Jack S. Burks

The effects of pregnancy in multiple sclerosis A retrospective study

We reviewed the medical records of 178 women with multiple sclerosis to evaluate the number of completed pregnancies, current disability status, and relationship of pregnancy to onset of MS symptoms. We found no differences in the long-term disability of women with no pregnancies, one pregnancy, or two or more pregnancies. Women who had initial symptom onset in pregnancy experienced less subsequent disability than women whose symptoms began before or after pregnancy. Therefore, pregnancy per se or number of pregnancies has no effect on subsequent disability.

REFERRAL BIAS IN MULTIPLE SCLEROSIS RESEARCH

Referral bias is a significant problem affecting the generalizability of clinical studies conducted in a university setting. To examine referral bias in our university-based multiple sclerosis referral center, we analyzed the characteristics of referral center patients compared to the population-based group of multiple sclerosis patients from which the referral center patients originated. The referral center patient group differed from those that remained in the population-based group in the following important ways: (1) they were younger, (2) they had more mobility impairment for their age, (3) disabled females were overrepresented compared to disabled males, (4) they more often reported recent disease worsening, (5) they had a higher frequency of early diagnosis supported by laboratory tests, and (6) they more often relied on neurologists and therapists for routine care of their disease. The multiple sclerosis referral center setting would appear to be ideal for the conduct of intervention trials, but inadequate for collecting representative natural history data.

Stress and Its Relationship to Acute Exacerbations in Multiple Sclerosis

The relationship of stressful life events (SLEs) to acute exacerbations of multiple sclerosis (MS) was prospectively studied in 55 consecutive patients with a relapsing-remitting disease course. The quantity and quality of SLEs were determined by the Psychiatric Epidemiology Research Interview (PERI-M) administered at 4-month intervals. Exacerbating cases (n = 20) did not experience a greater number of SLEs than nonexacerbating controls (n = 35); however, patients who experienced qualitatively extreme events were 3.7 times as likely to exacerbate as those not exposed to such events. The quality rather than the quantity of SLEs was associated with acute exacerbations of MS.

Higher than Expected Prevalence of Multiple Sclerosis in Northern Colorado: Dependence on Methodologic Issues

A population-based study of multiple sclerosis (MS) was conducted in 2 northern Colorado counties in 1982 to determine MS prevalence, to compare the rates with recent North American surveys and to compare the methods used in these studies. Provisional cases were identified from: the patient rolls of MS service organizations, chart reviews in 2 neurology practices, a survey of physicians and a review of hospital discharge diagnoses. Crude-point prevalence for the 2-county region was 84 per 100,000. The age-adjusted rate was higher than the rate for the region above the 37th parallel projected from data in a 1976 national survey, but was comparable to rates obtained in localized surveys conducted in the northern tier of the country. The methodological results revealed that the highest yield sources were the MS service organizations and the neurology practice chart reviews. MS prevalence surveys which neglect these methods may underestimate MS prevalence by as much as 20-40%.

Characterization of Viral Proteins Synthesized in 229E Infected Cells and Effect(s) of Inhibition of Glycosylation and Glycoprotein Transport

Coronaviruses were classified as a distinct group of viruses in 1968 (1) and four members of this group are recognized as human respiratory pathogens: These include B814 (2), the first human coronavirus (HCV) isolated 229E (3), OC-43 (4) and 692 (5), identified by immunoelectromicroscopy only. In addition to the respiratory pathogens, two coronaviruses have been isolated while working with brain tissue from multiple sclerosis patients (6). These viruses cross-react antigenically with OC-43 but neither of these viruses have been implicated in respiratory disease.

Care Patterns in Multiple Sclerosis: Principal Care, Comprehensive Team Care, Consortium Care

Health care for multiple sclerosis has evolved over the past two decades from fragmented, sporadic, and crisis-oriented interventions to an organized system of services. The proliferation of comprehensive care centers and the development of a network of health care providers have provided a model for other chronic neurologic illnesses. In addition, concepts such as principal care and maintenance therapy may prove to be relevant to care in multiple sclerosis.

A Review of the Current Medical Aspects of Multiple Sclerosis

care professionals to refamiliarize themselves with the latest information on multiple sclerosis. Information about multiple sclerosis in textbooks is slow to change, while new data is changing our perceptions and treatments of multiple sclerosis patients. For example, over 10 percent of patients referred to comprehensive multiple sclerosis centers do not have multiple sclerosis. The incidents of false positive diagnosis of multiple sclerosis in general rehabilitation centers is undoubtedly higher. Neurologic symptoms associated with a few scattered, small increased white matter signals on MRI do not make a diagnosis of multiple sclerosis. In patients with definite multiple sclerosis, many symptoms are not related to new lesions. For example, they may reflect a physiological response to temperature elevation related to urinary tract infection or emotional issues. These and many other issues make treating MS patients very challenging and difficult. While the natural history for many older MS patients is progressive neurologic impairment, rehabilitation technology can keep them at a high functional level. This chapter addresses issues related to caring for multiple sclerosis patients, which may differ significantly from some textbook perceptions of the disease.

Rehabilitation of Multiple Sclerosis Patients with Spinal Cord Dysfunction Compared to Spinal Cord Injury Patients

Many of the problems faced by the MS patient are similar to those of the spinal cord injury patient. The disease often begins in young adulthood. Common impair, ments include weakness, sensory loss, and spasticity as well as bowel, bladder, and sexual dysfunction. Both groups of patients can live long and productive lives with proper medical and rehabilitation management. However, there are important distinctions between the two groups. The most obvious is the relapsing-remitting or progressive course of multiple sclerosis versus the

Introduction to Principles of Rehabilitation

without a consciousness that differentiates the two approaches. For example, pediatricians and family medicine physicians often adopt a rehabilitation/functional ability mind set when dealing with complex and chronic diseases. If asked, they reply they are merely dealing with their patients as people who are struggling against the disease in a world that sets up roadblocks for disabled or chronically ill patients. The physician who specializes in rehabilitation combines the medical management of a disease with the management of the effects of the disease on the life of a

Detection of Coronavirus RNA in CNS Tissue of Multiple Sclerosis and Control Patients

The cause of multiple sclerosis (MS) remains unknown. One of the leading hypothesis states that MS may result from the direct or indirect effects of a CNS viral infection. The hallmark of MS is the demyelinating lesion which may represent the final immunopathological reaction to many viral or non-viral precipitants. We are investigating coronaviruses in MS. Previously, two CV’s were isolated from the brains of two patients with MS after passage through murine systems (1) . CV are widely distributed in nature and are common human and animal pathogens. In addition, CNS demyelination results from CV infection of rodents (2,3) and in one report primates (4). The putative MS isolates (CV-SD and CV-SK) are antigenically related to the human CV OC43 and the murine CV A59 (5) . To date no species specific marker has been identified and serologic data have not definitively resolved the species origin of CV-SD or CV-SK (5-7). Direct virus isolation from tissue is difficult, therefor to evaluate whether CV are present in human CNS tissue, the method of in situ hybridization (ISH) was performed using cDNA probes to detect CV-RNA. We report here the presence of CV-RNA sequences in human CNS tissue. In addition, CV-RNA is much more frequent in MS than non-MS tissue. These findings raise the question of a potential role for CV in MS.