Steroid Therapy Altered Serum Levels of CCL2 and CCL5 Chemokines in Multiple Sclerosis Patients during Relapse

Chemokines are involved in the pathogenesis of multiple sclerosis. The aim of this study was to determine the impact of steroid therapy on the levels of CCL2 and CCL5 chemokines. The study encompassed 30 patients with clinically definite relapsing-remitting multiple sclerosis who were treated with methylprednisolone due to the relapse of the disease. The control groups consisted of 20 patients during the stable stage of relapsing-remitting multiple sclerosis and of 15 patients with noninflammatory diseases of the nervous system. Both chemokines were markedly expresssed in serum by enzyme-linked immunosorbent assay. During relapse, the levels of both chemokines differed significantly from the levels measured in both control groups. After the methylprednisolone treatment, the chemokine levels changed significantly: the levels of CCL2 increased, whilst the levels of CCL5 decreased. These alterations did not correlate with the clinical state of the patients or with the therapeutic effect of the treatment and indicated that the inflammatory reaction accompanying the relapse was receding.

Correlations between IL-4, IL-12 levels and CCL2, CCL5 levels in serum and cerebrospinal fluid of multiple sclerosis patients

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS). Both cytokines and chemokines have been implicated in the pathogenesis of MS. The aim of the study was to assess whether cytokine levels are correlated with chemokine levels during a different stage of relapsing-remitting MS (RR-MS). The study included 53 patients with RR-MS (20 subjects in stable stage and 18 patients with relapse). By ELISA method, the levels of the interleukin-4 (IL-4), interleukin-12 (IL-12), CCL2 and CCL-5 chemokines were measured both in serum and cerebrospinal fluid (CSF) of all patients. The serum IL-4 and IL-12 levels and CSF CCL5 level of patients with stable RR-MS were significantly different from the control level and the IL-12 levels were correlated with CCL5 levels in serum. During the relapse, a significant change in chemokine levels both in serum and CSF and IL-12 in CSF were noted, however no correlations were found between cytokines and chemokines.

[Epidemiological aspects of multiple sclerosis in Lublin (Poland)]

BACKGROUND AND PURPOSE

The objective of this paper was to present an epidemiological analysis of multiple sclerosis (MS) in Lublin, identify MS prevalence as well as characterize the population of MS patients.

MATERIAL AND METHODS

Information about the patients was gathered and they were examined from 1996 to the end of 2000, that is within a 5-year period. The patients' data were obtained from the neurological departments in Lublin, most often neurological (but also general and ophthalmic) clinics, as well as from the Lublin MS Society. The remaining patients' data were obtained from the doctors, family members, the Lublin MS Society members, as well as from the hospital and clinic files. The patients were interviewed in detail using a prepared questionnaire. The diagnosis and its degree of certainty were determined in accordance with the Poser's criteria. The control group included 111 healthy people who were Lublin residents on the day of examination. The obtained results were analyzed in epidemiological and statistical terms.

RESULTS

On the prevalence day (31 December 1997) there were 204 MS cases in Lublin, including 141 women (69%) and 63 men (31%). The calculated incidence ratio was 57.3/105. The average age of MS onset was estimated to be 30.1 years. On 31 December 1997 the average duration of the illness was 15.4 years. The average age for the examined cases was 45.5 years. The average DSS (Disability Status Scale) score was 3.5. Most often the disease began with a single symptom, in 155 cases (75.9%), whereas several symptoms occurred in 37 patients (18.1%). The most common symptoms at the illness onset were sensory impairments (52 patients), optic neuritis (42 people) and pyramidal symptoms (34 patients). The most common form of the illness was a disseminated form, which was diagnosed in 131 patients (64.2%). In the examined patient population four types of MS were recognized. The relapsing-remitting MS (RR-MS) was observed in 62 patients (30.3%), the secondary progressive MS (SP-MS) in 83 patients (40.6%), and the primary progressive MS (PP-MS) was characteristic of 40 people (19.6%), while 19 patients (9.3%) experienced a benign course of MS.

CONCLUSIONS

Our results are typical for the region of high incidence of MS. They are similar to the data achieved in other populations of that region.

[Development of binding antibodies to interferon-beta during treatment of multiple sclerosis with different types of interferon-beta]

Interferon beta (IFN-beta) is generally considered an effective treatment for multiple sclerosis (MS). Importance of binding antibodies (BAb), which are created during the treatment of MS by the use of IFN-beta, hasn't been completely explained, however it is generally reckoned that they might be one of the factors diminishing treatment efficacy. The aim of the study was the appreciation of BAb occurrence during the treatment of MS by the use of different types of interferon beta and their impact on clinical efficacy. The study included 47 patients with relapsing-remitting MS. Within 24 months 37 patients were given two different preparations of IFN-beta 1-a and 10 patients were given IFN-beta 1-b. Every 6 months clinical parameters and BAb level in serum by EIA method were estimated. All preparations of IFN-beta induced appearance of BAb, but frequency of developing BAb to IFN-beta varied according to the IFN beta given. The high levels of BAb appeared significant frequently in patients treated with IFN-beta 1-b than in patients treated with both preparations of IFN-beta 1-a. After 2 years of treatment greater disability, measured by EDSS scale was encountered in patients with high levels of BAb but differences weren't statistically significant. As well, it wasn't stated significant correlation between exacerbation numbers during the treatment.

Interleukin-8 and RANTES levels in patients with relapsing-remitting multiple sclerosis (RR-MS) treated with cladribine

OBJECTIVE

Chemokines are involved in the pathogenesis of multiple sclerosis. The aim of the study was to evaluate the effects of immunosuppressive therapy on production of two proinflammatory chemokines--interleukin-8 (IL-8) and RANTES (regulated on activation, normal T cell expressed and secreted).

MATERIALS AND METHODS

Twenty-five patients with relapsing-remitting multiple sclerosis were treated with 2-chlorodeoxyadenosine (Cladribine), administered subcutaneously in 6 cycles repeated every 5 weeks. IL-8 and RANTES levels were measured by the enzyme-linked immunoassay (ELISA) method in serum and cerebrospinal fluid (CSF) before and after treatment.

RESULTS

After Cladribine treatment the levels of IL-8 decreased significantly in CSF only, whereas the RANTES levels decreased significantly both in CSF and serum.

CONCLUSION

Our results suggest that Cladribine therapy might modify the circulating level of RANTES.

Respiratory function in amyotrophic lateral sclerosis

The aim of this study was to examine the vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1) in relation to the site of amyotrophic lateral sclerosis (ALS) onset and the duration of the disease. Respiratory involvement is the principal cause of death in ALS patients. The study was conducted at the Department of Neurology, University School of Medicine in Lublin. The study comprised 18 ALS patients. The average duration of ALS was 12 months. The patients were divided into two groups according to the site of ALS onset and into two groups according to the duration of the disease. FVC was significantly higher in the group of patients with a limb onset than in the group of patients with a bulbar onset of the disease. The study has shown respiratory function disturbances in ALS patients. FVC significantly depends on the site of ALS onset but not on the duration of the disease.

[The formation and significance of antibodies to interferon beta during immunomodulating treatment of multiple sclerosis]

Patients with multiple sclerosis receiving interferon beta (IFN) may develop neutralizing anti-interferon beta antibodies (NABs). The importance of NABs has not been completely explained, however it is generally reckoned that they might be one of the factors diminishing treatment efficacy. This paper presents the consequences of NABs formation during IFN therapy. Differences of immunogenicity between the interferon beta products with regard to their structure, formulation, dose, route of administration were presented and the influence of NABs on the biological and clinical activity of IFN beta therapy was shown.

Tumour of great occipital foramen

We present the case of tumour of the great occipital foramen in a patient who was having headaches and significant mobility restriction of the cervical spine. Attention is called to diagnostic and surgical difficulties related to this location of neoplasm.

Rare first symptoms of multiple sclerosis

The most frequent first symptoms of multiple sclerosis are the following: sensory symptoms, optic neuritis, motor and cerebellar syndromes. Three female patients have been diagnosed with multiple sclerosis on the basis of Poser's criteria. The onset of the disease was manifested in these cases with non-typical and rare symptoms. Patient 1, a woman, aged 24. The first symptom of the disease was an isolated lesion of nerve VI on the right side. Patient 2, a women, aged 30. The first symptom of the disease was acute pain localised within the area of the lumbar-sacral spine. Patient 3, a woman, aged 43. The first symptom of the disease was loss of taste and smell.

Thymectomy as an effective treatment in myasthenia

The paper describes a patient case with early diagnosed myasthenia introduced, who after thymectomy and postsurgical pharmacology achieved a total remission of the disease within six years.

Oligoclonal bands measured in unconcentrated cerebrospinal fluid and other biochemical parameters in multiple sclerosis

Various biochemical parameters of cerebrospinal fluid (CSF) obtained from sixty-nine patients with RRMS (relapse-remitting MS) were compared in this study. Total protein level, white blood cells (WBC) count and presence of oligoclonal bands (OB) in CSF were examined. The presence of OB in unconcentrated CSF using an isoelectrofocusing assay on agarose gels and silver staining were measured in 72 percent of patients. The average CSF total protein level measured by Lowry assay was 269 mg/l (range from 61 to 712 mg/l). The mean level of white blood cells (WBC) was higher than in general population and it was 12 cells/microl. We found an increased level of WBC count among patients with the presence of oligoclonal bands in CSF.

Diagnosis: miner's nystagmus

We present the patient with pendular nystagmus. The condition is secondary to long-term work as an underground coal miner. The issue is worth describing because of its rare presence in contemporary either neurological or ophthalmological literature.

Vitamin B12 deficiency as a potential cause of dementia

There is a patient case with dementia and brain MRI massive abnormalities, probably in the course of vitamin B12 deficiency.

Problems in diagnosing cranial base meningioma in patients with multiple sclerosis

A 49-year-old patient had been suffering from the relapsing-remitting form of multiple sclerosis since the age of 23. Attacks of the disease appeared every 2 years in the form of right-sided hemiparesis, vertigo, and problems in maintaining balance. The symptoms disappeared after treatment. At the age 32 retrobulbar inflammation of the second cranial nerve appeared with visual acuity weakness. The symptoms disappeared after treatment. At the age of 42, bilateral weakness of visual acuity appeared and then epileptic attacks occurred. After surgical treatment of meningioma the symptoms disappeared. Only the features of a psycho-organic syndrome remained. The following attack of MS appeared 2 years after surgical intervention. MRI of the head disclosed numerous demyelinating foci.

The use of instrumental examinations in the diagnosis of headaches

Headaches are the most common complaint reported by patients to their physician. They can be divided into spontaneous and symptomatic. The findings of the history and examination may suggest the need for diagnostic testing. The ancillary investigation and management of headache is discussed.

Hemiballismus following general anesthesia. A case report

Hemiballismus is characterized by the abrupt onset of violent proximal flinging movements, affecting the limbs, neck and trunk on one side of the body. It is caused by the lesion in the region of the contralateral subthalamic nucleus of the Luys. Usually it is a self-limiting disease, lasting 6-8 weeks. A 49-year-old man has been admitted to the hospital after flinging movements of his right arm and the right side of the trunk occurred. A few days earlier he had undergone general anesthesia prior to a dental procedure. There was trouble in waking the patient afterwards. The movements lasted a few days. MRI of the brain revealed ischemic lesions areas in T2-weighted images localized in the region of globus pallidus bilaterally. EEG was abnormal, and showed slowed background activity with slow waves in left temporal lobe. He was treated with haloperidol, clonazepam and vasoactive medications. In spite of administered treatment, hemiballic movements reappeared occasionally. Due to increased frequency of the movements the patient was hospitalized again two years later. The second MRI revealed changes described earlier and a new ischaemic focus in left parietal lobe. Continuation of treatment with haloperidol was administered.

Influence of the new medicine--2-CDA (Cladribine) on the ultrastructure of the extrabulbar segment of the optic nerve in rabbits of New Zealand breed

Experiments were carried out on the rabbits of New Zealand breed weighting about 3 kg. Rabbits from the experimental group received Cladribine in the dose of 0.07 mg/kg/24 h each morning subcutaneously for 6 days, three cycles with 5-week intervals. Specimens of the optic nerve were stained according to the Reynold's method and observed in Tesla BS-500 transmission electron microscope. Results achieved from examinations of slides in experimental group indicate that Cladribine administered in the dose corresponding to therapeutic dose used in humans for experimental treatment of sclerosis multiplex does not cause the damage of extrabulbar segment of optic nerve in experimental animals. The achieved results suggest necessity of new research works regarding the eye structures of mesenchymal origin.

Histological examination of the extrabulbar segment of the optic nerve in experimental animals after administration of Cladribine

The experiment was carried out on rabbits, females of New Zealand breed, weighting about 3 kg. Rabbits from the experimental group I received Cladribine in the dose corresponding to the schema of the experimental treatment in the hairy cell leukemia and animals from the experimental group II, the dose corresponding to the experimental treatment in multiple sclerosis. The optic nerves were collected for histological examinations in the light microscope. It appeared that administration of Cladribine in the dose corresponding to the therapeutic dose used in therapy of hairy cell leukemia and sclerosis multiplex does not cause evident morphological changes in the extrabulbar segment of the optic nerve on the level of the light microscope.

The effect of epilepsy on emotional state in Hamilton and Beck questionnaire studies

Patients with epilepsy present higher rate of psychological and psychiatric problems and emotional disturbances are estimated as the most frequent ones with prevalence of depression about tree times higher than it was observed in general population. In the presented study the occurrence of depressive symptoms was compared in a total of 60 adult patients with newly recognized and chronic epilepsy during remission of illness as well as pharmacoresistant. 21-items Hamilton Depressive Scale and Beck Depressive Inventory were applied once in each testified patient, consecutively by a physician or a patient himself during interictal period. Our study has found a higher level of depressive signs in newly diagnosed than in chronic patients during remission of illness but also in patients with an active process. The scoring rates both on HDRS and BDI were respectively characteristic of moderate or mild intensity of depressive disturbances. This comparison allows us to make a suggestion that diagnosis of epilepsy with its well-known stigmatization and limitations of different life activities may act as a stressing factor that enhances anxiety and depressive reactions in early phase of illness.

Effectiveness of adjunctive therapy with tiagabine in mentally disabled patients with epilepsy

Previous reports justified positive impact of tiagabine, a new-generation antiepileptic drug on neuropsychological functioning as well as minimal risk of psychiatric exacerbations. In this prospective, open, observational, non-comparative, short-term--6 months' study we evaluated efficacy and tolerability of tiagabine as add-on in polytherapy in 30 young adults with both refractory epilepsy and mild or moderate mental retardation. About 40% of patients experienced improvement in seizure frequency of 50% or more and none complained of seizure deterioration. Overall seizure frequency fell down from a mean 9.9 at the baseline to 6.3 seizure days per month. The seizure rate was reduced from 14.9 to 9.2 per month after 24 weeks of add-on phase. Adjunctive tiagabine therapy appeared to be associated with reduction in overall seizure severity characteristics expressed as enhancement of mild seizures from 30 to 50% of patients and reduction in severe seizures from 30 to 16%. Responders reported an improvement in most health-related quality of life domains but mostly cognition, medication effects and social functioning. The majority (90%) of patients did not report additional adverse effects with tiagabine; the most common complains associated with central nervous system (vertigo, weakness, nervousness) were transient and did not cause discontinuation. Blood counts and liver functional tests did not show any clinically relevant changes. In this short-term observation tiagabine seemed to be a beneficial antiepileptic drug for mentally retarded patients with epilepsy as it decreased seizure frequency and severity, improved the patients' sense of the quality of life without enhancement of the risk of adverse effects in polytherapy.

[Open trial of the effectiveness of interferon beta 1a (Avonex) in multiple sclerosis. Clinical assessment using motor coordination tests]

OBJECTIVE

The aim of the study was to evaluate clinical efficacy and safety of interferon beta 1A (Avonex) in the Polish population of remitting-relapsing multiple sclerosis (RR MS) patients.

MATERIAL AND METHODS

The study was organized as an open, multi-center trial with 126 RR MS patients. Intramuscular Avonex was administered once a week in the dose of 30 mcg. The treatment duration was 24 months. The annual relapse rate (ARR), proportion of relapse-free patients, the average change in EDSS scores between the baseline and the study completion, and the proportion of patients who deteriorated on the EDSS scale during the treatment were used as evaluation parameters. Additionally, to obtain quantitative data, the 9HPT and 25 FW test results were taken into account.

RESULTS

A significant decrease in the ARR was noted in the course of treatment (from 1.47 in the 2-year period preceding the study to 0.38). The mean EDSS score for the whole group was higher by 0.13 on the study completion. However, patients without motor deficits (EDSS < 2.0) at baseline improved by 0.25 on the EDSS during the treatment, while those with motor deficits (EDSS 2.0 to 4.0)--deteriorated by 0.65. In the period under study 45.8% of the patients remained stable, 26.7% improved and 27.5% deteriorated on the EDSS. The mean duration of the 9HPT test performance increased by 0.67 sec for the dominant, and by 0.97 sec for the non-dominant hand from the baseline to post-treatment evaluation. But again, in patients without any motor deficits the mean time of 9HPT test performance was shorter post-treatment than at baseline for the dominant and non-dominant hand, while in those with motor deficits it was longer for both hands on the study completion. The mean performance time on the 25 FW test was longer by 0.74 sec on the study completion for the whole group, but in patients without motor deficits the increase in the 25 FW performance time was significantly smaller than in those with baseline EDSS scores ranging from 2.0 to 4.0. Avonex did not cause any significant abnormalities in laboratory parameters monitored during the treatment, and no significant side effects were observed except for flu-like symptoms following an Avonex injection.

CONCLUSION

Results of this study confirmed a beneficial effect of 1FNb 1A (Avonex) in the dose of 30 mcg per week on the clinical status of MS patients. The findings indicate a better treatment outcome in patients with less pronounced neurological deficits at baseline.

Markers of inflammation in cerebral ischemia

The study sought to determine whether cerebral ischemia is associated with inflammatory reactions indicated by an increase in levels of selected acute phase proteins (APP), C-reactive protein (CRP), fibrinogen, alpha-1 antitrypsin (AAT) and acidic alpha-1 glycoprotein (AGP). These proteins are thought to be markers of inflammatory reactions. We investigated 30 patients with acute cerebrovascular ischemia, 20 patients with transient ischemic attack, and 20 patients from a control group. Levels of CRP, AAT, AGP, and fibrinogen in blood sera were determined in all patients by kinetic turbidimetry. In the patients with cerebral infarct an increase was found in the levels of APP, which suggests that ischemic necrosis is associated with inflammatory reactions. All patients require active treatment of an inflammatory process that is associated with stroke.

Effect of riluzole (Rilutek) treatment on plasma amino acid percentages in amyotrophic lateral sclerosis patients

The aim of the study was to investigate the effect of riluzole (Rilutek) treatment on plasma amino acids (AA) percentage capacity in amyotrophic lateral sclerosis (ALS) patients. Excitatory AA may be important in the pathogenesis of ALS. Riluzole is a neuroprotective drug that blocks glutamatergic neurotransmission in the central nervous system. The study was conducted at the Department of Neurology, University School of Medicine in Lublin. The study comprised 20 ALS patients. Plasma AA were measured by automated ion-exchange chromatography before and after 3 months of riluzole treatment. The study has shown a significant decrease in serine percentage capacity and a significant increase in isoleucine percentage capacity in the plasma of the ALS patients, however the plasma excitatory AA percentage capacity was not significantly changed after 3 months of the riluzole treatment. Our investigations revealed that riluzole does not significantly influence the majority of plasma AA percentage capacity in ALS patients.