-
Robert N Schwendimann, Meghan K Harris,
Debra G Elliott,
Uma Menon,
Eduardo Gonzalez-Toledo,
Robert Zivadinov,
Thomas A Pressly,
Roger E Kelley,
Romy Hoque,
Marjorie Fowler,
Amir H Maghzi,
Masoud Etemadifar,
Mohammad Saadatnia,
Alireza Minagar
[show abstract]
[hide abstract]
ABSTRACT: Sarcoidosis is a multisystemic granulomatous disease, which uncommonly affects nervous system. However, when present, it may affect both central and peripheral nervous systems and potentially mimics other chronic diseases of the nervous system. Pathogenesis of neurosarcoidosis remains largely unknown, and its diagnosis and management pose serious challenges to clinicians. Early diagnosis and aggressive treatment of neurosarcoidosis are necessary to produce satisfactory clinical outcomes. This review discusses clinical manifestations, current diagnostic studies, and currently available modalities for management of neurosarcoidosis.
(C) 2012 Lippincott Williams & Wilkins, Inc.
American Journal of Therapeutics 07/2012; Publish Ahead of Print. · 1.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Multiple sclerosis (MS) is believed to be an immune-mediated neurodegenerative disorder of the human central nervous system which usually affects younger adults with certain genetic backgrounds. The causes and cure for MS remain elusive. Based on the recent advances in our understanding of the pathogenic mechanisms of MS, it appears to represents a heterogeneous group of disorders with dissimilar pathophysiology and neuropathology. Currently, there is no unifying hypothesis to explain the pathogenesis of this complex disease. The three prevailing concepts on the pathogenesis of MS include viral, immunological, and vascular hypotheses. This review presents MS as a neuroinflammatory disease with a significant vascular component and examines the existing evidence for the role of cerebral endothelial cell dysfunction in the pathogenesis of this progressive central nervous system (CNS) inflammatory disorder.
Pathophysiology 02/2011; 18(1):3-12.
-
[show abstract]
[hide abstract]
ABSTRACT: Apart from tremor and restless-legs syndrome, abnormal involuntary movements are uncommon in patients with multiple sclerosis. A review of the literature in multiple sclerosis reveals case reports of a variety of other movement disorders such as myoclonus, spasmodic torticollis, paroxysmal dystonia, chorea, ballism, and parkinsonism. This chapter presents a thorough review of these movement disorders in multiple sclerosis patients and provides readers with potential underlying pathogenetic mechanisms.
Handbook of Clinical Neurology 01/2011; 100:307-14.
-
[show abstract]
[hide abstract]
ABSTRACT: We previously reported a correlation between levels of micro particles carrying CD31 (PMP(CD31+)) and disease activity in MS. However, the effects of long term (12 month) treatment with high dose, high frequency interferon-β1a (Rebif™) on plasma levels of PMP(CD31+), PMP(CD146+), and PMP(CD54+) and MRI measures of disease activity have not yet been assessed.
During this prospective 1-year study, we used flow cytometry to measure changes in plasma micro particles (PMP) bearing CD31 (PMP(CD31+)), CD146 (PMP(CD146+)), and CD54/ICAM-1 (PMP(CD54+)) in 16 consecutive patients with relapsing-remitting MS (RRMS) before and after 3, 6, and 12 months of subcutaneous therapy with interferon-beta1a (44 micrograms, 3X weekly). At each visit, clinical exams and expanded disability status scale (EDSS) scores were recorded.
Plasma levels of PMP(CD31+), and PMP(CD54+) were significantly reduced by treatment with IFN-β1a. PMP(CD146+) appeared to decrease only at 3 months and did not persist at 6 and 12 months (p = 0.0511). In addition, the decrease in plasma levels of PMP(CD31+) and PMP(CD54+) levels at 12 months were associated with a significant decrease in the number and volume of contrast enhancing T1-weigthed lesions.
Our data suggest that serial measurement of plasma micro particles (PMP), particularly in the initial stages of MS (when neuro-inflammatory cascades are more intense), may serve as reliable and reproducible surrogate markers of response to IFN-β1a therapy for MS. In addition, the progressive decline in plasma levels of PMP(CD31+) and PMP(CD54+) further supports the concept that IFN-β1a exerts stabilizing effect on the cerebral endothelial cells during pathogenesis of MS.
Journal of Neuroinflammation 01/2011; 8:43. · 3.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that develops in the context of portosystemic venous shunting, in the presence or absence of intrinsic hepatic disease. HE is clinically characterized by altered sensorium and a spectrum of neuropsychiatric abnormalities. Several hypotheses have been proposed to explain the underlying pathogenic mechanisms of altered brain function associated with advanced hepatic disease and portosystemic shunting. HE may lead to profound coma and death; however, in many cases it is reversible. This article discusses the most recent developments in understanding the pathophysiology of HE and its diagnosis and management.
Neurologic Clinics 02/2010; 28(1):89-105. · 2.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vasculitis or angiitis refers to a group of inflammatory disorders of the blood vessels that cause structural damage to the affected vessel, including thickening and weakening of the vessel wall, narrowing of its lumen, and, usually, vascular necrosis. Systemic vasculitis is classified according to the vessel size and histopathologic and clinical features. Vasculitides with small vessel involvement typically include Henoch-Schönlein purpura and cryoglobulinemia. Polyarteritis nodosa and Wegener granulomatosis are small- and medium-sized vessel vasculitides, whereas temporal arteritis and Takayasu arteritis involve large vessels. In this article, the authors provide a review of the neurologic presentations of the major systemic vasculitides.
Neurologic Clinics 02/2010; 28(1):171-84. · 2.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Abnormal involuntary movements are major features of a large group of neurologic disorders, some of which are neurodegenerative and pose a significant diagnostic and treatment challenge to treating physicians. This article presents a concise review of clinical features, pathogenesis, epidemiology, and management of seven of the most common movement disorders encountered in a primary care clinic routinely. The disorders discussed are Parkinson disease, essential tremor, restless legs syndrome, Huntington disease, drug-induced movement disorder, Wilson disease, and Tourette syndrome.
The Medical clinics of North America 04/2009; 93(2):371-88, viii. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Acute demyelinating disorders of the central nervous system represent some of the most formidable management and therapeutic challenges to clinicians. These disorders include acute relapses of multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis, optic neuritis, and transverse myelitis. This paper summarizes clinical manifestations of these disorders, as well as treatment strategies. Currently, immunosuppression with corticosteroids for the acute events is the mainstay of treatment. Other experimental therapies, which may be effective in certain patients, are discussed.
Current Treatment Options in Neurology 02/2009; 11(1):55-63. · 1.29 Impact Factor
