ABSTRACT
BACKGROUND: MS and psoriasis are both autoimmune diseases putatively mediated mainly by T cells. OBJECTIVE: We conducted a case control study to investigate whether patients with MS have a high rate of comorbid psoriasis. METHODS: The cohort consisted of 214 consecutive MS patients and a control group of 192 consecutive patients with headache. RESULTS: There was a higher than expected frequency of psoriasis among the MS patients. There was no gender effect and none of the 9 affected MS patients were among the 22 MS patients with primary progressive disease. Six of those 9 patients started interferon-ß treatment after being diagnosed with MS, and 4 of them experienced exacerbation of psoriasis during exposure to interferon-ß. There was no exacerbation in the co-morbid patients during treatment with other disease-modifying drugs. CONCLUSIONS: Our observation confirms other reports on an association of MS with autoimmune diseases and supports the hypothesis of autoimmune pathogenesis for MS. The current findings should raise the level of awareness of psoriasis among patients with MS, and of the need to consider a potential exacerbation of psoriasis by interferon-ß therapy.
Subject(s)
Multiple Sclerosis/complications , Psoriasis/complications , Adult , Case-Control Studies , Disability Evaluation , Female , Humans , Male , Middle AgedSubject(s)
Influenza A Virus, H1N1 Subtype , Influenza Vaccines/adverse effects , Influenza, Human/prevention & control , Myelitis, Transverse/etiology , Adult , Glucocorticoids/administration & dosage , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/administration & dosage , Spinal Cord/pathologyABSTRACT
Chronic daily headache (CDH) is a debilitating disorder that becomes a treatment challenge in patients refractory to the treatment. We hereby report our experience with topiramate treatment in patients with refractory CDH. The study design was a prospective, protocol-based follow-up and retrospective analysis of headache diaries. We treated with topiramate at slowly increased moderate increments 11 CDH patients who were refractory to multiple previous treatments. Topiramate treatment was effective in 7 (64%) patients. The treatment resulted in a 66% (median) decrease of the headache days per week and a significant decrease in headache severity, a reduction of the headache hours per day, and weekly analgesic consumption. These effects continued for an average follow-up of 8+/-4 months. The average effective dose was 100 mg/day. Slowly increasing the drug at moderate increments resulted in high tolerability of topiramate. We found topiramate to be an effective long-standing treatment option for patients with refractory CDH. Slow increments of the dosage contributed to high tolerability of the drug.
