-
[show abstract]
[hide abstract]
ABSTRACT: Multiple sclerosis (MS) causes a broad range of neurological symptoms. Most common is poor balance control. However, knowledge of deficient balance control in mildly affected MS patients who are complaining of balance impairment but have normal clinical balance tests (CBT) is limited. This knowledge might provide insights into the normal and pathophysiological mechanisms underlying stance and gait. We analysed differences in trunk sway between mildly disabled MS patients with and without subjective balance impairment (SBI), all with normal CBT. The sway was measured for a battery of stance and gait balance tests (static and dynamic posturography) and compared to that of age- and sex-matched healthy subjects. Eight of 21 patients (38%) with an Expanded Disability Status Scale of 1.0-3.0 complained of SBI during daily activities. For standing on both legs with eyes closed on a normal and on a foam surface, patients in the no SBI group showed significant differences in the range of trunk roll (lateral) sway angle and velocity, compared to normal persons. Patients in the SBI group had significantly greater lateral sway than the no SBI group, and sway was also greater than normal in the pitch (anterior-posterior) direction. Sway for one-legged stance on foam was also greater in the SBI group compared to the no SBI and normal groups. We found a specific laterally directed impairment of balance in all patients, consistent with a deficit in proprioceptive processing, which was greater in the SBI group than in the no SBI group. This finding most likely explains the subjective symptoms of imbalance in patients with MS with normal CBT.
Experimental Brain Research 09/2011; 213(4):363-70. · 2.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To study whether onset of infantile spasms manifests seasonal variation, as previously reported, and whether any such seasonality is associated with treatment response and long-term outcome, data for 57 patients were retrospectively reviewed. The data were collected from hospital files and through a mail survey of children with infantile spasms born from 1980 to 2002 and monitored at the University Children's Hospital of Berne, Switzerland. The mean age at time of onset of infantile spasms was 7 months (range, 0.75-40), at diagnosis 8 months (range, 1-42) and at follow-up 11.3 years (range, 1-23 years). In 77% of participants, the etiology of infantile spasms was known (symptomatic); in the remaining 23% it was not known (nonsymptomatic). In contrast to previous findings, onset of infantile spasms was not associated with calendar month, photoperiod, or global solar radiation. Long-term prognosis was poor: 4 of the 57 (7%) children died; 49 (86%) had cognitive impairment and 40 (70%) had physical impairment; 31 (54%) had cerebral palsy, 37 had (65%) persistent seizures, and 9 (16%) had Lennox-Gastaut syndrome. Symptomatic infantile spasms were associated with worse cognitive outcome (P < 0.001), but treatment modality and overall duration of infantile spasms were not. There was no association of calendar month or photoperiod at onset with cognitive outcome or treatment response.
Pediatric Neurology 08/2010; 43(2):92-6. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cerebral vasculitis is a rare disease with a potentially harmful or even fatal outcome that often affects young adults. Primary autoimmune mediated disease can be distinguished from secondary vasculitis associated to infectious disorders, connective tissue diseases, malignancies or toxic drug effects. Pathomechanisms lead to destruction of the vessel wall and consecutive hemorrhagic or ischemic brain lesions. Beyond these mechanisms direct autoimmune mediated neurotoxicity is postulated. Clinical presentation is highly variable with potentially fluctuating signs and symptoms. Besides multifocal deficits from disseminated CNS involvement, diffuse encephalopathy or psychosis may result from diffuse CNS affection. For systemic vasculitis with CNS involvement, affection of joints, skin and organs may facilitate the diagnostic evaluation. CNS affection in systemic diseases is highly variable and may even precede systemic manifestation. The diagnostic work-up includes clinical evaluation, analysis of autoantibodies, MRI, digital subtraction angiography and biopsy of the affected tissue in doubtful cases. Standard therapy are corticosteroids often combined with immunosuppressants such as azathioprine, methotrexate or mycophenolate mofetil in chronic disease or cyclophosphamid in acute disorder. When therapy can be initiated timely, prognosis of cerebral vasculitis is usually favourable.
Therapeutische Umschau 06/2008; 65(5):259-63.
-
[show abstract]
[hide abstract]
ABSTRACT: Respiratory disorders with stridor are a frequent cause of admission for children in an emergency department. Laryngospasm, as an isolated symptom of epilepsy, is a rare phenomenon [1, 3, 5]. Other respiratory symptoms of epilepsy, rarely seen in childhood, might be apnoeic spells [2, 4]. We report on a child with laryngospasm due to focal epileptic seizures.
European Journal of Pediatrics 11/2005; 164(10):648-9. · 1.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In order to evaluate whether plasma levels of the potent vasoconstrictor endothelin-1 (ET-1) are increased in patients with multiple sclerosis (MS) and whether these patients exhibit an ET-1-mediated vascular dysregulation, ET-1 plasma levels were measured in 30 patients with MS. Blood flow velocities in the ophthalmic artery, central retinal artery, central retinal vein, short lateral posterior ciliary artery, and short medial posterior ciliary artery were assessed in parallel. ET-1 plasma levels were significantly increased in MS patients when compared to sex- and age-matched healthy controls (2.0 +/- 0.4 pg/ml, range 1.1-2.8 vs. 1.5 +/- 0.2 pg/ml, range 0.9-2.0; p < 0.001). Moreover, the patients exhibited significant alterations of extraocular blood flow. The role of ET-1 in the inflammatory process remains to be clarified.
European Neurology 01/2003; 49(3):164-8. · 1.81 Impact Factor
-
Ludwig Kappos,
Giancarlo Comi,
Hillel Panitch,
Joel Oger,
Jack Antel,
Paul Conlon,
Lawrence Steinman,
Alexander Rae-Grant,
John Castaldo,
Nancy Eckert, [......],
Alan Evans,
Pierre Bourgouin,
Alex Zijdenbos,
Shawki Salem,
Nicholas Ling,
David Alleva,
Eric Johnson,
Amitabh Gaur,
Paul Crowe,
Xin-Jun Liu
