ABSTRACT
Traditional paper-and-pencil neuropsychological batteries used to document cognitive deficits in multiple sclerosis (MS) patients lack timing precision. This makes it difficult to accurately measure psychomotor slowing, a central cognitive symptom of MS. Additionally, traditional batteries lack multiple alternate forms necessary to control for practice effects when assessing cognition over time. Finally such batteries are lengthy and expensive. Computerized neuropsychological batteries address many of these shortcomings. They measure response time more precisely, require less administration time, include alternate forms, and are ideal for rapid screening/triage. Although there are normative data on the reliability and validity of computerized measures, there have been no controlled validation studies with MS patients. The current study was designed to validate a computerized neuropsychological battery (ANAM) for use with relapsing-remitting (RR) MS patients. Prior to initiation of interferon-beta-1a (Avonex) treatment, subjects participated in a neuropsychological evaluation consisting of traditional and computerized measures. Moderate-to-high correlations were found between computerized and traditional measures. Computerized tests accurately predicted performance on key traditional tests. The battery was also concordant with traditional measures in identifying RR MS patients with and without neurocognitive impairment. Findings are discussed with respect to increased accuracy and accessibility of neuropsychological evaluations for MS patients.
Subject(s)
Cognition Disorders/diagnosis , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Neuropsychological Tests , Adolescent , Adult , Cognition Disorders/etiology , Diagnosis, Computer-Assisted , Female , Humans , Male , Middle Aged , Multiple Sclerosis, Relapsing-Remitting/complications , Predictive Value of TestsABSTRACT
OBJECTIVE: To review the occurrence of neurologic events suggestive of demyelination during anti-tumor necrosis factor alpha (anti-TNFalpha) therapy for inflammatory arthritides. METHODS: The Adverse Events Reporting System of the Food and Drug Administration (FDA) was queried following a report of a patient with refractory rheumatoid arthritis who developed confusion and difficulty with walking after receiving etanercept for 4 months. RESULTS: Nineteen patients with similar neurologic events were identified from the FDA database, 17 following etanercept administration and 2 following infliximab administration for inflammatory arthritis. All neurologic events were temporally related to anti-TNFalpha therapy, with partial or complete resolution on discontinuation. One patient exhibited a positive rechallenge phenomenon. CONCLUSION: Further surveillance and studies are required to better define risk factors for and frequency of adverse events and their relationship to anti-TNFalpha therapies. Until more long-term safety data are available, consideration should be given to avoiding anti-TNFalpha therapy in patients with preexisting multiple sclerosis and to discontinuing anti-TNFalpha therapy immediately when new neurologic signs and symptoms occur, pending an appropriate evaluation.
Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Demyelinating Diseases/etiology , Immunoglobulin G/adverse effects , Tumor Necrosis Factor-alpha/immunology , Adult , Adverse Drug Reaction Reporting Systems , Biopsy , Brain/pathology , Contraindications , Demyelinating Diseases/pathology , Etanercept , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/drug therapy , Receptors, Tumor Necrosis Factor , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Inflammatory myopathy has been associated with systemic inflammatory processes, endocrinopathies, malignancies and infections. Drug induced myopathies have been implicated with the use of several medications. We report a case of biopsy proven myositis whose symptoms began within 10 days of receiving leuprolide acetate therapy for prostate cancer. Drug withdrawal and brief steroid therapy resulted in clinical remission within two months of diagnosis.
Subject(s)
Leuprolide/adverse effects , Myositis/chemically induced , Prostatic Neoplasms/drug therapy , Aged , Biopsy , Humans , Leuprolide/therapeutic use , Male , Microscopy, Electron , Muscles/pathology , Muscles/ultrastructureABSTRACT
Pneumocystic carinii pneumonia (PCP) is a well-recognized complication of immunodeficiency disorders. PCP has been reported in patients with connective tissue diseases, but most were on cytotoxic drugs. We report a case of PCP occurring in a patient with giant cell arteritis who was receiving high dose prednisone. To our knowledge this complication has not been previously reported.
Subject(s)
Giant Cell Arteritis/drug therapy , Pneumonia, Pneumocystis/etiology , Prednisone/adverse effects , Aged , Humans , Male , Prednisone/administration & dosage , Prednisone/therapeutic useABSTRACT
Sacrococcygeal pain can arise from the sacrococcygeal joint, from contiguous structures sharing the same innervation, or from distant sites. True coccygodynia consists of pain arising from the sacrococcygeal joint, whereas pseudococcygodynia consists of pain referred to but not arising from the coccyx. Coccygodnia can usually be distinguished from pseudococcygodynia by physical examination with the diagnosis being confirmed by injection of local anesthetic into the sacrococcygeal joint. The etiology of pain not relieved by intraarticular injection can be further defined by selective neuroblockade. A method for defining the anatomic basis for sacrococcygeal pain is presented as well as a discussion of the relevant anatomy and differential diagnosis of sacrococcygeal pain.
