Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS.

BACKGROUND AND PURPOSE: First-line immunomodulatory treatment with interferon-beta or glatiramer acetate is accepted as effective basic therapy in patients with relapsing-remitting multiple sclerosis (RRMS). However, a considerable portion of patients does not benefit from treatment. METHOD: To test basic immunomodulatory treatment under real-life conditions, we retrospectively analyzed clinical and subclinical disease activity within the last 12 months in a cohort of 9916 patients with RRMS, of which 7896 patients were receiving immunomodulatory treatment. In addition, factors associated with treating physicians' consideration of a switch of current treatment were assessed. RESULTS: The majority of treated patients (approximately 66%) experienced no relapse during the last 12 months. However, in line with common clinical study findings, about one-third (approximately 34%) of patients had relapses. When MRI data were taken into account, approximately one-quarter (24%) of patients would qualify for therapy escalation to monoclonal antibody natalizumab. Relapse rate in the preceding year (the year directly prior to the start of retrospective data collection) was strongly associated with considering a switch of current treatment. In addition, therapy switch was more often considered in younger patients. The relationship between MRI findings in the absence of clinical symptoms and consideration of a treatment switch was not as clear. CONCLUSIONS: This analysis confirms that disease progression occurs in a considerable proportion of patients with RRMS. These patients should be considered for therapy escalation.

[Depression in Parkinson's disease--Part 2: Therapy and management]. / Depression beim idiopathischen Parkinson-Syndrom--Teil 2: Therapie und Management.

A good number of different methods and antidepressive agents are now available for the management of depressive symptoms, the efficacy of which has been confirmed by clinical studies. Various approaches--be it medication, electroconvulsive therapy (ECT), psychoeducation and psychotherapy--have also been developed to treat depression in patients with Parkinson's disease. Unfortunately, only a few controlled studies exist for this very specific group of patients. Systematic knowledge of treatment options, however, is lacking. Efficient management of depressive symptoms is absolutely indispensable considering the proven impact of a depression on the patients' quality of life. So far, more than half of the patients afflicted with Parkinson's disease and depression do not receive proper antidepressive therapy. This survey gives an overview on the pharmacological, somatic and psychological procedures of treatment applied in this group of patients, along with useful suggestions.

[Non-motor Symptoms Questionnaire and Scale for Parkinson's disease. Cross-cultural adaptation into the German language]. / Non-motor Symptoms Questionnaire und Scale für das idiopathische Parkinson-Syndrom. Interkulturell adaptierte Versionen in deutscher Sprache.

Idiopathic Parkinson's disease (PD) is a multisytem degenerative disorder. In addition to motor symptoms such as akinesia, rigidity and tremor, various non-motor symptoms occur, which are still insufficiently diagnosed. Moreover, the frequently used scales and scores do not adequately detect these non-motor symptoms. The Non-motor Symptoms Questionnaire (NMSQuest) is an established self-completed patient questionnaire with 30 qualitative questions covering all important non-motor symptoms of PD. The Non-motor Symptoms Scale (NMSScale) is a grade rating scale for estimating the frequency and severity of non-motor symptoms in PD. Since there are only original English versions of both questionnaires available, self-translated versions were frequently used or the questionnaires were not used at all in native German patients. We used international guidelines for cross-cultural adaptation of questionnaires to provide standard versions of both non-motor symptoms questionnaires in the German language.

Quality of life in 1000 patients with early relapsing-remitting multiple sclerosis.

BACKGROUND AND PURPOSE: To examine the quality of life (QoL) in a large cohort of untreated patients with relapsing-remitting multiple sclerosis (RRMS) and to investigate the impact of intramuscular (IM) interferon beta-1a (IFNbeta-1a) treatment. METHODS: Prospective, observational, open-label, multicentre study conducted in Germany. Untreated patients with RRMS who initiated treatment with IM IFNbeta-1a were included and followed for 12 months. QoL was measured using the EQ-5D questionnaire. Clinical response was assessed by relapse rate and disability (Expanded Disability Status Scale; EDSS). RESULTS: A total of 1157 patients were included [mean age 37.6 years, median disease duration 13 months, mean relapse rate 1.7 (95%CI: 1.58-1.73), median EDSS score 2.0]. Relapse rate was reduced to 0.6 at 12 months (95%CI: 0.51-0.69, P < 0.0001). EDSS did not change significantly. At baseline, QoL was considerably lower in MS patients compared with the general German population, but was improved after treatment initiation [utilities of EQ-5D: 0.77 (95%CI: 0.75-0.78) vs. 0.75 (95%CI: 0.74-0.76) at baseline, 95%CI for difference: 0.01-0.03, P = 0.0046]. Higher disease activity and inability to work were negative predictors of QoL. 14.7% of patients were incapable of working for MS-related reasons. CONCLUSIONS: Quality of life is considerably impaired in early stages of MS. Treatment initiation with IM IFNbeta attenuates MS disease activity and improves QoL. Inability to work early during the disease is a major challenge for the social security systems.

[Depression in Parkinson's disease. Part 1: epidemiology, signs and symptoms, pathophysiology and diagnosis]. / Depression beim idiopathischen Parkinson-Syndrom. Teil 1: Epidemiologie, Pathophysiologie, Klinik und Diagnostik.

Non-motor symptoms, such as psychiatric symptoms and autonomic dysfunction, are common co-morbid conditions in Parkinson's disease (PD) and major contributors to poor quality of life and disability. Within the group of neuropsychiatric conditions, depressive symptoms are the most common condition. Despite their frequency and importance, depressive symptoms can be difficult to assess and diagnose and thus depression in PD is frequently unrealized. Diagnostic challenges include the overlap of depressive symptoms with motor and non-motor symptoms of PD, such as dementia and apathy. Furthermore, there are no definite standards to assess and diagnose depression in PD leading also to the lack of exact data on the epidemiology of this non-motor symptom in PD. Depending on the diagnostic test and the study design the prevalence of depression in PD is reported between 7 and 72% of PD patients with approximately 40% in most cross-sectional studies. In contrast, the pathogenesis and long-term course of depression in PD remain elusive. Current hypothesis, however, includes that depressive symptoms are part of the core condition of PD when regarded as an entity. The present review summarizes the current knowledge on epidemiology, pathogenesis and diagnosis of depression in PD and proposes on this data base a standard procedure for screening and diagnosis of depressive symptoms in PD.

[Light and electron microscopy findings in early and late stages of heart failure. Studies of endomyocardial biopsies of patients with latent (LCM) and dilated (DCM) cardiomyopathy]. / Licht- und elektronenmikroskopische Befunde in Früh- und Spätstadien der Herzinsuffizienz. Untersuchungen an Endomyokardbiopsien von Patienten mit latenter (LCM) und dilatativer (DCM) Kardiomyopathie.

Right-ventricular myocardial biopsies were obtained from 28 patients with LCM (EF 72 +/- 10.4%) and 36 patients with DCM of different degrees (EF 45 +/- 15%). Using paraffin sections and electron micrographs, 16 structural variables were semiquantitatively evaluated. Hypertrophy of myofibres, and nuclear and mitochondrial alterations were significantly more pronounced in patients with DCM. A score of 9 selected variables was found to be significantly higher in the DCM-group as compared with the LCM-group. The diameter of the myofibres was significantly thicker in DCM (17.5 +/- 2.2 microns) than in LCM (14.6 +/- 0.95 microns), but no significant difference of the volume density of myofibrils and of mitochondria could be determined. In the myocytes of DCM the mitochondria were significantly smaller than in LCM. The EF correlates with the myofibre thickness, with the semiquantitative score, and with the size of the mitochondria, but no significant correlation was seen with the volume density of myofibrils or mitochondria. The study has shown: At present no alterations in myocardial biopsies are known to be diagnostic for LCM or DCM. The findings support the concept of a diffuse myocardial disease in LCM. Only one patient out of 28 exhibited a myocardium without any pathologic changes. There is no evidence for small vessel disease in LCM. From the morphological point of view DCM and LCM are different only in quantity, but not in quality of their structural alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of early atherosclerotic lesions by duplex scanning of the carotid artery.

A high-resolution ultrasound B-mode imaging system combined with a 16-sequential range-gated pulsed Doppler flow measuring device was used for the evaluation of nonstenotic extracranial carotid artery disease. Various types of atherosclerotic lesions were differentiated by Duplex system examinations in 54 carotid arteries examined in vitro in a postmortem study and in 51 carotid arteries examined in vivo from patients with angiographically proven cerebrovascular disease. In addition, the multigated Doppler system allowed the analysis of flow velocity profiles throughout the carotid arteries, the distinction between intraarterial flow and recent thrombus, and in particular the estimation of local flow alterations, which are diagnostic in the presence of sonolucent and shadowed plaques behind echo-dense lesions. A number of difficulties, which at present limit the application of Duplex system examination as a non-invasive "stand alone" method for detecting carotid disease, are discussed.