Paolo Pinelli

Intrathecal IgG synthesis in multiple sclerosis and other neurological diseases: A comparative evaluation by IgG-index and isoelectric focusing

SummaryIntrathecal IgG synthesis has been investigated by determining the IgG index and by isoelectric focusing in 30 cases of definite multiple sclerosis, in 15 cases of probable multiple sclerosis and in 128 patients affected by other neurological diseases. The blood-brain barrier function was evaluated at the same time by serum albumin/CSF albumin quotient and isoelectric focusing. The IgG index was found elevated in 73.3% of definite multiple sclerosis patients, while oligoclonal IgG bands occurred in 90%. In the other neurological diseases the IgG index was abnormally increased in 35.1% but IgG bands were present only in cerebrospinal fluid (CSF) in 1.5% and both in the CSF and serum in 7% of patients.The high capacity of isoelectric focusing to detect IgG oligoclonal bands in the CSF is pointed out as an extremely useful diagnostic tool in multiple sclerosis.ZusammenfassungDas Vorhandensein von IgG-Synthese im Nervensystem wurde mittels IgG-Index-Determination und mittels Isoelektrischer Fokalisation untersucht, und zwar bei 30 Fällen mit eindeutig diagnostizierter Multipler Sklerose, bei 15 Fällen, in denen Multiple Sklerose wahrscheinlich ist, und bei 128 Patienten, die andere neurologische Erkrankungen aufwiesen. Gleichzeitig wurde die Blut-Hirn-Schrankenfunktion untersucht mittels des Albuminserums des CSF-Albumin-Quotienten und Isoelektrischer Fokalisation. Es zeigte sich, daß der IgG-Index bei 73,3% der eindeutig diagnostizierten Multiple-Sklerose-Patienten erhöht ist, während bei 90% der Patienten das Vorhandensein von oligoclonalen Zonen nachweisbar war. Was die anderen neurologischen Erkrankungen betrifft, so war in 35,1% der Fälle der IgG-Index abnormal erhöht, während IgG-Bänder im Liquor nur bei 1,5% sowie beide bei 7% der Patienten im Liquor und im Serum vorhanden waren. Bei der Diagnose Multiple Sklerose wird der Isoelektrischen Fokalisation der höchste diagnostische Wert zugesprochen, um IgG-oligoclonale Bänder im Liquor nachzuweisen.

Neuromuscular diseases associated with benign monoclonal gammopathy: STUDY OF CSF AND SERUM PROTEINS BY ISOELECTRIC FOCUSING

In over 1200 cases examined by isoelectric focusing of CSF and serum proteins, 4 patients had benign monoclonal gammopathy. These patients were affected by amyotrophic lateral sclerosis of bulbar onset, sensitive neuropathy of Thevenard type, myasthenia gravis and limb‐girdle muscular dystrophy, respectively. The difficulty to relate the differences in the clinical features of these cases to a common physiopathological mechanism and the incidence of this finding (0.4% in 873 cases ranging from 21–60 years of age) do not seem to suggest any pathogenetic relationship between benign monoclonal gammopathy and the different neurological disorders encountered in these patients.

A Critical Appraisal of Neuromuscular Stimulation and Electrotherapy in Neurorehabilitation

The problems of neuromuscular electrostimulation in patients affected by central or peripheral nervous system chronic lesions have been analysed during an interdisciplinary meeting held in Pavia on Dec. 9, 1978 and evolved to the discussion of two previous workshops concerning the same topic. The effective value of functional electrical stimulation, especially for the lower limbs, seems to be proved in some patients with upper motor neuron lesions. However, a clear definition of patient selection criteria has not been given yet, while a comparison with the results with vibratory techniques is still be carried out. With regard to the so-called electrotherapy of denervated muscles. it has been stressed that the trophic state can also be promoted by vibratory mechanical stimulation while the electrical stimulation could partly reduce the diffuse type of membrane excitability present in the devervated muscle fibres; this effect might interfere negatively with the process of collateral nerve sprouting.

Subclinical myopathic findings in patients affected by malignant tumours

SummaryHistoenzymologic studies on representative muscles and the peripheral microcirculation from selected autopsies of non cachectic patients dying of neoplasms, without signs of neuromuscular involvement, demonstrate a high incidence of neuromuscular and microcirculatory changes. A correlation between neuromuscular changes and the peripheral microcirculation particularly evident in myopathic cases is discussed.

A Case of Late Onset Lipid Storage Myopathy

A 65-year-old woman showed the clinical picture of a myogenic myopathy, confirmed electromyographically. Detailed histopathological, histochemical and ultrastructural studies were performed on deltoid and quadriceps femoris biopsy specimens. Many muscle fibres were found to contain vacuolar spaces with lipid droplets: perivascular inflammatory changes were also observed. The affected fibres were consistently type I. Under the electron microscope the fibres contained large numbers of lipid droplets, usually next to normal mitochondria. A slight improvement occurred after prednisone therapy.