Article

The diagnosis of multiple sclerosis and the clinical subtypes

Departments of Medicine, Neurology, and Community and Family Practice, Duke University Medical Center, Box 3184 DUMC, Durham, NC 27710, USA.
Annals of Indian Academy of Neurology (Impact Factor: 0.51). 10/2009; 12(4):226-30. DOI: 10.4103/0972-2327.58276
Source: PubMed

ABSTRACT The diagnosis of multiple sclerosis (MS) requires objective findings referable to the central nervous system. A wide differential diagnosis often has to be considered. Magnetic resonance imaging and electrophysiologic and cerebrospinal fluid studies can all contribute to an early definitive diagnosis. The McDonald diagnostic criteria for MS (2005) are the currently recognized MS diagnostic criteria. The clinical subtypes of MS and their diagnosis are discussed in this article. Being informed of the diagnosis may be a stressful experience for the patient and this is also dealt with.

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    • "Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis? J Clin Neurosci (2014), http://dx.doi.org/10.1016/j.jocn.2014.05.023 criteria used today, which utilize MRI and other neurophysiology and laboratory testing to help establish early diagnosis and treatment [4]. The management of patients with MS and concomitant CS is challenging. "
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    ABSTRACT: Cervical stenosis (CS) and multiple sclerosis (MS) are two common conditions with distinctive pathophysiology but overlapping clinical manifestations. The uncertainty involved in attributing worsening symptoms to CS in patients with MS due to extremely high prevalence of asymptomatic radiological CS makes treatment decisions challenging. A retrospective review was performed analyzing the medical records of all patients with confirmed diagnosis of MS who had coexistent CS and underwent surgery for cervical radiculopathy/myeloradiculopathy. Eighteen patients with coexistent CS and MS who had undergone cervical spine decompression and fusion were identified. There were six men and 12 women with an average age of 52.7years (range 40-72years). Pre-operative symptoms included progressive myelopathy (14 patients), neck pain (seven patients), radiculopathy (five patients), and bladder dysfunction (seven patients). Thirteen of the 14 patients (92.9%) with myelopathy showed either improvement (4/14, 28.6%) or stabilization (9/14, 64.3%) in their symptoms with neck pain and radiculopathy improving in 100% and 80% of patients, respectively. None of the seven patients with urinary dysfunction had improvement in urinary symptoms after surgery. To conclude, cervical spine decompression and fusion can improve or stabilize myelopathy, and significantly relieve neck pain and radiculopathy in the majority of patients with coexistent CS and MS. Urinary dysfunctions appear unlikely to improve after surgery. The low rate of surgical complications in our cohort demonstrates that cervical spine surgery can be safely performed in carefully selected patients with concomitant CS and MS with a good clinical outcome and also eliminate CS as a confounding factor in the long-term management of MS patients.
    Journal of Clinical Neuroscience 07/2014; 21(12). DOI:10.1016/j.jocn.2014.05.023 · 1.32 Impact Factor
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    ABSTRACT: Cigarette smoking is the leading preventable cause of death and disease among adults, and there is evidence that smokers with multiple sclerosis (MS) are at an increased risk for accelerated disease conversion and progression toward disability. Recent research has shown resistance training (i.e., weight training) to be beneficial for smoking cessation in the general population; however, no study has examined the use of resistance training as an aid to cessation in those with MS. Methods: After receiving brief smoking cessation counseling and the nicotine patch, smokers with relapsing-remitting MS will be randomized into a Resistance Training (RT) or Contact Control (CC) group. Participants in the RT group will attend a 60-minute resistance training session twice weekly for eight weeks, while participants in the CC will attend a 30-minute health education control session twice weekly for eight weeks. Measurements will be taken at baseline, weekly during the intervention, at the end of the eight-week study period, and at a one-month follow-up. The primary outcome will be smoking cessation, indicated by a 7-day abstinence, and verified by biochemical assay (i.e., carbon monoxide breath test). Secondary outcomes will include other smoking-related variables (e.g., nicotine withdrawal symptoms), multiple sclerosis-related factors (e.g., fatigue), and physical assessments (e.g., muscular strength). Discussion: The results from this study will lay the foundation for subsequent tests of the intervention in smokers with MS, with the long-term goal of providing specific recommendations and guidelines for smoking cessation that can be integrated into the clinical care of persons with MS.
    Contemporary clinical trials 04/2012; 33(4):848-52. DOI:10.1016/j.cct.2012.04.010 · 1.99 Impact Factor
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