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MacCormick A, Sharma H. Early Recurrent Symptoms After Anterior Cervical Discectomy and Fusion Done for Myelopathy. Int J Spine Surg 2021; 14:S1-S4. [PMID: 33900936 DOI: 10.14444/7171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present a unique case with early recurrent myelopathic clinical manifestations following anterior cervical discectomy and fusion; however, he had an eventual diagnosis of multiple sclerosis rather than any residual cord compression on repeat imaging.
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Affiliation(s)
- Andrew MacCormick
- Radiology Registrar, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH
| | - Himanshu Sharma
- Consultant Spine Surgeon, South West Neurosurgery Centre, Derriford Hospital, Plymouth PL6 8DH
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Ohshita N, Gamoh S, Kanazumi M, Nakajima M, Momota Y, Tsutsumi YM. Anesthetic Management of a Patient With Multiple Sclerosis. Anesth Prog 2018; 64:97-101. [PMID: 28604090 PMCID: PMC5467764 DOI: 10.2344/anpr-64-02-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/27/2016] [Indexed: 11/11/2022] Open
Abstract
A 54-year-old woman diagnosed with multiple sclerosis (MS) at the age of 19 years was scheduled to undergo temporomandibular joint mobilization. She was currently in a remission phase from her MS but with persistent sequelae, including impaired eyesight and muscle weakness of the limbs. In addition, the blood vessels in her upper limbs were compromised by the formation of internal shunts secondary to vascular prosthesis replacements for plasma exchange therapy in MS. After a previous joint mobilization surgery, her temporomandibular joint developed adhesions with resultant trismus. One of the adverse effects of general anesthesia can be exacerbations of MS symptoms. Minimizing mental and physical stress caused by surgical and anesthetic procedures and maintenance of stable body temperature are important considerations. Awake intubation was performed under sedation with midazolam and fentanyl. After intubation, anesthesia was induced with propofol, remifentanil, and rocuronium. Maintenance of anesthesia was achieved with oxygen-N2O-sevoflurane, remifentanil, fentanyl, and rocuronium. In this case, no adverse events occurred intraoperatively. However, the patient experienced lingering weakness of the limbs in the postoperative period, and activities of daily living of the patient were affected.
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Affiliation(s)
- Naohiro Ohshita
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | - Shoko Gamoh
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
| | | | - Masahiro Nakajima
- Second Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Yoshihiro Momota
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology, Tokushima University, Tokushima, Japan
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Zuccolotto EB, Nunes GCM, Nogueira RSL, Pagnussatt Neto E, Nociti JR. Anesthetic management of a patient with multiple sclerosis - case report. Braz J Anesthesiol 2016; 66:414-7. [PMID: 27343793 DOI: 10.1016/j.bjane.2014.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. CASE REPORT A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. CONCLUSION The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.
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Affiliation(s)
- Eduardo Barbin Zuccolotto
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil
| | - Guilherme Coelho Machado Nunes
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil
| | - Rafael Soares Lopes Nogueira
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil
| | - Eugenio Pagnussatt Neto
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.
| | - José Roberto Nociti
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil
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Lariosa-Willingham KD, Rosler ES, Tung JS, Dugas JC, Collins TL, Leonoudakis D. Development of a central nervous system axonal myelination assay for high throughput screening. BMC Neurosci 2016; 17:16. [PMID: 27103572 PMCID: PMC4840960 DOI: 10.1186/s12868-016-0250-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Regeneration of new myelin is impaired in persistent multiple sclerosis (MS) lesions, leaving neurons unable to function properly and subject to further degeneration. Current MS therapies attempt to ameliorate autoimmune-mediated demyelination, but none directly promote the regeneration of lost and damaged myelin of the central nervous system (CNS). Development of new drugs that stimulate remyelination has been hampered by the inability to evaluate axonal myelination in a rapid CNS culture system. Results We established a high throughput cell-based assay to identify compounds that promote myelination. Culture methods were developed for initiating myelination in vitro using primary embryonic rat cortical cells. We developed an immunofluorescent phenotypic image analysis method to quantify the morphological alignment of myelin characteristic of the initiation of myelination. Using γ-secretase inhibitors as promoters of myelination, the optimal growth, time course and compound treatment conditions were established in a 96 well plate format. We have characterized the cortical myelination assay by evaluating the cellular composition of the cultures and expression of markers of differentiation over the time course of the assay. We have validated the assay scalability and consistency by screening the NIH clinical collection library of 727 compounds and identified ten compounds that promote myelination. Half maximal effective concentration (EC50) values for these compounds were determined to rank them according to potency. Conclusions We have designed the first high capacity in vitro assay that assesses myelination of live axons. This assay will be ideal for screening large compound libraries to identify new drugs that stimulate myelination. Identification of agents capable of promoting the myelination of axons will likely lead to the development of new therapeutics for MS patients. Electronic supplementary material The online version of this article (doi:10.1186/s12868-016-0250-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen D Lariosa-Willingham
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA.,Teva Pharmaceuticals, Biologics and CNS Discovery, Redwood City, CA, 94063, USA
| | - Elen S Rosler
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA.,Alios BioPharma, South San Francisco, CA, 94080, USA
| | - Jay S Tung
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA
| | - Jason C Dugas
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA.,Rigel Pharmaceuticals, South San Francisco, CA, 94080, USA
| | - Tassie L Collins
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA.,NGM Biopharmaceuticals, Inc., South San Francisco, CA, 94080, USA
| | - Dmitri Leonoudakis
- Translational Medicine Center, Myelin Repair Foundation, Sunnyvale, CA, 94085, USA. .,Teva Pharmaceuticals, Biologics and CNS Discovery, Redwood City, CA, 94063, USA.
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Zuccolotto EB, Nunes GCM, Nogueira RSL, Pagnussatt Neto E, Nociti JR. [Anesthetic management of a patient with multiple sclerosis - case report]. Rev Bras Anestesiol 2015; 66:414-7. [PMID: 25746339 DOI: 10.1016/j.bjan.2014.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. CASE REPORT A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. CONCLUSION The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.
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Affiliation(s)
- Eduardo Barbin Zuccolotto
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil
| | - Guilherme Coelho Machado Nunes
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil
| | - Rafael Soares Lopes Nogueira
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil
| | - Eugenio Pagnussatt Neto
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil.
| | - José Roberto Nociti
- Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil
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