Burcu Altunrende

The relationship of cognitive impairment with neurological and psychiatric variables in multiple sclerosis patients

Abstract Objective. Cognitive impairment (CI) in multiple sclerosis (MS) can develop any time. CI is associated with the degree of neuronal loss, but disease duration, fatigue, comorbid affective disorder, and drug dose may also affect cognition. Our aim was to assess which cognitive domain was disturbed primarily in mild MS patients and to see whether CI was related with clinical and psychiatric features. Method. Neurological and psychiatric evaluation of 31 MS patients and 31 age, sex, and education-matched healthy controls were made with Structured Clinical Interview for Axis I Disorders (SCID-I). Depression, anxiety, functionality, fatigue, and disability scoring were determined with Hamilton Depression-Anxiety scales, Global Assessment of Functionality, Fatigue Severity and Expanded Disability Status Scales. Cognitive functions were assessed using Mini Mental, Serial Digit Learning, Verbal and Nonverbal Cancellation, Stroop and Rey Auditory Verbal Learning tests. Results. Retrieval from long-term memory and psychomotor speed were significantly worse in MS group. CI was correlated with disease duration, number of attacks, and physical disability but not with depression and anxiety severity. Disease duration predicted disturbances in recall and psychomotor speed, whereas fatigue and disability predicted depression. Conclusion. Psychomotor speed and memory were primarily impaired in MS patients, and CI was closely associated with clinical aspects of MS rather than with depression and anxiety.

Fingolimod for the Treatment of Relapsing-Remitting Multiple Sclerosis

176 Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and is characterized by inflammation, demyelination, and axonal loss. Fingolimod is the first oral drug for the treatment of MS approved by the United States Food and Drug Administration, European Union countries, and various other countries. The compound exerts its effect via interaction with lysophospholipid receptors known as sphingosine-1 phosphate receptors. Although fingolimod has a very convenient daily oral dosing, it may cause development of bradycardia at the first dose, macular edema, infection, all of which require attention. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rates and is beneficial in brain magnetic resonance imaging measures when compared with both placebo and intramuscular interferon β-1a. This review describes the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of the management of MS.

IMPULSIVITY IN ALZHEIMER’S DISEASE AS DETECTED BY D-CPT

Background: Genetic studies identified an association between Alzheimer’s disease (AD) and common polymorphisms in the MS4A and TREM loci, each containing cluster of homologous genes. Methods:We searched for rare coding variants in 15 genes mapped to these loci by next generation sequencing of a North American dataset (210 cases and 233 controls). Results:Analysis of the MS4A gene-cluster revealed loss-of-function variants in 6 controls and 3 cases. Investigation of the TREM gene-cluster detected known AD associated TREM2 substitutions (p.R47H, p.D87N and p.H157Y) affecting both TREM2 isoforms (NM_018965 and NM_001271821). We also identified two cases with novel TREM2 variants (p.L205P and p.G219C), which mapped only to the isoform NM_001271821. A p.S248R substitution in the homologous TREML2 gene was detected in 5 controls and 1 case suggesting a protective effect (pooled p-value 1⁄4 0.033). Conclusions:Our study advocates for the importance of mutation analysis of controls, particularly for GWAS loci containing SNPs with a minor allele frequency higher in controls versus cases (e.g. MS4A locus), to search for functional variants with a protective effect.

Neuromyelitis optica and neuromyelitis optica spectrum disorders: the evaluation of 86 patients followed by Istanbul Bilim University, Department of Neurology

Background and objectives: Neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) are relatively rare disorders when compared to multiple sclerosis (MS). We aimed to evaluate clinical characteristics and disease course of the NMOSD patients followed at our department. Patients and methods: All the patients with the diagnosis of NMO/NMOSD followed since the establishment of our MS clinic in April 2011, were evaluated. Results: There were 70 patients (54 female, 16 male) with NMO/NMOSD followed at our MS unit; 22 had NMO, 32 had recurrent optic neuritis (RON); and 16 had longitudinally extensive transverse myelitis (LETM). The mean age of the patients was 41±14 (12-77) years. The disease duration was 4.5±4.7 years. The disease course was relapsing in 54 patients (77%). The first attack was bilateral ON (BON) and TM in 3 patients, ON and TM in 1 patient, ON in 44 patients (bilateral in 4) and TM in 22 patients. The mean of the duration between the first two relapses was 13.4±18.4 months. The mean EDSS score was 2.7±1.7 at the last visit. NMO IgG was positive in 12 patients with NMO (55%), 4 patients with LETM (25%), and 7 patients with RON (22%). Oligoclonal band was positive in 13 out of 36 patients (4 each with NMO and ON, two with ON and TM and three with LETM; 34%). In NMO/NMOSD patients, cranial magnetic resonance imaging (MRI) showed no abnormality in 51; nonspecific lesions in 28; and 1 patient had hypothalamic lesion. In spinal MRIs, 35 patients had LETM; four had suspected hyperintense T2 lesion in C5. Conclusion: This is one of the largest single center series collected over 2 years. NMO/NMOSD seems to be over-represented in our center since it is one of the few where NMO IgG testing is available. In NMO/NMOSD, early diagnosis and treatment, as well as differentiation from MS, is important to prevent the patient from the permanent disability. Disclosure: Dr. Altunrende has nothing to disclose. Dr. Altinkaya has nothing to disclose. Dr. Topcular has nothing to disclose. Dr. Meryem has nothing to disclose. Dr. Server has nothing to disclose. Dr. Firtina has nothing to disclose. Dr. Yenice has nothing to disclose. Dr. Akman-Demir has nothing to disclose.

Sympathetic skin responses from the scalp evoked by electrical stimulation in seborrheic dermatitis.

Although the role of autonomic nervous system in seborrheic dermatitis (SD) is still unclear, seborrhea is sometimes accepted as a sign of autonomic dysfunction in several nervous system diseases. Therefore, we aimed to investigate the sympathetic nervous system (SNS) activity in SD by recording sympathetic skin responses (SSR) from the scalp (S‐SSR). Thirty‐one control subjects and 22 SD patients were studied by evoking right and left S‐SSR with electrical stimulation of the right median nerve at the wrist. Mean latencies and maximum amplitudes were calculated for both sides in each group. In seven out of 31 control subjects and in 13 out of 22 patients, the S‐SSR could not be elicited on either side. There were four subjects with unilateral response in the patient group. There were significantly more non‐responders among the patients with SD (P < 0.000). This study suggests that in SD, the autonomic nervous system may be involved. The S‐SSR is a new site for recording SSR. The responses are relatively symmetrical and can be evoked easily by electrical stimulation, and may be used to evaluate the SNS function in SD patients and also in healthy subjects.