diagnóstico y estadísticas del líquido cefalorraquídeo

Background: In CSF analysis for diagnostics we have knowledge-based software for numerical and graphical data interpretation, but software programs for statistics are scarce. Free, stand-alone software programs that calculate all individual functions of CSF protein analysis and allow the statistical treatment of groups of diseases numerically and graphically are presented for relevant examples. Methods: Diagnosis of an intrathecal synthesis refers to the upper limit of the reference range, Qlim = Qmean +3SD, but statistical evaluation of its frequency is referred to Qmean+2SD. When quantifying intrathecal synthesis for statistics, either the absolute amount (IgGloc) or the relative intrathecal fraction (IgGIF) can be reported with reference to the mean reference curve, Qmean. The free software CSF research Tool for immunoglobulins allows diagnostic and statistic evaluations with Reibergrams and calculation of mean values and standard deviations from disease groups. The software FLC-K statistics for free light chains Kappa offers for diagnostics and statistics the numerical and graphical interpretation basis for statistical processing in exported Excel tables. A free "CSF-App" for Smartphones provides data calculation for diagnostics of single patients with examples of disease-related data patterns. Results: Patients with clinically isolated syndrome (CIS) who were later diagnosed as MS showed no immunological differences to patients initially diagnosed as MS (same mean quantity of intrathecal synthesis in CIS and MS detectable for IgG and FLC-K). The frequently claimed diagnostically higher sensitivity of the FLCK analysis compared to IgG, can be explained by the up to 3-fold higher mean intrathecal fraction of FLC-K, corresponding to a higher frequency in the detection of intrathecal synthesis with FLCK analysis. Conclusions: With a knowledge-based quantification in CSF analysis, supported by knowledge-based software programs, scientifically and diagnostically important results can be obtained(AU)

Introducción: Los programas de software gratuitos y autónomos que calculan todas las funciones individuales del análisis de proteínas del líquido cefalorraquídeo (LCR) y permiten el tratamiento estadístico de grupos de enfermedades de forma numérica y gráfica se presentan como ejemplos relevantes. Métodos: Cuando se cuantifica la síntesis intratecal para la estadística, se puede informar la cantidad absoluta (IgGloc) o la fracción intratecal relativa (IgGIF) con referencia a la curva de referencia media, Qmean. El software gratuito "CSF research Tool" para inmunoglobulinas permite realizar evaluaciones diagnósticas y estadísticas con Reibergrams y calcular los valores medios y las desviaciones estándar de los grupos de enfermedades. El software FLC-K statistics para Free light chains Kappa ofrece para el diagnóstico y la estadística la base de interpretación numérica y gráfica para el procesamiento estadístico en tablas exportadas de Excel. El programa CSF-App para teléfonos inteligentes es gratuito y ofrece el cálculo de datos para el diagnóstico de pacientes individuales con ejemplos de patrones de datos relacionados con enfermedades. Resultados: Los pacientes con síndrome clínico aislado (SCA) que posteriormente fueron diagnosticados como EM no mostraron diferencias inmunológicas con respecto a los pacientes inicialmente diagnosticados como EM (la misma cantidad media de síntesis intratecal en el síndrome clínico aislado y EM detectable para IgG y FLC-K). La sensibilidad más elevada que se afirma con frecuencia en el diagnóstico del análisis de FLC-K en comparación con la IgG, puede explicarse por la fracción intratecal media hasta tres veces mayor de FLC-K, que corresponde a una mayor frecuencia en la detección de la síntesis intratecal con el análisis de FLC-K. Conclusiones: Con la cuantificación en el análisis del LCR se pueden obtener resultados importantes desde el punto de vista científico y diagnóstico(AU)

Is that a scolex? a case of clinically isolated syndrome

Clinically Isolated Syndrome is an initial demyelinating event of the central nervous system that has been associated with the future development of multiple sclerosis. Diagnostic studies include clinical and paraclinical studies. Patients with lesions on MRI of the brain at baseline will more likely develop multiple sclerosis compared to patients without findings. We report a case of a 10-year-old female of Colombian ancestry and origin, who presented with indiscernible neurological clinical signs and symptoms, with MRI brain with and without contrast showing demyelinating lesions with one lesion 'suggesting' a scolex.

Clinical Application of 2017 McDonald Diagnostic Criteria for Multiple Sclerosis

BACKGROUND AND PURPOSE: McDonald criteria for multiple sclerosis diagnosis have been revised over the years, diagnostic procedures have been simplified and earlier diagnosis facilitated. The new 2017 revision introduces other important changes, with a further simplification for the diagnosis. Oligoclonal bands reassume a more relevant role in the workup. METHODS: We describe 3 typical cases of patients admitted for clinically isolated syndrome and illustrate how the application of the new criteria can change the diagnostic approach with respect to the previous criteria. RESULTS: In two of the three cases a diagnosis of multiple sclerosis is now possible. CONCLUSIONS: The new 2017 Multiple Sclerosis criteria may have an important impact in clinical practice with an earlier treatment to avoid the risk of disease dissemination. Their application requires a careful assessment to avoid misdiagnosis and mistreatments.

Research progress of predictive markers of multiple sclerosis after a clinically isolated syndrome / 中华实用儿科临床杂志

A clinically isolated syndrome(CIS) is a term that describes a first clinical episode in which a patient has symptoms and signs suggestive of an inflammatory demyelinating disorder of the central nervous system.And it often affects optic nerves,the brainstem,or the spinal cord,and 30％-70％ of the CIS patients may develop multiple sclerosis(MS).Disease-modifying treatments may delay the development from CIS to MS.Their use in CIS is limited because of uncertain long-term clinical prognosis,treatment benefits and adverse effects.This article reviews the advances of predictive markers of conversion to MS after a CIS,in order to provide the reference for clinical treatment.

Research progress on the effect of cytomegalovirus infection on lipid metabolism / 临床儿科杂志

Human cytomegalovirus (HCMV) has a higher prevalence in the population, and most normal individuals after primary infection can establish latent infections. Recent reports have suggested that cytomegalovirus infection associated with lipid metabolism, and play an important role in the pathogenesis of many diseases, such as hepatitis, atherosclerosis, isolated syndrome, metabolic syndrome, etc. This article summarized the relationship between cytomegalovirus infection and lipid metabolism, as well as its role in a variety of diseases progression.

Cognitive impairment is correlated with reduced quality of life in patients with clinically isolated syndrome / Comprometimento cognitivo correlaciona-se com redução da qualidade de vida em pacientes com síndrome clinicamente isolada

OBJECTIVE: To evaluate the quality of life (QoL) and potential QoL determinants in patients with clinically isolated syndrome (CIS). METHODS: Eighteen CIS patients and eighteen controls were submitted to QoL evaluation with Functional Assessment of Multiple Sclerosis QoL instrument (FAMS). Cognition was evaluated with specific battery tests; Anxiety and depression with Beck Anxiety (BAI) and Depression (BDI) Inventories and Neurological disability with Guy's Neurological Disability Scale (GNDS). RESULTS: There was a significant difference in QoL between CIS patients and controls. CIS patients had worse performance in Paced Auditory Serial Addition 2 seconds (p=0.009) and fluency tests (p=0.0038). There was a significant difference in BAI (p=0.003), but no significant difference in BDI between patients and controls. There were significant correlations between QoL measure and verbal fluency and Stroop's test. CONCLUSIONS: Cognition, but not anxiety, depression and disability, was associated with reduced quality of life.

OBJETIVO: Avaliar a qualidade de vida (QoL) e seus potenciais determinantes em pacientes com síndrome clinicamente isolada (SCI). MÉTODOS: Dezoito pacientes com SCI e 18 controles realizaram avaliação da QoL com Escala de Determinação da QoL na Esclerose Múltipla; cognição foi avaliada com bateria de testes específica; ansiedade e depressão com os Inventários de Beck de ansiedade (BAI) e de depressão (BDI) e a incapacidade neurológica com a Guy's Neurological Disability Scale. RESULTADOS: Houve diferença significativa na QoL avaliada entre pacientes com SCI e controles. Pacientes com SCI apresentaram pior desempenho no Pased Auditory Serial Addition 2 segundos (p=0,009) e na fluência verbal (p=0,0038). Houve diferença no BAI (p=0,003), entretanto sem diferença do BDI entre pacientes e controles. Houve correlações significativas entre QoL, fluência verbal e Stroop. CONCLUSÕES: Alterações cognitivas tiveram correlação com diminuição da QoL, o que não ocorreu com a depressão, ansiedade e incapacidade neurológica.

Cognitive impairment in patients with clinically isolated syndrome / Comprometimento cognitivo em pacientes com síndrome clinicamente isolada

Cognitive abnormalities have been extensively studied in Multiple Sclerosis (MS). However, little is known aboutthe cognitive involvement in patients with Clinically Isolated Syndrome (CIS). Objective: This study aimed to investigatecognitive impairment in patients with CIS compared with healthy subjects. Methods: 18 CIS patients and 18 controlswere subjected to the Wechsler memory scale, Rey Auditory Verbal Learning, Rey Complex Figure, Paced Auditory SerialAddition, Digit Span, verbal fluency, Stroop color card test, D2, and Digit Symbol tests. Results: CIS patients had significantlyworse performance on the Paced Auditory Serial Addition Test (PASAT) 2 seconds (P=0.009) and on verbal fluency tests(P=0.0038) than controls. Conclusion: CIS patients had worse cognitive performance than controls on neuropsychologicaltests evaluating executive functioning.

As alterações cognitivas na Esclerose Múltipla (EM) têm sido bastante estudadas. No entanto, ainda são poucosos estudos acerca do comprometimento cognitivo em pacientes com Síndrome Clinicamente Isolada (SCI). Objetivo:O objetivo deste estudo foi o de investigar funções cognitivas em pacientes com SCI em relação a um grupo controle.Métodos: Dezoito pacientes com SCI e 18 controles saudáveis foram submetidos à avaliação neuropsicológica, incluindoos seguintes testes: Escala Wechsler de Memória, ?Rey Auditory Verbal Learning Test?, Figura Complexa de Rey, ?PacedAuditory Serial Addition (PASAT) 2 e 3 segundos, ?Digit Span?, fluência verbal, teste de Stroop, D2 e ?Digit Symbol Test?.Resultados: Pacientes com SCI tiveram desempenho significativamente inferior nos testes PASAT 2 segundos (P=0.009)e fluência verbal (P=0.0038) quando comparados ao grupo controle. Conclusão: Pacientes com síndrome clinicamenteisolada apresentaram pior desempenho cognitivo em testes relacionados a funções executivas.

Anxiety and depressive symptoms in clinically isolated syndrome and multiple sclerosis / Ansiedade e depressão em pacientes com síndrome clínica isolada e esclerose múltipla

Depression and anxiety have been reported in patients with multiple sclerosis (MS) and in patients with clinically isolated syndrome (CIS). However, the precise mechanisms that lead to depressive and anxiety symptoms in these patients are still unclear. In this study we evaluated with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) patients with MS and CIS and compared them to controls. We also correlated BDI and BAI scores with clinical parameters. Kruskall-Wallis followed by Dunn's Multiple Comparison Test, Chi-square and Spearman test were used. Patients with MS had higher depressive and anxiety scores than controls. The BDI and BAI scores of patients with CIS were not significantly different from controls. There was a positive correlation between BDI, BAI and EDSS. Our results corroborate the view that MS patients have higher depression and anxiety levels than control subjects. Anxiety and depressive symptoms also seem to progress according to the severity of the disease.

A depressão e a ansiedade têm sido descritas em pacientes com esclerose múltipla (EM) e síndrome clinicamente isolada (CIS). Entretanto, os mecanismos precisos que determinam o surgimento de depressão e ansiedade ainda não estão elucidados. No presente estudo, foram utilizadas as escalas de Beck para depressão (BDI) e ansiedade (BAI) em pacientes com EM, CIS e controles. O grau de comprometimento funcional dos pacientes e o tempo de doença foram correlacionados com parâmetros clínicos. Foram utilizados os testes de Kruskall-Wallis seguido do teste de múltiplas comparações (Dunn's Test), qui-quadrado e o teste de Spearman. Pacientes com EM apresentam escores mais elevados de depressão e ansiedade do que controles. Houve correlação positiva entre os escores do BDI e do BAI com o grau de comprometimento funcional avaliado pela EDSS. Nossos resultados corroboram a visão de que pacientes com EM exibem mais ansiedade e depressão que controles. Sintomas ansiosos e depressivos parecem progredir com a gravidade da doença.

Cognitive impairment in clinically isolated syndrome: a systematic review / Prejuízo cognitivo na síndrome clínica isolada: uma revisão sistemática

The pattern of cognitive abnormalities in multiple sclerosis (MS) has been extensively studied and well characterized. However, little is known about the cognitive involvement in patients with the clinically isolated syndrome (CIS). Objectives: To perform a systematic review of the results of the studies on cognitive dysfunction in CIS patients. Methods: Cochrane, Lilacs, PubMed/Medline and SciELO databases were searched for studies involving patients with clinically isolated syndrome submitted to neuropsychological evaluation. Results: Seven studies fulfilled the selection criteria adopted in this review. The pattern of cognitive abnormalities in CIS resembles that found in patients with MS and is characterized by attention deficit, reduced information processing speed and impaired working memory and executive functions. The frequency of cognitive impairment in CIS seems to be lower than in MS. Conclusions: Cognition should be evaluated in patients with CIS. Future studies are required to evaluate the impact of cognitive abnormalities and to correlate them with axonal damage findings in patients with CIS.

As alterações cognitivas na esclerose múltipla (EM) são muito estudadas e bem caracterizadas. No entanto, pouco se sabe sobre o envolvimento cognitivo em pacientes com síndrome clínica isolada (SCI). Objetivos: Revisar sistematicamente resultados obtidos em estudos sobre cognição em pacientes com SCI. Métodos: Revisamos as seguintes bases de dados: Cochrane, Lilacs, Pubmed/Medline e Scielo buscando artigos em que pacientes com SCI foram submetidos à avaliação neuropsicológica. Resultados: Sete estudos preencheram critérios adotados pelos autores desta revisão. O padrão do prejuízo cognitivo em SCI é semelhante ao encontrado na EM, caracterizado por déficit de atenção, redução da velocidade de processamento, comprometimento da memória de trabalho e de funções executivas. A freqüência de disfunção cognitiva é inferior na SCI do que na EM. Conclusões: Pacientes com CIS devem ser avaliados quanto à cognição. Estudos futuros são necessários para avaliar o impacto do prejuízo cognitivo e correlacioná-lo com achados de dano axonal em pacientes com SCI.

Spinal Clinically Isolated Syndromes:Clinical and MRI Analysis / 实用放射学杂志

Objective To evaluate the clinical manifestations and magnetic resonance imaging(MRI) features of the clinically isolated syndrome(CIS) of the spinal cord.Methods MRI features and expanded disability status scale(EDSS) score in 63 patients with multiple sclerosis(MS) showed early clinical manifestations of spinal CIS were retrospectively analysed.Results 52.9% of MS patients in the early performance was the spinal CIS,88.9% was acute or subacute onset,42.9% of the initial symptoms was isolated sensory dysfunction,and 54.9% had cervical spinal cord involvement.The first MRI positive rate was 91.1% and 35.3% presented with "multifocal" plagues.81.7% of the MRI lesions were not more than two vertebral segments,and 89.0% in the axial diameter of the spinal cord did not exceed 1/2.The number,volume and area of MRI lesions at baseline confirmed the positive correlation with EDSS at diagnosis of MS.Corticosteroid therapy before and after the EDSS score was of a significant difference(P= 0.003).Conclusion Spinal CIS often occurs in cervical spinal cord with acute or subacute onset,and incomplete spinal cord injury.MRI may detect "multifocal" plagues.Quantitative MRI is valuable for the assessment of prognosis.Early intravenous corticosteroid therapy can be an effective way to ease symptoms.