ABSTRACT
The organization of healthcare for patients with multiple sclerosis (MS) has changed considerably over the past 15 years, with the creation of health networks providing a new impetus towards better coordination of healthcare through a multidisciplinary approach, and improvement of educational training for both patients and healthcare professionals. In this context, therapeutic educational programs (TEPs) for patients have placed patients at the center of their own care pathway, thereby changing the doctor-patient relationship. Today, TEPs cover the various needs of patients in their everyday lives, whether they are medical, social or psychological. However, the arrival of a wide range of new medications, the complexity of therapeutic decisions and management of risk increase the need for organized expertise via centers of resources and competencies (CRCs) for MS, approved since 2016 as part of the French National Neurodegenerative Diseases Plan (NDDP). This NDDP 2014-2019 provides an incentive to change the organization of healthcare for MS patients by adapting it according to regional specificities and resources. Whatever the chosen system of organization, it should allow for a good well-coordinated multidisciplinary care pathway that is easily accessed by patients.
Subject(s)
Multiple Sclerosis/therapy , Patient-Centered Care/organization & administration , Health Personnel/organization & administration , Humans , Patient Care Team/organization & administration , Patient Care Team/standards , Patient Education as Topic/methods , Patient Education as Topic/organization & administration , Patient-Centered Care/standards , Physician-Patient RelationsABSTRACT
INTRODUCTION: Described in 1890, Uhthoff's symptom corresponds to a transient blurred vision provoked by physical exercise or an increase of temperature. It is a frequent symptom occurring during the course of multiple sclerosis. PATIENTS AND METHOD: We report here four cases of patients presenting isolated Uhthoff phenomenon preceding multiple sclerosis by several years. RESULTS: These four patients presented transient neurological symptoms induced by intensive sporting activity for 1 to 6 years before diagnosis of multiple sclerosis. These symptoms were often visual but sometimes motor or sensorial. All symptoms appeared above a certain threshold specific to each patient, after 15 to 30minutes of intense physical exercise (bike, running or handball) and all disappeared after a few minutes to one hour rest with full recovery to baseline. DISCUSSION: Uhthoff's phenomenon is explained by a conduction block. It is due to axonal demyelization that provokes a reorganization of sodium channels induced by a decrease in a safety factor highly sensitive to temperature, or by release of soluble blocking substances (oxide nitric or cytokines). CONCLUSION: Without being specific, this symptom is strongly suggestive of this disease. Our case reports confirm the existence of "infraclinic multiple sclerosis".
Subject(s)
Multiple Sclerosis/complications , Vision Disorders/etiology , Adolescent , Adult , Bicycling/physiology , Disability Evaluation , Exercise/physiology , Female , Football/physiology , Humans , Male , Multiple Sclerosis/physiopathology , Neural Conduction/physiology , Running/physiology , Temperature , Vision Disorders/physiopathology , Young AdultABSTRACT
OBJECTIVE: To determine the proportion of patients with multiple sclerosis (MS) who respond to interferon-beta (IFNB) therapy and assess whether clinical characteristics differ in IFNB responders vs nonresponders. METHODS: Data on all patients who received IFNB who were entered in the prospective European Database for Multiple Sclerosis (EDMUS) database in Lyon as of March 31, 2001, were reviewed. Responders were defined as having a lower relapse rate on IFNB compared with the year or 2 years prior to IFNB therapy. RESULTS: Two hundred sixty-two patients with relapsing MS received at least 6 months of IFNB: 200 relapsing remitting (RR) and 62 relapsing secondary progressive (SP). One-third of patients experienced a higher or identical annual relapse rate while on IFNB treatment. Compared with nonresponders, responders were older and had longer disease duration at the time IFNB was initiated. RRMS responders also had a higher relapse rate during the year prior to IFNB therapy and SPMS responders had a higher Disability Status Scale score at initiation of IFNB. CONCLUSION: Clinical profiles of patients with relapsing MS who respond to IFNB may differ from those who do not with a more inflammatory and less neurodegenerative disease at the time IFNB is initiated.
Subject(s)
Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Multiple Sclerosis, Chronic Progressive/drug therapy , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Adult , Age of Onset , Databases, Factual , Female , France/epidemiology , Humans , Interferon beta-1a , Interferon beta-1b , Male , Multiple Sclerosis, Chronic Progressive/epidemiology , Multiple Sclerosis, Relapsing-Remitting/epidemiology , Prospective Studies , Remission Induction , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
We report a case of a mitochondrial cytopathy (MERRF) with a late diagnosis because of the absence of Ragged-Red Fibers (RRF) in the first muscular biopsy performed in childhood. Eight years after the onset of the disease the familial history and the clinical manifestations were very suggestive of a mitochondrial cytopathy and a second biopsy was performed confirming the diagnosis of MERRF. The authors discuss several hypotheses to explain the negativity of the first muscular biopsy. The absence of ragged-red fibers does not exclude the diagnosis of a mitochondrial cytopathy and other investigations are justified such as the biochemical study of the respiratory chain and the molecular analysis of mitochondrial DNA.
Subject(s)
MERRF Syndrome/pathology , Muscle Fibers, Fast-Twitch/pathology , Muscle, Skeletal/pathology , Adult , Biopsy , Diagnosis, Differential , Electron Transport Complex IV/analysis , Follow-Up Studies , Humans , Male , Succinate Dehydrogenase/analysisABSTRACT
BACKGROUND: Benign recurrent meningitis, or Mollaret's meningitis, is an uncommon disease whose viral origin was long unidentified. Since 1991, about twenty cases have been reported in patients with herpes infection. CASE REPORT: A female patient had experienced repeated episodes of spontaneous meningitis since 1983. The episodes resolved spontaneously and no etiology had been identified. A spinal tap was performed when the patient was again hospitalized a new episode of meningitis and PCR amplification of the herpes simplex virus type 2 (HSV 2) was positive. The patient was given long term acyclovir per os. A new spinal tap after resolution of the meningitis episode was PCR HSV2 negative. DISCUSSION: HSV2 infection is one of the known causes of Mollaret's meningitis. Long-term antiviral therapy appears to prevent recurrence as was observed in our patient.
Subject(s)
Herpes Genitalis/complications , Herpesvirus 2, Human , Meningitis, Viral/etiology , Acyclovir/therapeutic use , Adult , Antiviral Agents/therapeutic use , Female , Follow-Up Studies , Herpesvirus 2, Human/genetics , Humans , Meningitis, Viral/diagnosis , Meningitis, Viral/drug therapy , Polymerase Chain Reaction , Recurrence , Syndrome , Time FactorsABSTRACT
We report the case of a 48-year-old patient who developed acute onset bilateral, peripheral motor dysfunction in the arms and forearms. Clinical history, electromyography and laboratory tests confirmed the diagnosis of peripheral neuropathy caused by lead poisoning from the domestic water supply. The EMG showed axonal alterations. Improvement was observed after treatments with chelating agents and removal of the source of poisoning. This case provides the opportunity to recall the traditional 1889 Dejerine classification of lead-related peripheral neuropathies and is a warning signal that lead poisoning remains a problem in peri-urban areas of developed countries.
