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    ABSTRACT: Parainfectious disorders of the nervous system encompass those meningo-encephalo-radiculomyelitic conditions that are temporally associated with a systemic infection, antigenic stimuli, or toxin exposure, in the absence of evidence of direct neuronal infection or invasion of the central nervous system (CNS) or peripheral nervous system (PNS). Pathogenetic mechanisms can be due to immune-mediated processes (such as bystander activation, molecular mimicy) or the inciting insult can be due to toxic factors, as in the case of botulism. A myriad of clinical manifestations can occur including headache, seizures, and mental status changes, ranging from mood and behavioral disturbances to varying levels of alteration in consciousness. Focal neurological deficits can include aphasia, hemiparesis, or paraparesis. The PNS can also be affected leading to cranial nerve involvement, focal or multifocal neuropathies, and dysfunction of the autonomic nervous system. Diagnosis is based not only on the history, examination, laboratory, and neuroimaging data but also on epidemiological factors. The parainfectious disorders covered in this review are cat scratch disease, Lyme borreliosis, legionellosis, brucellosis, botulism, pertussis, and mycoplasma. Each is associated with a distinct organism, has both systemic and neurological manifestations, and has a different epidemiological profile.
    No preview · Article · Dec 2013 · Handbook of Clinical Neurology
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    ABSTRACT: Introduction: Alemtuzumab is a humanized IgG1 kappa monoclonal antibody approved for treatment of B-cell chronic lymphocytic leukemia. This cytolytic antibody is directed against CD52 and depletes lymphocytes, with monocytes, macrophages, natural killer cells and a subpopulation of granulocytes being affected to a much lesser degree. Alemtuzumab is currently under review to treat relapsing multiple sclerosis (MS) in the United States, based on positive Phase II and Phase III trials in both treatment-naïve and treated relapsing MS patients. There was excellent efficacy in suppressing both clinical and neuroimaging disease activities. In these trials, the comparator arm was not placebo, but high dose frequently dosed subcutaneous interferon beta 1a. Alemtuzumab has recently been approved by the European authorities for active relapsing MS, in essence as a first-line agent. It produces long-standing effects, consistent with an induction agent. Efficacy will have to be weighed against risk of adverse effects, which include autoimmune disorders and infection. Alemtuzumab joins an increasingly crowded market, and will add to the complexity of treating MS. Areas covered: This review will discuss alemtuzumab as a therapy for MS, reviewing PubMed for clinical trials, publications and presentations at international meetings. It will focus on a United States market perspective. Expert opinion: Alemtuzumab offers induction strategy for very active relapsing MS patients who have failed conventional therapy, and possibly selected treatment-naive patients. Alemtuzumab use is likely to be restricted to specialized MS centers, with long-term monitoring to determine the true risk for adverse effects.
    No preview · Article · Dec 2013 · Expert opinion on biological therapy
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    ABSTRACT: Daily assessments can provide insight into the temporal characteristics of fatigue. They can demonstrate consistency or reveal variability, as when fatigue changes with the underlying medical condition, improves with therapy, or worsens as a medication side effect. We adapted a fatigue measure from the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) for daily assessment and examined its psychometric properties in a month-long prospective study. Three groups of 100 participants each were drawn from two fatigue-related clinical disorders [osteoarthritis (OA) and premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD)], and a general population sample (GP). They completed brief daily web-based fatigue measures at home on 28 consecutive evenings. Compliance was high for all samples, based on the percent of participants who remained in the study (98 % for GP and OA, 95 % for PMS/PMDD). The new scale performed consistently across the groups, sensitively measuring fatigue with high reliability (>0.90) especially in the average to high fatigue level range. Supporting known-groups validity, fatigue scores were elevated in the clinical groups as compared to the GP. The scale was sensitive to change, with the PMS/PMDD sample showing a linear increase in fatigue prior to menses onset, and a sharp drop off afterward. The scale was psychometrically sound across diverse clinical and general population samples, though less reliable when assessing lower levels of fatigue.
    Full-text · Article · Oct 2013 · Quality of Life Research
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