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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).


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).




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).

Case series

132 people presenting with a clinically isolated syndrome (CIS) were prospectively recruited between 1984-87, and followed up clinically and radiologically 1, 5, 10, 14, 20 and now 30 years later. All available notes and magnetic resonance imaging (MRI) scans were reviewed, and MS was defined according to the 2010 McDonald criteria.

RESULTS: Clinical outcome data was obtained in 120 participants at 30 years. Eighty were known to have developed MS by 30 years. Expanded disability status scale (EDSS) scores were available in 107 participants, of whom 77 had MS: thirty-two (42%) remained fully ambulatory (EDSS ≤3.5) all of whom had relapsing-remitting MS (RRMS), three (4%) had RRMS and EDSS >3.5, 26 (34%) had secondary progressive MS (all had EDSS >3.5), and MS contributed to death in 16 (20%). Of those with MS, 11 have been treated with a DMT. The strongest early predictors (within 5 years of presentation) of secondary progressive MS (SPMS) at 30 years were presence of baseline infratentorial lesions and deep white matter lesions at one year.

INTERPRETATION: Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, while others ran a more favourable long-term course. These outcomes could, in part, be predicted by radiological findings from within a year of first presentation 8).

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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.
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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.
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.
Chung KK, Altmann D, Barkhof F, Miszkiel K, Brex PA, O'Riordan J, Ebner M, Prados F, Cardoso MJ, Vercauteren T, Ourselin S, Thompson A, Ciccarelli O, Chard DT. A thirty year clinical and MRI observational study of multiple sclerosis and clinically isolated syndromes. Ann Neurol. 2019 Nov 6. doi: 10.1002/ana.25637. [Epub ahead of print] PubMed PMID: 31693200.
multiple_sclerosis.txt · Last modified: 2019/11/08 18:56 by administrador