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Brain and Nerve = Shinkei Kenkyu No... Apr 2020The diagnosis of multiple sclerosis (MS) relies on the demonstration of disease dissemination in space and time, and the exclusion of other neurological disorders....
The diagnosis of multiple sclerosis (MS) relies on the demonstration of disease dissemination in space and time, and the exclusion of other neurological disorders. However, it is often difficult to exclude alternative diagnoses with a single MRI examination or during a short clinical course. "Red flags" are recommended as clinical and paraclinical indicators that could help suggest alternative diagnoses to MS, and may improve diagnostic accuracy.
Topics: Demyelinating Diseases; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Nervous System Diseases
PubMed: 32284460
DOI: 10.11477/mf.1416201534 -
Cold Spring Harbor Perspectives in... Mar 2018Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS), which gives rise to focal lesions in the gray and white... (Review)
Review
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS), which gives rise to focal lesions in the gray and white matter and to diffuse neurodegeneration in the entire brain. In this review, the spectrum of MS lesions and their relation to the inflammatory process is described. Pathology suggests that inflammation drives tissue injury at all stages of the disease. Focal inflammatory infiltrates in the meninges and the perivascular spaces appear to produce soluble factors, which induce demyelination or neurodegeneration either directly or indirectly through microglia activation. The nature of these soluble factors, which are responsible for demyelinating activity in sera and cerebrospinal fluid of the patients, is currently undefined. Demyelination and neurodegeneration is finally accomplished by oxidative injury and mitochondrial damage leading to a state of "virtual hypoxia."
Topics: Brain; Demyelinating Diseases; Disease Progression; Humans; Inflammation; Multiple Sclerosis; Nerve Degeneration
PubMed: 29358320
DOI: 10.1101/cshperspect.a028936 -
Nature Reviews. Neurology Jun 2020
Topics: Demyelinating Diseases; Humans; Oligodendroglia; Remyelination
PubMed: 32203392
DOI: 10.1038/s41582-020-0341-7 -
Seminars in Arthritis and Rheumatism Dec 2011To estimate the rate of demyelinating diseases in patients with rheumatic diseases treated with tumor necrosis factor (TNF) antagonists and to describe the cases... (Review)
Review
OBJECTIVES
To estimate the rate of demyelinating diseases in patients with rheumatic diseases treated with tumor necrosis factor (TNF) antagonists and to describe the cases reported to 3 different pharmacovigilance sources.
METHODS
All confirmed cases of demyelinating disease, optic neuritis, and multiple sclerosis (MS) in patients with rheumatic diseases treated with TNF-antagonists were reviewed from 3 different sources: (1) the Spanish Registry of biological therapies in rheumatic diseases (BIOBADASER); (2) the Spanish Pharmacovigilance Database of Adverse Drug Reactions (FEDRA); and (3) a systematic review (PubMed, EMBASE, and the Cochrane Library). In BIOBADASER, the incidence rate per 1000 patients was estimated with a 95% confidence interval (95% CI).
RESULTS
In 21,425 patient-years in BIOBADASER, there were 9 patients with confirmed demyelinating disease, 4 with optic neuritis, and 1 with MS. In addition, 22 patients presented polyneuropathies, paresthesias, dysesthesias, facial palsy, or vocal cord paralysis without confirmed demyelination. The incidence rate of demyelinating disease in patients with rheumatic diseases exposed to TNF-antagonists in BIOBADASER was 0.65 per 1000 patient-years (95% CI: 0.39-1.1). The incidence of MS in BIOBADASER was 0.05 (95% CI: 0.01-0.33), while the incidence in the general Spanish population was 0.02 to 0.04 cases per 1000. Compared with BIOBADASER, cases in FEDRA (n = 19) and in the literature (n = 48) tend to be younger, have shorter exposure to TNF-antagonists, and recover after discontinuation of the drug.
CONCLUSIONS
It is not clear whether TNF antagonists increase the incidence of demyelinating diseases in patients with rheumatic diseases. Differences between cases depending on the pharmacovigilance source could be explained by selective reporting bias outside registries.
Topics: Antirheumatic Agents; Databases, Factual; Demyelinating Diseases; Humans; Incidence; Pharmacovigilance; Rheumatic Diseases; Tumor Necrosis Factor-alpha
PubMed: 22152489
DOI: 10.1016/j.semarthrit.2011.05.003 -
Anaesthesia Sep 1980The demyelinating diseases are classified and the current concepts of the aetiology and pathophysiology of the most common of these diseases, multiple sclerosis, are... (Review)
Review
The demyelinating diseases are classified and the current concepts of the aetiology and pathophysiology of the most common of these diseases, multiple sclerosis, are described. The effects of the impaired function, local responses and known complications of the disease on the choice of anaesthetic, drugs and techniques are discussed.
Topics: Anesthesia, General; Anesthesia, Local; Demyelinating Diseases; Humans; Multiple Sclerosis; Preoperative Care
PubMed: 7004260
DOI: 10.1111/j.1365-2044.1980.tb03947.x -
British Medical Bulletin Jan 1977
Review
Topics: Acute Disease; Demyelinating Diseases; Evoked Potentials; Humans; Multiple Sclerosis; Neural Conduction; Optic Neuritis; Synapses; Temperature; Time Factors; Visual Acuity; Water-Electrolyte Balance
PubMed: 318885
DOI: 10.1093/oxfordjournals.bmb.a071390 -
Archives of Disease in Childhood Mar 2022There are several important relapsing demyelinating syndromes (RDS) that may present in childhood, of which paediatric-onset multiple sclerosis is the most common. These... (Review)
Review
There are several important relapsing demyelinating syndromes (RDS) that may present in childhood, of which paediatric-onset multiple sclerosis is the most common. These are rare conditions, so recognising presentations and referring early to specialist services is important to enable prompt diagnosis and effective treatment. Understanding of RDS is rapidly evolving, with many new and effective treatments that aim to reduce relapses and disability accumulation. A holistic and child-focused approach to management is key to supporting patients and families, with thought given to early detection of cognitive and psychological issues to provide appropriate support.
Topics: Adolescent; Anti-Inflammatory Agents; Brain; Child; Demyelinating Diseases; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Multiple Sclerosis; Myelin-Oligodendrocyte Glycoprotein; Neuromyelitis Optica; Occupational Therapy; Recurrence
PubMed: 34230009
DOI: 10.1136/archdischild-2021-321911 -
Progress in Brain Research 2017Demyelinating diseases, such as multiple sclerosis (MS), are responsible for a significant portion of the neurological disability burden worldwide, especially in young... (Review)
Review
Demyelinating diseases, such as multiple sclerosis (MS), are responsible for a significant portion of the neurological disability burden worldwide, especially in young adults. Demyelination can be followed by a spontaneous regenerative process called remyelination, in which new myelin sheaths are restored to denuded axons. However, in chronic demyelinating disease such as MS, this process becomes progressively less efficient. This chapter reviews the biology of remyelination and the rationale and strategies by which it can be enhanced therapeutically in acquired demyelinating disease.
Topics: Demyelinating Diseases; Humans; Multiple Sclerosis; Myelin Sheath; Nerve Regeneration; Remyelination; Stem Cells
PubMed: 28554395
DOI: 10.1016/bs.pbr.2016.12.013 -
Progress in Neurobiology Jun 1994
Review
Topics: Animals; Blood-Brain Barrier; Demyelinating Diseases; Encephalitis; Humans; Microglia; Multiple Sclerosis; Myelin Sheath; Oligodendroglia; T-Lymphocytes
PubMed: 7972853
DOI: 10.1016/0301-0082(94)90011-6 -
Continuum (Minneapolis, Minn.) Oct 2017This article reviews the chronic demyelinating neuropathies, with a focus on the diagnosis and treatment of immune-mediated neuropathies and the features that can help... (Review)
Review
PURPOSE OF REVIEW
This article reviews the chronic demyelinating neuropathies, with a focus on the diagnosis and treatment of immune-mediated neuropathies and the features that can help differentiate immune-mediated neuropathies from other chronic demyelinating peripheral nerve conditions.
RECENT FINDINGS
Advances in clinical phenotyping and outcomes assessment have enabled neurologists to improve disease recognition, treatment, and disease monitoring. Our understanding of the immunopathogenesis of demyelinating neuropathies is evolving. Identification of new antibodies and recognition that node of Ranvier dysfunction may be an early pathogenic feature may herald further diagnostic and treatment advancements.
SUMMARY
The chronic demyelinating polyneuropathies are heterogeneous. The clinical and diagnostic features are sometimes overlapping, and the specific disorders are variable in pathogenesis, treatment, and prognosis. This heterogeneity underscores the importance of achieving diagnostic accuracy and implementing disease-specific treatment approaches.
Topics: Chronic Disease; Demyelinating Diseases; Humans; Polyneuropathies
PubMed: 28968364
DOI: 10.1212/CON.0000000000000517