Thursday, July 31, 2008

Infratentorial lesions predict disability in MS

Minneboo A, Barkhod F, Polman CH et al. Infratentorial lesions predict long term disability in patients with initial findings suggestive of multiple sclerosis. Arch Neurol 2004; 61:217-221.

42 patients assessed over 8.7 years. Thos chosen had initial findings c/w MS based on MRI and these patients were followed until they achieved EDSS of 3.0. 26/42 converted to CDMS (clinically definite MS). Gad lesions and hypointense T1 lesions were not predictuive. 2 or more infratentorial lesions best predicted disability.

Sastre-Garriga J, Tintore M, Rovira A et al. Specificity of Barkhod criteria in predicting conversion to multiple sclerosis when applied to clnically isolated brainstem syndromes.
Arch Neurol 2004; 61: 222-224.

51 patients with CISB (clinically isolated brainstem syndromes) and 102 with other CIS (clinically isolated syndromes) were followed for 34, and 40 months respectively. (The CIS had 46 with transverse myelitis and 56 with optic neuritis). The specificity of the Barkhof criteria was less in CISB v other CIS (61 v 73 %), due to infratentoria lesion requirement having less specificity (no dissemination in space). Conclusion-- beware of specificity in CISB

Fatigue in MS

Factors causing/correlating with fatigue in MS
2. Deconditioning
3. hypothyroidism
4. anemia
5. medications
6. ambient temperature
7. relapse/exacerbation
8. psychological concerns
9. N acetylaspartate-creatine ratio in MR spectroscopy (indicates axonal damage)

NOT correlated
1. T2 lesion volume on MRI
2. Gad lesions
3. C reactive protein
4. transcranial magnetic stimulation response (measure of motor conduction) not difference in larger fibers (may not be the ones involved in fatugue)

Source-- editorial Arch Neurol 2004Feb pp.176-177 Michael Racke Kathleen Hawker and Eliot Frohman, Fatigue in multiple Sclerosis: is the picture getting simpler or more complex