Double-blind randomized trial of ACTH versus dexamethasone versus methylprednisolone in multiple sclerosis bouts. Clinical, cerebrospinal fluid and neurophysiological results.

30 patients with acute exacerbations of multiple sclerosis were treated by ACTH, dexamethasone or methylprednisolone in a double-blind randomized study. Clinical parameters were assessed; cerebrospinal fluid and neurophysiological parameters (visual- and brainstem-evoked potentials) were evaluated at the beginning and at the end of treatment. Dexamethasone was more effective than ACTH and 6-methylprednisolone in shortening bout duration. Neither CSF nor neurophysiological parameters were significantly affected by therapy.

Double blind controlled randomized study on azathioprine efficacy in multiple sclerosis. Preliminary results.

The preliminary results of a double blind controlled prospective randomized trial of Azathioprine for therapeutic efficacy in 38 patients with Multiple Sclerosis are reported. Progression of the disease is significantly reduced in Azathioprine-treated group in comparison to Placebo-treated patients, but this effect is reached only after 3 years of treatment (P less than 0.025) regardless of the clinical course and without affecting relapse rate.

Cerebrospinal fluid and peripheral blood T-lymphocyte subsets in multiple sclerosis: monoclonal antibody analysis and correlations with clinical activity.

Enumeration of cerebrospinal fluid and peripheral blood T-lymphocyte subsets (T-total, T-helper and T-suppressor) was performed by monoclonal antibody technique in 18 patients with Multiple Sclerosis and in 4 patients with non-inflammatory neurological diseases. While no differences were observed in peripheral blood subsets among the various phases of the disease, a marked rise in cerebrospinal fluid helper-suppressor ratio was seen in acute relapses. The results give further support to the concept of a strict compartimentalization in immune response abnormalities in Multiple Sclerosis patients.

Prognostic value of cerebrospinal fluid electrophoresis in optic neuritis and suspected multiple sclerosis.

The prognostic significance of cerebrospinal fluid electrophoresis and IgG-index has been investigated in 44 patients, of whom 10 had optic neuritis and 34 suspected, possible or probable multiple sclerosis. The predictive value of CSF oligoclonal banding for future disease dissemination is very high in the suspected multiple sclerosis subgroup, where after a follow-up of 4.4 years, 7 out of 7 band-positive patients displayed further disease activity. The absence of CSF oligoclonal bands seems to carry a relatively benign short-term (follow-up 3.4 years) prognosis in suspected MS cases.

Intraventricular interferon in a case of subacute sclerosing panencephalitis.

A patient with subacute sclerosing panencephalitis (SSPE) was treated by direct administration of Interferon B into the cerebral ventricles. Immediately after the first dose intrathecal synthesis of IgG and the CNS antimeasles antibody titer fell significantly, only to rise again to the pretreatment levels 2 months after discontinuation of treatment. There was no improvement in the patient's clinical status.

Oculomotor disturbances in Balint's syndrome: anatomoclinical findings and electrooculographic analysis in a case.

A 67-year-old man had repeated cerebral ischemic attacks, which resulted in a clinical picture combining paralysis of visual fixation, optic ataxia and impairment of visuospatial orientation, consistent with the definition of Balint's syndrome. Postmortem examination showed multiple lesions involving the occipital cortex of both sides and the white matter underlying the right insular cortex. EOG recording demonstrated a marked impairment of refixation saccades and saccades on verbal command. Smooth pursuit movements were completely abolished. Visual fixation was randomly achieved after many erratic exploratory movements and steadily maintained on the target (spasmodic fixation). During spasmodic fixation, EOG recording detected an ocular flicker resulting in a continuous instability of eye position. It is suggested that these findings may all be accounted for by the loss of panoramic vision due to a bilateral impairment of cortical areas 18 and 19.

Brainstem auditory evoked potentials in the diagnosis of multiple sclerosis.

Brainstem auditory evoked potentials (BAEPs) have been investigated in 34 patients affected by multiple sclerosis. Abnormalities were found in 68% of the patients. Silent lesions of the brainstem were detected in 60% of the clinically definite and in 44% of the probable cases. The diagnostic value of these findings is discussed.

Peripheral neuropathy and solitary myeloma: analysis of serum and CSF IgG in two cases.

Clinical and laboratory findings of two patients affected by solitary myeloma, IgG3 lambda type, with peripheral neuropathy are reported. In both cases the same IgG isoelectrofocusing pattern was found in cerebrospinal fluid and serum samples. Data are consistent with damage of the blood-brain barrier.

[Polyacrylamide gel disc electrophoresis in the study of cerebrospinal fluid proteins in inflammatory diseases of the central nervous system Preliminary results]. / L'elettroforesi a disco su gel di poliacrilamide nello studio delle proteine liquorali nelle malattie infiammatorie del sistema nervoso centrale (CNS). Risultati preliminari.

The present study was designed to evaluate the potential of polyacrylamide disc electrophoresis of CSF proteins as an adjunct to laboratory diagnosis of neurological inflammatory diseases. The results of polyacrylamide and cellulose acetate electrophoresis of 42 CSF samples from control subjects and patients with various inflammatory diseases of CNS are presented. A comparison between results from both techniques is made. The polyacrylamide disc electrophoresis has been found valuable in the study of liquoral proteins with particular attention to gammaglobulins because this resolving power is superior to the other method. However, the Authors emphasize the importance of distinguishing the genetically determined proteins and haptoglobins and of the use of specific criteria in interpretation of a CSF protein pattern.

Multiple sclerosis and migration in Italy: a case/control study. Preliminary reports.

The present study was performed on Milan residents, in order to evaluate the risk of acquiring multiple sclerosis between patients born in Milan and patients born in Southern Italy. For this purpose, 216 consecutive subjects with definite or probable multiple sclerosis, inmates of the Neurological Institute C. Besta (Milan) from 1968-1976, were matched with 216 controls, uniform as regards age, sex, profession and residence, who were hospitalized at the same time for other neurological diseases. Comparing the case/control pairs of the migration, we observed that the North-Centre born had a relative risk of acquiring the disease significantly superior to one (RR = 1.9; P = 0.01) as compared to migrants from the Southern regions of Italy.

Myasthenia gravis. Anti-acetylcholine receptor antibodies.

Human acetylcholine receptor and the Lefvert method (13) were used to determine the serum levels of anti-acetylcholine receptor antibodies in 27 patients with Myasthenia Gravis. Antibodies were detected in 22 patients (81%). Negative results were generally obtained in patients having milder forms of the disease. To find out whether serum levels of antibodies correlate with the severity of the disease, we compared the median antibody levels in patients with Type 1 and 2A Myasthenia Gravis with those of patients with type 2B and 3. Significantly lower titers were observed in the first group. Nevertheless, there were many overlapping values in the range of each class of the disease. A more definite relationship was observed in the follow-up of single patients. As a rule, clinical deterioration was accompanied by an increase of antibody levels and viceversa.