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multiple_sclerosis

Multiple sclerosis (MS)

Multiple sclerosis (MS) is characterized by widespread immunomodulatory demyelination of the CNS resulting in nerve cell dysfunction.

The spinal cord is frequently affected by atrophy and/or lesions in multiple sclerosis.

Abdominal reflexes disappear in 70-80 %.

Cell replacement therapy is an effective strategy to repair the myelin in MS.

The limited efficacy of immunomodulatory treatments (e.g. interferons) for MS, means that more rational, if not, better approaches in the treatment of MS have been sought, such as enhancement of neuroregeneration (e.g. remyelination) via stem cell transplantation. Oligodendrocytes are a good stem cell source because lineage differentiation of these cells is primarily altered in MS (20,32). Moreover, we hypothesize that transplanting BMDOs loaded with Ephrin (BMDO+Ephrin) may increase migratory capacity of these grafts and eventually promote remyelination, behavioral recovery and improvement of motor functions in MS animals. Of course, several issues remain to be addressed prior to establishing the optimal efficacy of BMDO+Ephrin transplantation in MS animal models. For instance, timing of transplantation after EAE induction is critical for successful functional outcomes. Therefore, early transplantation post- immunization should be performed, especially for chronic EAE. Furthermore, aside from looking into remyelination in white matter tracts of the cerebral hemispheres after BMDO+Ephrin transplantation in animal models of MS, we also need to characterize the effects of these transplants in the spinal cord. It would also be worthwhile to explore other proteins aside from ephrin (e.g. syndecans) that could enhance migration of transplanted oligodendrocytes 1).

Complications

Brain Tumor

The diagnosis of a brain tumor in a MS patient is challenging, due to several reasons that include the fact that new neurological symptoms in MS patients are easily attributed to a relapse of the disease and the MRI lesions, even if suspicious, are commonly diagnosed or confused as a tumefactive form of MS. Also the cooccurrence of two neurological diseases in the same patient is uncommon, particularly oligodendroglioma and MS 2) 3) 4) 5).

Cervical stenosis

Cervical spinal 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.

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 this 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 6).

Diagnosis

Treatment

Outcome

Quality of life, in patients with multiple sclerosis is an issue that worries health personnel, it is essential to implement strategies for reducing the impact of the disease on patients' lives, mainly through the application of programs aimed to decrees depression and improve social support 7).

1)
de la Pena I, Pabon M, Acosta S, Sanberg PR, Tajiri N, Kaneko Y, Borlongan CV. Oligodendrocytes engineered with migratory proteins as effective graft source for cell transplantation in multiple sclerosis. Cell Med. 2014 Apr 10;6(3):123-127. PubMed PMID: 24999443; PubMed Central PMCID: PMC4080202.
2)
Carvalho AT, Linhares P, Castro L, Sá MJ. Multiple sclerosis and oligodendroglioma: an exceptional association. Case Rep Neurol Med. 2014;2014:546817. doi: 10.1155/2014/546817. Epub 2014 Aug 7. PubMed PMID: 25180114; PubMed Central PMCID: PMC4142296.
3)
Khan OA, Bauserman SC, Rothman MI, Aldrich EF, Panitch HS. Concurrence of multiple sclerosis and brain tumor: clinical considerations. Neurology. 1997;48(5):1330–1333.
4)
Green AJ, Bollen AW, Berger MS, Oksenberg JR, Hauser SL. Multiple sclerosis and oligodendroglioma. Multiple Sclerosis. 2001;7(4):269–273.
5)
de la Lama A, Gómez PA, Boto GR, et al. Oligodendroglioma and multiple sclerosis. A case report. Neurocirugia. 2004;15(4):378–383.
6)
Tan LA, Kasliwal MK, Muth CC, Stefoski D, Traynelis VC. Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis? J Clin Neurosci. 2014 Jul 31. pii: S0967-5868(14)00353-1. doi: 10.1016/j.jocn.2014.05.023. [Epub ahead of print] PubMed PMID: 25088960.
7)
Ochoa-Morales A, Hernández-Mojica T, Paz-Rodríguez F, Jara-Prado A, Trujillo-De Los Santos Z, Sánchez-Guzmán MA, Guerrero-Camacho JL, Corona-Vázquez T, Flores J, Camacho-Molina A, Rivas-Alonso V, Dávila-Ortiz de Montellano DJ. Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability. Mult Scler Relat Disord. 2019 Sep 9;36:101386. doi: 10.1016/j.msard.2019.101386. [Epub ahead of print] PubMed PMID: 31520986.
multiple_sclerosis.txt · Last modified: 2019/09/15 22:05 by administrador