Positive effects of fampridine on cognition, fatigue and depression in patients with multiple sclerosis over 2 years.

OBJECTIVE: To assess the effects of PR-fampridine on cognitive functioning, fatigue and depression in patients with multiple sclerosis (PwMS). METHODS: Thirty-two PwMS were included in this trial. Cognitive performance was assessed in an open-label and randomized double-blind, placebo-controlled study design using a comprehensive neuropsychological test battery as well as questionnaires examining depression and fatigue. RESULTS: We found significant improvements in cognitive measures assessing alertness (tonic alertness, p = 0.0244 and phasic alertness, p = 0.0428), psychomotor speed (p = 0.0140) as well as verbal fluency (p = 0.0002) during open-label treatment with PR-fampridine. These effects of performance were paralleled by patients' perception of reduced fatigue (physical, p = 0.0131; cognitive, p = 0.0225; total, p = 0.0126). Fampridine-induced improvements in phasic alertness (p = 0.0010) and measures of fatigue (physical, p = 0.0014; cognitive, p = 0.0003; total, p = 0.0005) were confirmed during randomized, double-blind, placebo-controlled assessment in the second year. In addition, we found positive effects of PR-fampridine on depressive symptoms (p = 0.0049). We demonstrated persisting beneficial effects of PR-fampridine on fatigue in PwMS over a period of more than 2 years. Drug responsiveness regarding cognitive performance and fatigue was not limited to walking responders. CONCLUSIONS: Our data demonstrate significant positive effects of treatment with PR-fampridine over 2 years on different cognitive domains as well as fatigue and depression in a cohort of PwMS. These findings imply that PR-fampridine should be considered as symptomatic treatment improving aspects of cognition, fatigue and depression in PwMS.

Unrealistic optimism and 'nosognosia': illness recognition in the healthy brain.

INTRODUCTION: At the centenary of research on anosognosia, the time seems ripe to supplement work in anosognosic patients with empirical studies on nosognosia in healthy participants. To this end, we adopted a signal detection framework to investigate the lateralized recognition of illness words--an operational measure of nosognosia--in healthy participants. As positively biased reports about one's current health status (anosognosia) and future health status (unrealistic optimism) have both been associated with deficient right hemispheric functioning, and conversely with undisturbed left hemispheric functioning, we hypothesised that more optimistic participants would adopt a more conservative response criterion, and/or display less sensitivity, when identifying illnesses in our nosognosia task; especially harmful illnesses presented to the left hemisphere via the right visual field. MATERIAL AND METHODS: Thirty-two healthy right-handed men estimated their own relative risk of contracting a series of illnesses in the future, and then completed a novel computer task assessing their recognition of illness names presented to the left or right visual field. To check that effects were specific to the recognition of illness (rather than reflecting recognition of lexical items per se), we also administered a standard lateralized lexical decision task. RESULTS: Highly optimistic participants tended to be more conservative in detecting illnesses, especially harmful illnesses presented to the right visual field. Contrary to expectation, they were also more sensitive to illness names in this half-field. CONCLUSIONS: We suggest that, in evolutionary terms, unrealistic optimism may be an adaptive trait that combines a high perceptual sensitivity to threat with a high threshold for acknowledging its presence. The signal detection approach to nosognosia developed here may open up new avenues for the understanding of anosognosia in neurological patients.

Emotional well-being and predictors of birth-anxiety, self-efficacy, and psychosocial adaptation in healthy pregnant women.

BACKGROUND: A broad body of studies have shown that emotional well-being during pregnancy influences birth outcome and postpartum mood state, but few longitudinal studies have examined the extent of changes of emotional well-being during late pregnancy. Furthermore, up to now it has remained unclear which factors are predictive for emotional well-being during pregnancy. This prospective longitudinal study has two main aims. First of all, possibly occurring changes of birth anxiety, self-efficacy for labor and delivery, and psychosocial adaptation to pregnancy in primiparous healthy women during the final trimenon will be described. Second, predictors of these assessed constructs during the final trimenon as well as the extent of these constructs as predictors for the psychological status postpartum will be shown. METHODS: A prospective longitudinal study was conducted with 61 pregnant women recruited from childbirth classes. RESULTS: The results showed significant changes in emotional well-being--measured by birth anxiety, self-efficacy for labor and delivery, and psychosocial adaptation to pregnancy--during the final trimenon: the women were more confident in their ability to cope with labor and delivery. Birth anxiety did not change significantly during the final trimenon. Regression analyses revealed different psychosocial predictor variables for emotional well-being during late pregnancy. The predictive factor for an unfavorable psychological status postpartum was birth anxiety. CONCLUSIONS: The results of this study suggest that the importance of discovering psychosocial problems of pregnant woman early in pregnancy could be imperative in preventing psychosocial problems later in pregnancy as well as postpartum.