Forms of disease progression and prognostic factors in multiple sclerosis

Basing on the diagnostic criteria, an analysis of 687 cases of multiple sclerosis (MS) is represented according to the different forms of course, their frequency and the degree of severity. For the progressive course--either secondary after attacks or primary--a higher proportion of disease with severe disturbances resp. comparatively malignant forms have been found; furthermore, a critical time of progression could be ascertained. The determination of the disability status (using the EDSS) during a longer space of time showed a more unfavourable prognosis for the males. The development of disability was more distinct at onset of disease in the elder-aged groups. The problems of uncertain factors influencing the course and prognosis of disease are pointed out in connection with the heterogeneity of MS, basing on the pathogenetic components.     

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.     

Lymphocyte sensitivity to brain specific glycoprotein in multiple sclerosis]

The lymphocytes of seven out of eight multiple sclerosis patients were sensitized to brain-specific glycoproteins that had been isolated from extracts of human white matter and purified by means of affinity chromatography utilizing specific antibodies as immunoadsorbents. The diagnosis of multiple sclerosis for the eighth patient, whose lymphocytes were not sensitized, was doubtful. A significant correlation between the severity of the disease and degree of lymphocyte sensitization was not obtained, although the most disabled patient showed the greatest sensitization.     

Preliminary results of imurek treatment of multiple sclerosis]

The authors, after presenting a survey of the literature on the treatment of multiple sclerosis with immunosuppressants, report their experience with Imurek. Of 53 patients with a chronic and progressive course of the disease, objective improvement could be observed in 17. In 20 patients the symptomatology remained unchanged, although 4 of them reported subjective improvement. In 16 patients, progression of the disease could not be stopped. Better results of treatment could be obtained for those forms of the disease where the course was, first, in the form of what may be referred to as outbursts and, later, in a chronic and progressive form. -Possible side effects are pointed out.     

Some problems of genetic counseling in schizophrenic psychoses

The authors sum up the most important basic principles of diagnostics and genetics of the schizophrenic psychoses from the viewpoint of genetic counseling for the practising psychiatrist and medical geneticist. Regarding genetic counselling strategy, in addition to nosological considerations, they stress the importance of socio-cultural and social psychological factors and of the emotional atmosphere in the family, which should all be taken into account together. Because of the special situation of schizophrenic (and in general, psychiatric) patients and their families, they regard it as advisable to set up a separate psychiatric genetic counselling service.     

Serum creatine kinase activity in psychoses]

This is a report of the initial results of determinations of the creatine kinase activity in the serum of forty psychiatric and twenty-five neurological patients. A determination of the creatine kinase activity made in the first days of an acute endogenous psychosis invariably showed an increase in creatine kinase which returned to normal values after eight to fourteen days. Patients with residual schizophrenia, conditions of acute excitation accompanying psychopathy, and abnormal personality or circumscribed paranoid development showed creatine activity in the range of normal values. Alcoholics with incipient or strongly marked delirium tremens showed normal creatine kinase activity in those cases where the situation was not complicated by additional traumata or other accompanying diseases.     

Studies of higher nervous activity in functional psychoses

Psychiatric illnesses can be conceived of as experiments of nature, providing a variety of pathopsychological mechanisms which may elucidate normal psychological processes. Clinically the reactive psychoses are predominantly psychogenic reaction types. They present disturbances of higher nervous activity, similar to those of the neuroses. The unconditional reflex activity is practically as in normal controls, and the most outstanding finding was the large effect of psychodynamic complex structures. This is a physiological parallel to the clinical manifestations with great concern over experienced mental trauma. In the manic-depressive psychoses the most characteristic feature is a marked disturbance of unconditional reflex activity. This factor may be an important physiological mechanism underlying the more biological than psychodynamic reaction type and partly explain the changes of mood and associated interferences with sleep, body weight, sexual activity, aggression and other instinctual and vegetative functions. Schizophrenic psychoses also present changes of unconditional reflex activity, predominantly in the direction of inhibition of response. In addition there are severe dissociations within and between the three levels of unconditional reflexes and the two signaling systems. It is suggested that schizophrenia represents a functional maladaptation, which can be explained from the principles of autokinesis and schizokinesis established by Gantt in animal experiments. Prognostic models based on experimentally established impairment of performances were shown to predict long-term risks of schizophrenic defects just as well as models based on constellations of clinical symptoms. I would predict that psychophysiology and experimental psychology will become increasingly more important for establishing diagnosis and prognosis in the functional psychoses. The data of this article point toward a basis for a prophylactic psychiatry.     

Epileptic seizures in multiple sclerosis

Starting from informations in the literature, the authors deals with eight own cases, suffering from clinically certain multiple sclerosis and showing, as a further sign, epileptic seizures. Compared to the total of patients, these eight cases represent 1.78 p.c. of all patients treated for multiple sclerosis in this clinic. The features of seizures, frequency and dynamics of occurrence are referred to. The authors point out that it is necessary to differential between epileptic seizures and non-epileptic attacks, and they draw attention to the fact that here are difficulties with regard to differential diagnosis if epileptic seizure appears as a initial symptom of multiple sclerosis.     

Loneliness in cancer and multiple sclerosis patients

Loneliness is a universal social phenomenon often producing debilitating effects on many aspects of human functioning. The present study compared the qualitative aspects of loneliness in two terminally ill samples to that of a more healthy sample. 329 multiple sclerosis and 315 cancer patients, as well as 391 nonrandom healthy participants answered a 30-item questionnaire on loneliness. Analysis indicated the experience of loneliness which characterizes multiple sclerosis and cancer patients differs from that of the more healthy group.     

Etiology and pathogenesis of multiple sclerosis: current aspects of causative factors in the disease course

The components of pathogenesis of multiple sclerosis are presented. (I.) Genetic and metabolic factors were found to be fundamental for cellular immune reaction; the association with class 2 MHC (HLA-DR; IR) antigens is more relevant than that of class 1 MHC (HLA-ABC) antigens. (II.) A reaction to several viruses may be significant for the induction and the heterogenous course of disease; some mechanisms of an immune-dysbalance--induced by viruses--are exposed. (III.) Disturbances of cellular immunoregulation, a reduced activity of T-suppressor-lymphocytes, a break of immune tolerance and cytotoxic effector mechanisms are decisive for the autoimmune processes. In all, on the basis of multi-genetic anomalies a multi-phase pathogenesis may be assumed, developing in manner of a cascade in several steps and phases.     

Serum creatinphosphokinase (CPK) in endogenic psychoses]

Creatinphosphokinase (CPK) was determined in 141 patients with manic-depressive and schizophrenic psychoses. In general endogenic psychoses of the manic and depressive type as well as chronic schizophrenias show normal CPK values. In acute cases of paranoid-halluzinatory schizophrenias normal values are predominant. In catatonic schizophrenias, as a rule, clearly increased enzyme activities are found. Thise increased values suggest a postulated somatic disease as a cause of the psychosis. Thus, the determination of CPK provides a useful aid in the diagnosis and control of the course of catatonic schizophrenic.     

Self and body esteem perception in multiple sclerosis

Self esteem and body esteem were examined in a group of 35 relapsing-remitting multiple sclerosis (MS) patients using the Body Esteem Scale (BES) and the Eysenck Self Esteem Scale (ESES) and compared to age and sex matched normal controls. There were 23 females and 12 males in the MS patient's group; average age 38.9 years (range: 22-52). All participants completed the self-rated BES evaluating the following subscales: females - sexual attractiveness, physical condition and weight concern; males - physical attractiveness, physical condition and upper body strength. In addition all participants were scored, following a semi-structured interview, on the ESES. Psychiatric co-morbidity was excluded using a semi-structured interview by the consulting psychiatrist. All evaluations were carried out during the remitting phase. Statistical analysis, comparing patients to healthy controls, demonstrated lowered self-rating of the physical condition (males < 0.05, females < 0.001). On the other hand, no significant differences were found in the physical (male) or sexual (female)?attractiveness subscales. The mean ESES score in the patients group was 23.2 ± 4.0, slightly above the reported average. The controls mean ESES was 28.4 ± 3.6, (P < 0.05). No correlation was found between self and body esteem amongst M.S. patients. This study emphasizes impaired perception of body esteem in multiple sclerosis patients even in remission. The preservation of physical and sexual attractiveness may be related to the non-disfiguring nature of the disease. Preservation of self-esteem in MS patients suggests that body-esteem should be the focus of supportive treatment.     

Coding processes and executive functions in multiple sclerosis

Although episodic memory deficit in patients with multiple sclerosis (ME) is a well established fact, there is no agreement about the origin of this disorder in terms of cognitive processes. Whereas most of the studies attribute this deficit to defects in memory recovery processes, others contribute evidence in favor of the hypothesis that considers that it originates in difficulties in coding memory processes.However, the analysis of the relationship between coding processes and memory functioning in ME is a scantly studied topic. In the present article, we studied coding processes and their relationships with executive control processes in a group of patients with ME. We used a set of indexes of the Test of Verbal Learning from the TAVEC test for the evaluation of the coding processes. To assess the executive processes we used a semantic verbal fluency task, the WCST, and WAIS III scale of matrixes. We worked with 36 patients with ME diagnosis and 36 healthy control participants, paired by age and educational level. The results showed a deficit in the coding processes and the existence of a significant association between these processes and executive functioning.     

Self and body esteem perception in multiple sclerosis

Self esteem and body esteem were examined in a group of 35 relapsing-remitting multiple sclerosis (MS) patients using the Body Esteem Scale (BES) and the Eysenck Self Esteem Scale (ESES) and compared to age and sex matched normal controls. There were 23 females and 12 males in the MS patient's group; average age 38.9 years (range: 22-52). All participants completed the self-rated BES evaluating the following subscales: females - sexual attractiveness, physical condition and weight concern; males - physical attractiveness, physical condition and upper body strength. In addition all participants were scored, following a semi-structured interview, on the ESES. Psychiatric co-morbidity was excluded using a semi-structured interview by the consulting psychiatrist. All evaluations were carried out during the remitting phase. Statistical analysis, comparing patients to healthy controls, demonstrated lowered self-rating of the physical condition (males < 0.05, females < 0.001). On the other hand, no significant differences were found in the physical (male) or sexual (female)--attractiveness subscales. The mean ESES score in the patients group was 23.2 +/- 4.0, slightly above the reported average. The controls mean ESES was 28.4 +/- 3.6, (P < 0.05). No correlation was found between self and body esteem amongst M.S. patients. This study emphasizes impaired perception of body esteem in multiple sclerosis patients even in remission. The preservation of physical and sexual attractiveness may be related to the non-disfiguring nature of the disease. Preservation of self-esteem in MS patients suggests that body-esteem should be the focus of supportive treatment.     

Epidemiologic study on the etiopathogenesis of multiple sclerosis

A computer-aided evaluation of those affected with multiple sclerosis (n = 90) with regard to the actually discussed hypothesis on the aetiology of this disease results in 10 significant signs. These signs in their majority support the combined hypothesis of a disturbed regulation of infection and immunity. Frequently, as early as in childhood and youth the upper airways are affected, and this is coupled with a severe course of the disease. The incidence also shows familially and territorially frequent occurrences.     

Treatment of cognitive impairment in multiple sclerosis

Cognitive impairment in multiple sclerosis is an increasingly recognized entity. This article reviews the cognitive impairment of multiple sclerosis, its prevalence, its relationship to different types of multiple sclerosis, and its contribution to long-term functional prognosis. The discussion also focuses on the key elements of cognitive dysfunction in multiple sclerosis which distinguish it from other forms of cognitive impairment. Therapeutic interventions potentially effective for the cognitive impairment of multiple sclerosis are reviewed including the effects of disease modifying therapies and the use of physical and cognitive interventions.