Childhood multiple sclerosis: a review

Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system (CNS) that is increasingly recognized as a disease that affects children. Similar to adult-onset MS, children present with visual and sensory complaints, as well as weakness, spasticity, and ataxia. A lumbar puncture can be helpful in diagnosing MS when CSF immunoglobulins and oligoclonal bands are present. White matter demyelinating lesions on MRI are required for the diagnosis; however, children typically have fewer lesions than adults. Many criteria have been proposed to diagnose MS that have been applied to children, mostly above 10 years of age. The recent revisions to the McDonald criteria allow for earlier diagnosis, such as after a clinically isolated event. However, children are more likely than adults to have monosymptomatic illnesses. None of the approved disease-modifying therapies used in adult-onset MS have been approved for pediatrics; however, a few studies have verified their safety and tolerability in children. Although children and adults with MS have similar neurological symptoms, laboratory (cerebrospinal fluid) data, and neuroimaging findings, the clinical course, pathogenesis, and treatment of childhood onset MS require further investigation.     

Cerebrospinal fluid diagnosis of multiple sclerosis]

Starting from the knowledge accumulated with respect to the etiopathogenesis and the components of immunoreaction a minimal to maximal program by steps has been developed for the cerebrospinal fluid (CSF) in multiple sclerosis (MS). It is based on fundamental methods (I), special supplementary methods (II), and relatively specific immunological methods (III). For MS five possible conditions of the CSF could be determined from alterations of cells and variations in protein: a (1) typically complete and (2.) typically incomplete immunoreactive encephalomyelitic (encephalitic) syndrome, a (3.) nonspecific CSF-syndrome of low degree and less typical character (in the sense of an acute or subacute irritation syndrome) an (4.) atypical syndrome of a considerable degree, and a (5.) normal condition of the cerebrospinal fluid. The significance of immunoreactive cerebrospinal fluid syndromes to the diagnostic criteria of multiple sclerosis as well as further relatively disease-specific methods (such as the MEM test and MSF assay) of determining cellular immunity, are discussed.     

多发性硬化诊疗指南评析

我国无统一的多发性硬化（MS）诊断标准,MS的诊断依据Poser标准和McDonald标准。McDonald标准是建立在Poser标准基础上,但更注意利用包括MRI在内的相关实验室检查来证明多发性硬化在时间和空间上的多发性,有利于MS的早期诊断及治疗。对于没有MRI仪器的地方或不能承担MRI检查费用者,可用Poser标准进行诊断,但要注意行视觉诱发电位检查及脑脊液寡克隆IgG区带测定。     

Cytodiagnosis in the cerebrospinal fluid with special reference to illness course phases in diseases of the central nervous system

The cytological diagnostic of CSF is indicated in inflammations, vascular and tumorous diseases. A change of normal ratio of 4:1 of CSF-lymphocytes and -monocytes and/or the appearance of functionally active forms of these cell-lines are typical for immunoreactive inflammation (lymphoid cells) or cleaning up (macrophages). Cellular reactions with differing pleocytosis are caused by different irritations within the space of CSF: during the acute phase of meningitis with granulocytosis, in the following cleaning up with monocytosis and macrophages and in inflammatory and immunological reactions with lymphocytosis, lymphoid cells and plasmocytes. Necessary to CSF-diagnostic is the correlation of the stages of the course of disease additional with regard to the quantitative and qualitative results of CSF-protein. Findings of the examination of CSF-cells in diseases of CNS are represented in tabular form.     

Examining adversarial growth in illness: The factor structure of the silver lining questionnaire (SLQ-38)

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.     

The first year after diagnosis: psychological impact on people with multiple sclerosis

The impact of multiple sclerosis (MS) diagnosis on newly diagnosed individuals remains so far little explored. Our aim is to outline affective, personality and quality of life (QoL) correlates of MS patients shortly after MS diagnosis. Thirty-eight (22 F and 16 M) newly-diagnosed MS patients (mean interval from diagnosis communication 4.7 ± 3.8 months, range 1–12 months) underwent the Montgomery–Åsberg Depression Rating Scale and a comprehensive psychological evaluation: Beck Depression Inventory-II, State-Trait Anxiety Inventory, Psychophysiological Questionnaire-Revised, Fear Survey Schedule, Maudsley Obsessional-Compulsive Questionnaire, Impact of Event Scale-Revised, Personal Meaning Questionnaire, Problem Solving Inventory and Multiple Sclerosis Quality of Life-54. The Expanded Disability Status Scale was assessed during the neurological examination. Depressive symptomatology, only partially related to disability, was observed in approximately 40% of patients. The prevalent approach to MS diagnosis was one of avoidance in 65.8% of cases. QoL reductions in self-perception and psychological well-being emerged, together with a peculiar perception of change in health that was not related to neurological disability. With regard to personality assessment, depressive personal meaning organization correlates inversely with important QoL measures. Newly-diagnosed patients go through a complex network of psychological changes still in the initial phases immediately after diagnosis. A thorough understanding of these adjusting aspects by the neurologist could be crucial in improving patients’ QoL, participation in relevant disease decisions and adherence to pharmacological therapy.     

Management of multiple sclerosis: the role of coping self-efficacy and self-esteem

Patients with multiple sclerosis (MS) engage in various coping behaviours in order to manage their disease. The aim of this study is to find out if the self-esteem of patients is associated with coping strategies – problem-focused (e.g. making a plan of action when confronted with a problem); emotion focused (e.g. get emotional support from community); and focused on stopping unpleasant emotions and thoughts (e.g. keeping oneself from feeling sad), and if it can enhance or hinder coping efforts in the disease management. We collected data from 155 consecutive MS patients who completed the Coping Self-Efficacy Scale (CSE) and the Rosenberg Self-esteem Scale (RSE). Explained variance for problem-focused coping, emotion-focused coping, and coping focused on stopping unpleasant emotions and thoughts was 33, 24, and 31%, respectively. Self-esteem seems to be associated with coping strategies indicating that feelings of self-worth are linked with the ability to handle difficult life situations and can be helpful in chronic disease management.     

Effects of intraseptal zolpidem and chlordiazepoxide on spatial working memory and high-affinity choline uptake in the hippocampus

Injection of GABA(A)/benzodiazepine receptor ligands into the medial septum (MS) alters the activity of cholinergic neurons that innervate the hippocampus and can produce bidirectional modulation of spatial memory. Recent evidence suggests that two subtypes of the GABA(A) receptor are differentially localized to either GABAergic (alpha(1)/beta(2)/gamma(2)) or cholinergic (alpha(3)/beta(3)/gamma(2)) neurons within the MS. The present studies characterized the dose-related behavioral and neurochemical effects of intraseptal infusions of two benzodiazepine (BDZ) agonists that appear to exhibit different profiles of pharmacological specificity for these receptor subtypes. Male Sprague-Dawley rats were cannulated and then artificial CSF, chlordiazepoxide (CDP: 8 or 12 microg), or zolpidem (4, 8, or 12 microg) was injected into the MS. Spatial working memory was assessed in a delay radial-arm maze task and the activity of cholinergic neurons in the MS was evaluated by high-affinity choline uptake (HA-ChU) in the hippocampus. Intraseptal injection of either CDP or zolpidem produced dose-related impairments in spatial working memory and decreases in hippocampal HAChU. Both BDZ agonists were found to produce retrograde memory deficits and a decrease in HAChU following the highest dose tested (12 microg). However, intraseptal injection of 8 microg of zolpidem produced a behavioral deficit comparable to the high dose of CDP, but did not alter HAChU within the HPC. Although the cholinergic component of the septohippocampal pathway has been shown to be important in modulating hippocampal physiology and spatial memory processes, data from the present experiments suggest that the GABAergic component may also play an important role in the behavioral functions of the septohippocampal pathway.     

Experiences with the indirect Clausen Test using NTA as an antigen in multiple sclerosis and other neurologic diseases

The present study based on the indirect Clausen-test using NTA and PHA as antigens contributed to therapy control and possibly prognosis assessment rather than to immunological differential diagnosis.     

代谢综合征：一个颇具争论的病名

代谢综合征（MS）囊括了肥胖、高血糖、高血压、血脂紊乱等代谢异常,其预测心血管疾病和糖尿病的能力得到公认。但是,医学界对MS的探索并没有停步,有关其命名、病因、不同组分预测疾病的能力等存在着争议。客观评价MS将有助于提高医生对疾病相互关系的认识。     

Possibilities of rapid diagnosis in meningitis

The paper reviews rapid diagnosis methods for meningitis, covering currently proved immunological and physiochemical procedures, supplemented by reference to clinical biochemical tests.     

Unemployment among women with multiple sclerosis: the role of coping and perceived stress and support in the workplace

Unemployment is high among individuals with multiple sclerosis (MS). Certain disease variables and demographics have been found to distinguish employed and unemployed individuals. However, these variables only account for 14–20% of the variance. Other factors, such as coping, perceived stress and social support, in the workforce have been proposed, but not yet fully examined. The purpose of the present investigation was to examine the role of known factors associated with unemployment in MS, as well as coping and perceived work stress and social support. Sixty-eight women with MS were asked about their employment status and reasons for leaving. They completed a comprehensive assessment including measures of cognition, disease symptoms, psychological functioning, coping and stress. Consistent with previous findings, certain disease and demographic variables were associated with being unemployed. In particular, women who left work due to their MS were found to be older, had a longer disease duration and progressive course, reported greater disability and fatigue, and performed worse on a cognitive measure. However, we also found that coping style distinguished those who were employed from those who left work due to their MS. In particular, those who left work reported utilizing maladaptive coping mechanisms such as behavioral disengagement and substance use. With regard to perceived work stress and support, individuals who were employed reported that job security and fellow co-workers were more of an uplift than a hassle in their lives, suggesting some benefit in employment. These findings suggest that further consideration be given to role of coping and perception of the benefit of employment among individuals with MS when making recommendations regarding work decisions.     

Depression,Positive and Negative Affect,Optimism and Health-Related Quality of Life in Recently Diagnosed Multiple Sclerosis Patients: The Role of Identity,Sense of Coherence,and Self-efficacy

The study aimed to describe the levels of depression, positive and negative affect, optimism and health-related quality of life (HRQOL) in a group of recently diagnosed multiple sclerosis (MS) patients (up to 3 years since the diagnosis), taking into account gender, age, and disease duration differences, and to investigate the possible role of identity, sense of coherence (SOC), and self-efficacy in MS (SEMS) on patients’ depression, positive and negative affect, optimism, and HRQOL. The cross-sectional study involved 90 MS patients (61% women; age: M = 37, SD = 12) with an Expanded Disability Status Scale score between 1 and 4 (mild to moderate disability). Patients completed measures of depression (CESD-10), positive and negative affect (PANAS), optimism (LOT-R), HRQOL (SF-12), identity motives, SOC, and SEMS. Depression scores were near the cut-off level for clinically significant depressive symptoms, and negative affect was higher and HRQOL was lower than those in the general population. Women and younger patients reported better adjustment as time passes since the diagnosis. Results of multiple regressions indicated that higher SOC was related to higher mental health, lower negative affect and lower depression. Higher SEMS was predictive of greater positive affect and lower negative affect, whereas higher identity satisfaction was predictive of higher positive affect and optimism and lower depression. The results suggest the usefulness of addressing identity redefinition, SOC and self-efficacy in psychological interventions aimed at promoting patients’ adjustment to MS.     

Social-emotional aspects of quality of life in multiple sclerosis

Multiple sclerosis (MS) is an inflammatory auto-immune disease of the central nervous system. It leads to many impairments including physical, cognitive, psychological, and social challenges. Our study examined gender and cultural associations with quality of life (QoL), personal characteristics, and benefits from having MS among those with MS. The study was conducted in Austria and the United States. The sample included 128 participants, 64 in each country, of whom 78 were women and 50 were men aged between 20 and 57 years. We used standard statistical tests, including analyses of covariance (ANCOVA) and partial correlations for the analysis of quantitative data. For the qualitative part of the survey we used semi-structured interviews, which we transcribed and coded to identify categories in the answers for qualitative analyses. Austrian participants with MS perceived a higher social-emotional QoL in comparison to American participants. American participants expressed a higher self-esteem in comparison to Austrian participants. Men reported a lower ability to express love than women. Independent of sex/gender and nationality, participants reported benefits through the disease, especially with regard to improved compassion, mindfulness, improved family relations and lifestyle gains. The qualitative interviews revealed additional gender differences for coping with the illness; and in experiences, expectations, and challenges related to MS. These insights can be used to develop targeted psychological and social support interventions aimed toward improving social-emotional QoL for persons with MS.     

Personality in multiple sclerosis (MS): impact on health,psychological well-being,coping, and overall quality of life

Personality has long been considered a factor that can account for differences in health, well-being, and overall quality of life (QOL). A ‘Distressed or Type D Personality’ has been studied in medical populations as a predictor of several outcomes. The purpose of the present investigation was to determine the presence of Type D Personality in multiple sclerosis (MS) and its role on disease symptoms, disease management, health-related behaviors, coping, psychological well-being, and overall QOL and functioning. Two hundred and thirty (230) individuals with MS completed a survey assessing personality, disease symptoms, disease management, coping, self-efficacy, locus of control (LOC), psychological well-being, and QOL. Thirty-seven (16%) individuals were found to be ‘Type D+.’ Such individuals reported greater fatigue, pain, depression, and anxiety and worse disease management and adherence. They also reported engaging in maladaptive means of coping. Compared to ‘Type D?’ they reported lower self-efficacy, LOC, QOL and greater perceived stress. Finally, ‘Type D+’ individuals were more likely to be considering leaving the workforce. Findings suggest that ‘Type D’ Personality is associated with various negative outcomes in MS. Consideration of the routine assessment of personality in MS seems warranted and may better inform interventions and ward off poor outcomes.     

Factors affecting the disease course in multiple sclerosis

This study investigate the significance of various data of patient's and family's history according to the disease activity of MS. 350 patients with definitive MS were divided into two groups according to a different clinical course. There was no difference in the frequency of the registered factors between these two groups. Our conclusion is, that the evaluated factors don't have prognostic significance in the course of MS. The results support the model of a phase characteristic course of MS which has been suggested by Fog and Linnemann.     

Perception of affective prosody in patients at an early stage of relapsing–remitting multiple sclerosis

Cognitive dysfunction is well known in patients suffering from multiple sclerosis (MS) and has been described for many years. Cognitive impairment, memory, and attention deficits seem to be features of advanced MS stages, whereas depression and emotional instability already occur in early stages of the disease. However, little is known about processing of affective prosody in patients in early stages of relapsing–remitting MS (RRMS). In this study, tests assessing attention, memory, and processing of affective prosody were administered to 25 adult patients with a diagnosis of RRMS at an early stage and to 25 healthy controls (HC). Early stages of the disease were defined as being diagnosed with RRMS in the last 2 years and having an Expanded Disability Status Scale (EDSS) of 2 or lower. Patients and HC were comparable in intelligence quotient (IQ), educational level, age, handedness, and gender. Patients with early stages of RRMS performed below the control group with respect to the subtests ‘discrimination of affective prosody’ and ‘matching of affective prosody to facial expression’ for the emotion ‘angry’ of the ‘Tübingen Affect Battery’. These deficits were not related to executive performance. Our findings suggest that emotional prosody comprehension is deficient in young patients with early stages of RRMS. Deficits in discriminating affective prosody early in the disease may make misunderstandings and poor communication more likely. This might negatively influence interpersonal relationships and quality of life in patients with RRMS.     

Neuropsychological profile of multiple sclerosis

Multiple Sclerosis (MS) is the most common non-traumatic neurological disorder among young and middle-aged people. The aim of the present study was to examine the cognitive functioning of a group of MS patients. A sample of 80 participants diagnosed with MS and 40 controls received a comprehensive neuropsychological battery. Participants with MS scored lower than controls on all of the neuropsychological tests and significantly lower (p < .05) on 84% (16/19) of them. The global neuropsychological profile of the MS group included deficits in executive function, speed of information processing, memory, visuo-spatial abilities and attention. Cognitive deficits are one of the main symptoms of MS. Recognition of these deficits is relevant both to the diagnosis and rehabilitation of this disorder.     

Brain-immune interactions in neuropsychiatry: highlights of the basic science and relevance to pathogenic factors and epiphenomena

Unraveling the significant complexity of brain-immune interactions could provide essential new insights and potential treatment considerations for the clinical neurosciences. Despite considerable research relating immunological changes to major neuropsychiatric disorders, it has been difficult to establish that immunological processes are involved in the development of central nervous system pathology associated with these disorders. This brief article highlights some of the landmark basic studies and seeks to convey essential principles guiding research in brain-immune interactions. Research in this area often incorporates several disciplines, ranging from psychology and neuroscience to immunology and molecular genetics. The clinical implications of this area of research are discussed, with emphasis on the challenge of disentangling pathogenic factors and valid markers of disease from epiphenomena.     

Adaptive Tasks in Multiple Sclerosis: Development of an Instrument to Identify the Focus of Patients' Coping Efforts

Objective : Adaptive tasks, referring to the subjective evaluation of disease-related stressors in relation to personal concerns, have been neglected in the extensive literature on coping with chronic disease. In this study, the development of an instrument for measuring adaptive tasks is described: the Questionnaire Adaptive Tasks in Multiple Sclerosis (QuAT-MS). Method : The QuAT-MS is based on a bottom-up categorization of patients' statements on the losses, threats, and challenges brought about by their disease, and employs 10 scales to measure the importance attached to particular disease-related stressors. Validity and reliability of this bottom-up categorization were established in a sample of MS patients ( N = 259) by examining their associations with related concepts relevant in adaptation to disease, such as coping (CISS), coping resources (LOT, self-efficacy), and quality of life (SIP). We also investigated whether patients' backgrounds and disease characteristics were related to adaptive tasks. Results : Adaptive tasks are more closely related with concepts relevant for adaptation (coping and coping resources) than with physical functioning (SIP) and disease-related characteristics (illness duration). Adaptive tasks are also associated with gender and level of education. Conclusion : It is concluded that adaptive tasks can be distinguished from related concepts like coping and quality of life. Furthermore, the QuAT-MS offers a reliable and patient-centred instrument for measuring the tasks which MS patients identify in their adaptation process.