Profile of Polish patients with primary progressive multiple sclerosis.

BACKGROUND: Epidemiologic data on primary progressive multiple sclerosis (PPMS) in Poland are limited. The aim of this study was to assess selected clinical and socio-demographic factors of Polish patients with PPMS and compare this form and relapsing-remitting (RRMS) and secondary progressive (SPMS) forms. METHODS: Patients who attended follow-up visits under the Registry of Patients with Multiple Sclerosis (RejSM) were enrolled in the study in the autumn of 2017. The prevalence of individual types of the disease was compared and the clinical, demographic, and social differences between RRMS, PPMS and SPMS were analyzed. RESULTS: Of the 8,045 registered patients, current data as on December 31, 2017 was obtained from 4,398 patients. The RRMS form was seen in 2,925 patients (66.5%); secondary progressive form, in 1.051 patients (23.9%); and PPMS, in 422 patients (9.6%). The first symptoms of PPMS appeared almost 10 years later than in patients with RRMS (39.2 ±â€¯11.4 vs. 29.8 ±â€¯9.8). The period from the first symptoms to diagnosis was more than twice as long in patients with PPMS (5.8 ±â€¯3.4) than RRMS (2.4 ±â€¯1.6). SPMS was diagnosed on average after 14 years of RRMS (46.2 ±â€¯13.5). The RRMS form was more frequently found in women (2.4:1), while the PPMS form was almost equal in both sexes (1.2:1). The average degree of disability based on the Expanded Disability Status Scale was 3.2 ±â€¯2.1 for RRMS, 4.6 ±â€¯2.4 for PPMS and 5.2 ±â€¯3.6 for SPMS. The dominant symptom in PPMS was paresis of the lower limbs (86%). Patients with PPMS had higher education and higher instance of marriage than those with RRMS or SPMS. CONCLUSIONS: PPMS occurs in about 10% of Polish patients with multiple sclerosis, and the first symptoms appear at around 40 years of age with the same frequency in both sexes. PPMS diagnosis takes more than twice the time for RRMS.

Vitamin D as an immune modulator in multiple sclerosis.

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disorder of the central nervous system. The disease is characterised by inflammation with extensive immune infiltration, demyelination, axonal loss and damage of oligodendrocytes, presumably auto-immune in nature. The influence of environmental factors on the development and activity of MS has been known for a long time. Vitamin D and sun exposure are among the most important ones. Both serum vitamin D level and sun exposure independent of vitamin D production are correlated with epidemiological and clinical parameters of MS, and the impact of vitamin D on immune parameters has been clearly confirmed in experimental studies. Nevertheless, the impact on clinical aspects is inconclusive, especially when the influence of supplementation is assessed. In this work we review the state of knowledge regarding the effect of vitamin D on immune cells subsets in relation to experimental and clinical studies.

Severe disease exacerbation in a patient with neuromyelitis optica spectrum disorder during treatment with dimethyl fumarate.

BACKGROUND: Certain disease-modifying drugs for multiple sclerosis are known to be ineffective in treating neuromyelitis optica spectrum disorder (NMOSD), and can even induce subsequent relapses. CASE PRESENTATION: Here, we report on a patient with NMOSD who was misdiagnosed with multiple sclerosis and experienced severe exacerbations 3 months following initiation of treatment with dimethyl fumarate. The patient developed severe relapse in the form of myelitis extending from the medulla down to the T1 vertebral level. Cord swelling seen as contrast enhancement on magnetic resonance imaging was observed. This swelling resulted in spastic hemiplegia with severe painful dysesthesia. After a diagnosis of NMOSD was confirmed, dimethyl fumarate was discontinued and treatment with azathioprine was initiated. Subsequently, although her neurological status stabilized, residual deficits persisted. CONCLUSION: The case described here suggests that dimethyl fumarate is unsuitable for NMOSD treatment as it may cause disease exacerbations.

Total-tau in cerebrospinal fluid of patients with multiple sclerosis decreases in secondary progressive stage of disease and reflects degree of brain atrophy.

INTRODUCTION: Tau protein is a potential marker of neuronal damage. The aim of the study is to investigate its potential role as a marker of brain atrophy in multiple sclerosis (MS). MATERIALS AND METHODS: Cerebrospinal fluid (CSF) and blood samples were collected from 48 patients with multiple sclerosis. Total-tau (t-tau) and phospho(181Thr)-tau (p-tau) concentrations were assayed with commercially available INNOTEST® hTAU Ag and INNOTEST® phospho181Thr-tau((181P)) and correlated with indices of brain atrophy in magnetic resonance imaging (MRI) and clinical characteristics of the study population. RESULTS: T-tau concentration in CSF was significantly higher in relapsing-remitting (RR) compared to secondary progressive (SP) MS patients (P = 0.01). Brain parenchymal fraction (BPF) was significantly decreased in SP patients (P = 0.002). BPF in the whole study population correlated inversely with Expanded Disability Status Scale (EDSS) (r = -0.51, P = 0.0002) and Multiple Sclerosis Severity Score (MSSS) (r = -0.42, P = 0.002). T-tau in CSF in the whole patient group correlated inversely with EDSS (r = -0.58, P = 0.0006). CONCLUSIONS: The results of our study suggest that total-tau concentration in CSF in a MS population decreases in the course of disease and reflects degree of parenchymal brain loss.

Rare first symptoms of multiple sclerosis.

The most frequent first symptoms of multiple sclerosis are the following: sensory symptoms, optic neuritis, motor and cerebellar syndromes. Three female patients have been diagnosed with multiple sclerosis on the basis of Poser's criteria. The onset of the disease was manifested in these cases with non-typical and rare symptoms. Patient 1, a woman, aged 24. The first symptom of the disease was an isolated lesion of nerve VI on the right side. Patient 2, a women, aged 30. The first symptom of the disease was acute pain localised within the area of the lumbar-sacral spine. Patient 3, a woman, aged 43. The first symptom of the disease was loss of taste and smell.