A. Zibetti

Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests

Abstract We evaluated the risk of developing clinically definite multiple sclerosis (CDMS) after an acute attack of isolated optic neuritis (ON) in 112 patients, in relation to demographic and paraclinical findings. Patients were examined by brain MRI, CSF analysis, and multiple evoked potentials (EPs); 10 were lost to follow-up, and the other 102 were enrolled in a prospective study (follow-up duration 6.3 ± 2.2 years). Of these, 37 (36.3%) developed CDMS after a mean interval of 2.3 ± 1.6 years. The risk of developing CDMS was 13% after 2 years, 30% after 4, 37% after 6, and 42% after 8 and 10 years. Gender, age, and season of ON onset did not affect the risk. MS occurred in 37 of 71 patients (52.1%) with one MRI lesion or more; no patient with a normal MRI developed the disease. MS developed more frequently in patients with intrathecal IgG synthesis than in those without (43% vs. 28%), but the difference was not statistically significant. Multiple EPs showed a slight predictive value only including somatosensory EPs of the lower limb. Multiple sclerosis was mild in most cases (EDSS 2.2 ± 1.9). The EDSS was less than 4 in 32 cases (86%), between 4 and 6 in 2 (5%), higher than 6.5 in 3 (8%).

Erectile impotence in multiple sclerosis: a neurophysiological study

Pudendal evoked potentials, motor evoked potentials of the bulbocavernosus muscle to magnetic stimulation and bulbocavernosus reflex were recorded in 34 patients with multiple sclerosis (MS). Responses were delayed in 26, 20 and 3 cases respectively. No relationship was found between neurophysiological abnormalities and the presence or severity of erectile dysfunction, showing that these tests have little diagnostic usefulness in MS patients with impotence. Nocturnal penile tumescence was assessed in 14 cases: the test result was normal in 10 patients, including 3 severely paraplegic subjects.

Motor potentials of inferior orbicularis oculi muscle to transcranial magnetic stimulation. Comparison with responses to electrical peripheral stimulation of facial nerve.

Magnetic stimulation at the vertex evoked a motor potential (MP) in the inferior orbicularis oculi muscle of 10 healthy subjects with an onset latency of 8-13 msec. Its amplitude increased and its latency decreased when the muscle was contracted: the latency measured 9.5 +/- 1.3 msec with an intensity of stimulation 10-15% above threshold in the contracted muscle. This MP is secondary to excitation of the motor cortex. With the coil placed over the occipital scalp and the same stimulation intensity, an MP was recorded with an onset latency at 4.5 +/- 0.6 msec. This response reflects the activation of the facial nerve root. The peripheral electrical stimulation of the facial nerve at the mandible angle elicited an MP with an onset latency at 3.5 +/- 0.4 msec. Most records showed the presence of late components at about 30 msec for all types of stimulation.

Perineal motor potentials to magnetic stimulation, pudendal evoked potentials and perineal reflex in women.

Motor potentials to transcranial and lumbar magnetic stimulation were recorded from the perineum in 14 healthy women. The response to transcranial stimulation presented an onset at 20.2 +/- 1.3 ms and a negative peak at 25.1 +/- 1.9 ms. Lumbar responses presented an onset at 5.1 +/- 0.8 ms, and the motor central conduction time measured 14.4 +/- 1.5 ms. Perineal reflex, cortical and lumbar pudendal evoked potentials were recorded after electrical stimulation of the labia minora. These tests are of possible clinical use in the evaluation of sphincter disturbances as they investigate the afferent and efferent pathways concerning pudendal nerve function.

Sexual dysfunction in male multiple sclerosis patients in relation to clinical findings

Seventy‐seven consecutive male patients with clinically definite or laboratory supported definite multiple sclerosis were submitted to a questionnaire and a clinical interview in order to assess the frequency, the nature of sexual dysfunction and its relationship with clinical findings. Twenty‐six patients (35%) complained of erectile dysfunction: the defect was partial and inconstant in 11 patients (14%), complete and fixed in 15 (21%). Six patients complained of premature ejaculation, in three of whom the symptom was already present before the onset of the disease. Taking the series as a whole, sexual life was poor or not satisfying at all in 34 patients. Erectile dysfunction was associated with the presence and severity of bladder dysfunction and with disability. The relationship with sensory impairment of legs was slight, no relationship was found with motor involvement of legs, type of course, age and disease duration.

A case of myasthenia gravis associated with optic neuritis.

SummaryA case of myasthenia gravis is described in association with optic neuritis in which brain-stem auditory and somatosensory evoked potentials were normal. CSF contained alkaline oligoclonal IgG bands. Blood lymphocyte subpopulations showed a decreased number of T-suppressor cells.ZusammenfassungEs wird ein Fall von Myasthenia gravis beschrieben bei welchem auch eine Opticusneuritis beobachtet wurde. Die akustischen evozierten Hirnstammpotentiale sowie die somatosensorischen evozierten Potentiale waren normal. Im Liquor fanden sich oligoklonale IgG-Banden. In der Subpopulation der Blutlymphocyten war eine verminderte Zahl von T-Supressorzellen vorhanden.

Polyneuritic onset in multiple sclerosis.

AbstractA case of definite MS with unusual polyneuritic onset is described. The case is discussed in the light of published data and of experimental studies that have demonstrated a cross reaction between central and peripheral nervous system antigens.SommarioViene presentato un caso di SM definita con inusuale esordio polinevritico dimostrato con EMG. Gli autori discutono tale evenienza alla luce dei dati della letteratura e rispetto a studi sperimentali che dimostrano una reazione crociata tra antigeni del CNS e PNS.

Natural interferon‐beta in chronic progressive multiple sclerosis: results after 2 years of treatment and 2 years of follow up

Seventeen chronic progressive multiple sclerosis patients were treated with natural interferon‐beta (IFN‐β) for 2 years, thereafter they were followed up for 2 years. IFN‐β was given 1 million IU/day i.m. for 1 week, then 3 million IU daily for 3 weeks followed by a maintenance regimen of 2 million IU twice a week for 23 months. Kurtzke Expanded Disability Status Scale score was 5.5 at entry and did not change at the end of the first year. It increased to 5.8 at the end of the second year and to 6.5 at the end of the follow‐up. Three patients worsened after 1 year, six after 2 years and nine at the end of the follow‐up. Brain MRI was performed at entry and after 1 year: mean lesion score increased by 13.4%. MRI changes were not correlated with clinical course. Natural IFN‐β seemed to have some beneficial effect when high doses were given: this effect tended to disappear after IFN‐β was reduced, followed by a more severe disease progression after its withdrawal.

Blood leukocyte adhesion assay in multiple sclerosis patients treated with interferon beta

5 6 3 Therapeutic and DiagnostieAppllcations of Solubilized MHC Ih Pepfide Complexes in Multiple Sclerosis E. SpaeL N. Wehner, S. Mocei, M. Zilberm an, L. Schain, D. Buekm an, J. Winldehake, M. Howard, Anergen, lnc., USA 5 6 6 S e r u m Soluble I C A M I and Gela t inase B Novd M a r k e r s of Clinical Efficacy of the R I F N b e t a l b in R d a p s i n g R c m i t t i n g