[Review of the novelties presented at the 26th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) (II)]. / Revision de las novedades presentadas en el XXVI Congreso del Comite Europeo para el Tratamiento e Investigacion en Esclerosis Multiple (ECTRIMS) (II).

The new insights presented at European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held in the city of Gothenburg, Sweden, in October 2010, have been summarized at the third edition of Post-ECTRIMS meeting held in Madrid in November 2010. Encouraging findings from the 5-years follow up extension from PreCISe study confirm the benefit of early treatment with glatiramer acetate in patients with clinically isolated syndromes (CIS) against the conversion to clinically definitive multiple sclerosis and cerebral atrophy with an adequate safety and tolerability. Regarding treatment decision with escalation or induction therapy, different strategies have been proposed depending on to the characteristics of the individual patient with CIS. Findings from several of the reported studies have revealed the favorable role of combined therapy on relapse rate but not on magnetic resonance parameters in patients with recurrent-remittent multiple sclerosis. Novel therapies such as alemtuzumab, daclizumab ofatutumab or ocrelizumab have shown promising findings regarding efficacy. Nevertheless, safety findings for these emerging therapies have detected some severe adverse events, the main ones being potentially fatal opportunistic infections such as progressive multifocal leukoencephalopathy (PML) caused by JC virus, mainly linked to natalizumab treatment. In this regard, clinicians will face the assessment of he benefit-risk ratio when deciding on the adequate treatment for each patient in the clinical setting. In this regard, determination of antibodies to JC virus by a novel two-step enzyme-linked immunosorbent assay (ELISA) could provide clinicians with a useful tool to stratify PML risk in patients. Regarding non pharmacologic therapies, behavioral intervention has emerged as an effective therapy in the treatment of depression in multiple sclerosis, showing additional benefits on fatigue, disability and adherence to treatment.

[Impairment, disability and handicap scales in multiple sclerosis]. / Escalas de deterioro, discapacidad y minusvalía en la esclerosis múltiple.

INTRODUCTION AND METHOD: In recent years the need to create scales for measuring the dysfunction or impairment suffered by patients with multiple sclerosis has increased. The aim of the scales that measure neurological impairment is two fold: to homogenise the data from different series so that studies into the prognosis and natural history of the disease can be compared, and to measure the changes in the progress of the disease when a therapy has been established. Over the past few years a large number of scales have appeared that attempt to redress the shortcomings of the EDSS (Expanded Disability Status Scale). The latest of these, the MSF Composite, manages to overcome the statistical problems of the EDSS and enables significant differences between two groups to be detected when studying the effect of a treatment. CONCLUSIONS: In the coming years we will possibly witness a joint use of several of the scales described, and both the EDSS and the Composite will be employed together in the evaluation of patients in therapeutic protocols, perhaps together with a quality of life scale.

Escalas de deterioro, discapacidad y minusvalía en la esclerosis múltiple / Impairment, disability and handicap scales in multiple sclerosis

Introducción y desarrollo. Durante los últimos años ha aumentado la necesidad de crear escalas de medición de la disfunción o deterioro que sufren los pacientes con esclerosis múltiple. El objetivo de las escalas que miden el deterioro neurológico es doble: homogeneizar los datos de las diferentes series para que los estudios pronósticos y de historia natural de la enfermedad sean comparables, y medir los cambios en la evolución de la enfermedad cuando se instaura una terapia. Han aparecido en los últimos años un gran número de escalas que intentan solventar los déficit de la EDSS ( Expanded Disability Status Scale). La última de todas, el MSF Composite, consigue evitar los problemas estadísticos de la EDSS y permite encontrar diferencias significativas entre dos grupos al estudiar el efecto de un tratamiento. Conclusiones. Posiblemente en los años venideros asistamos a una utilización conjunta de varias de las escalas que se detallan, y tanto la EDSS como el Composite se empleen de forma conjunta en la valoración de enfermos en protocolos terapéuticos, quizá junto con alguna escala de calidad de vida (AU)

[Axonal damage in multiple sclerosis]. / Daño axonal en la esclerosis múltiple.

The presence of axonal lesions in plaques of demyelination in patients with multiple sclerosis (MS) has been known for many years. Traditionally it was believed that axonal loss occurred in chronic lesions. However, demonstration of pathological degeneration in active plaques, use of new resonance techniques such as spectroscopy or the transfer of magnetization, showing axonal damage in white matter of apparently normal aspect, and the presence of axonal neurofilaments in the cerebrospinal fluid during the episode has made it necessary to reconsider the contribution made by axonal damage to the pathogenesis of MS. Besides, recent studies have shown that a factor present in the cerebrospinal fluid of patients with MS may contribute to the induction of neuronal apoptosis. These facts, apart from their pathogenic implications and consequent clinical repercussions, will affect investigation of alternative treatments for this disorder, and by means of clinico-immunoradiological correlation will help to define the prognosis of the course of the disorder in these patients.

Daño axonal en la esclerosis múltiple / Axon damage in multiple sclerosis

La existencia de lesión axonal en placas de desmielinización de enfermos con esclerosis múltiple (EM) es un hecho conocido desde hace años. Clásicamente, se ha considerado que la pérdida axonal se encontraba en las lesiones crónicas. La demostración patológica de axones en la degeneración en placas activas, la utilización de nuevas técnicas de resonancia, como la espectroscopía o la transferencia de magnetización, que muestran la existencia de daño axonal en la sustancia blanca de apariencia normal, y la existencia durante el brote de neurofilamentos axonales en el líquido cefalorraquídeo, han llevado a tener que replantear la contribución que el daño axonal tiene en la patogenia de la EM. Recientes estudios han demostrado, además, que algún factor que se encuentra en el líquido cefalorraquídeo de pacientes con EM podría contribuir a inducir la apoptosis neuronal. Estos hechos, aparte de las implicaciones patogénicas, con la consiguiente repercusión clínica, afectarán a la investigación de posibles alternativas terapéuticas para esta enfermedad y, a través de correlaciones clínico-inmuno-radiológicas, ayudarán a definir el pronóstico evolutivo de los pacientes (AU)

[The social and work-related impact of multiple sclerosis]. / Impacto sociolaboral de la esclerosis múltiple.

OBJECTIVE: To analyse the repercussion of the disease in social and occupational status of multiple sclerosis patients. To describe the frequency with these patients are faced to architectural barriers in their own home. PATIENTS AND METHODS: We addressed a postal survey to 250 patients previously evaluated in our multiple sclerosis unit. Clinical data were recorded in the EDMUS database. RESULTS: A hundred and sixty patients answered the questionnaire. Mean age was 39.2 +/- 11.9 years. Mean duration of the disease was 10.05 +/- 8.4 years. Twenty-one per cent of patients were in progressive phase of the disease. Eighty-nine patients (55.6%) were unemployed. Unemployed patients had arrived to a moderate disability level (EIS > or = 3) before than employed patients. Only 17% of patients older than 50 years were employed vs. 63% of those among 26-35 years. Only EIS and years of school attendance were independently related to the unemployment status. Forty per cent of patients referred household income greater to $8,000/year. Thirty-six per cent of patients with severe disability (EIS > 6) was living in a floor with stairs and without lift. Forty-four per cent of patients with EIS > 6 had architectural barriers in their bathroom. CONCLUSIONS: More than half of multiple sclerosis patients were unemployed. Only the degree of disability and educational level were related in a independent way with unemployment status. Many patients unable to walking unaided had architectural barriers at home.

[Dissociated sensory loss syndrome in multiple sclerosis]. / El síndrome sensitivo suspendido en la esclerosis múltiple.

Spatial and temporal dissemination of demyelinating lesions continue to provide the basis for diagnosing multiple sclerosis (MS). We describe 20 patients (from a series of 234 with MS) who experienced flare-ups consistent with sensory suspension syndrome (SSS). The presence of syringomyelic cavities (non communicating syringomyelia) was ruled out by nuclear magnetic resonance imaging (NMR). We discuss the possible locations of lesions responsible for this syndrome: the trigeminus, dorsal root entry zones, anterior medullary white matter, and the mid-lateral portion of the spinothalamic tract. MS should be included as a differential diagnosis in young patients presenting with SSS.