Spotlight on Multiple sclerosis: neurobehavioral aspects

Multiple sclerosis is a chronic autoimmune, inflammatory neurologic disease that leads to varying degrees of myelin and axonal injury and destruction in the central nervous system. Although the course of multiple sclerosis is varied and unpredictable, most people with multiple sclerosis initially experience reversible neurologic deficits that are followed by progressive deterioration over time. In addition to debilitating motor symptoms, neurologic deficits such as spasticity, ataxia, and dysesthesia may accompany changes in cognitive and psychiatric status.

In this article, Dr. Adam Gerstenecker of the University of Alabama at Birmingham discusses the neurobehavioral aspects of multiple sclerosis. Cognitive impairment is common in multiple sclerosis, with prevalence rates ranging from 45% to 65% at both the earlier and later stages of the disease. Although cognitive decline is more common in the progressive form of multiple sclerosis, evidence suggests that cognitive impairment is a central feature of multiple sclerosis regardless of phenotype. Cognitive impairment in multiple sclerosis affects most cognitive domains, but processing speed, visual learning, and short-term memory deficits are most common. Cognitive slowing has been observed to be significantly associated with brain volume loss and global gray matter atrophy, and evidence suggests that cognitive decline in multiple sclerosis leads to functional impairments in instrumental activities of daily living. In terms of psychiatric features, mood disorders dominate the clinical picture, with up to 80% of people with multiple sclerosis endorsing some level of depressive symptomology.

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Spotlight on Balo concentric sclerosis

Balo concentric sclerosis is often a distinct demyelinating syndrome. In this article, Dr. Thomas Scott of Allegheny Neurological Associates argues that no clear evidence differentiates Balo concentric sclerosis from other acute, aggressive forms of multiple sclerosis. The author discusses how the spectrum of Balo concentric sclerosis has changed with the discovery of nonfatal cases by MRI. In addition, he describes its spectrum of symptoms and provides the current concepts behind the formation of its rings. In this update, the author speculates that much about the mechanism of tissue destruction in multiple sclerosis may be inferred from pathological observations in Balo concentric sclerosis.

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Spotlight on Fatigue in multiple sclerosis

Fatigue is one of the most common and debilitating symptoms affecting persons with multiple sclerosis, reported by at least 75% of persons with multiple sclerosis at some point in the disease course. It is also one of the most difficult symptoms to treat due to its subjective nature and complex pathophysiology. Moreover, other conditions that disproportionately affect persons with multiple sclerosis, including depression and several sleep disorders, may contribute to or be mistaken for the symptom of fatigue, making it difficult to distinguish treatable from untreatable causes. Physicians treating persons with multiple sclerosis should be familiar with the common presentations and definitions of multiple sclerosis-related fatigue, currently proposed causes of fatigue, and approach to treatment. In this article, Dr. Tiffany Braley of the University of Michigan provides a review of the common presentations, causes, evaluation, and treatment of multiple sclerosis-related fatigue.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Ankylosing spondylitis

Ankylosing spondylitis is of neurologic interest not only because it may exhibit nervous system manifestations but also because it can be viewed as the articular homologue of multiple sclerosis. It is a chronic, generally progressive autoimmune disease that strikes in the prime of life and gives rise to a varied spectrum of articular and, oftentimes, extraarticular symptoms. What is known of its mechanism of disease could contribute to understanding multiple sclerosis and other autoimmune diseases. In this clinical summary, Dr. Walter Carlini of Providence Medical Group – Medford Neurology in Medford, Oregon, discusses the clinical manifestations, diagnostic work-up, and management, including effective, potentially disease-modifying immunomodulatory therapies for ankylosing spondylitis that are now available.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Multiple sclerosis: treatment of its symptoms

In this clinical summary, Regina Berkovich MD PhD of the USC Keck School of Medicine and St-Petersburg Pavlov State Medical University and Daniel Kantor MD of Neurologique Foundation discuss treatment of the most common symptoms experienced by patients with multiple sclerosis. It is incumbent upon neurologists, as the primary professionals involved in multiple sclerosis patient care, to become well adept at managing the symptoms important to patients and their care partners/caregivers. Although there is increased attention on new disease-modifying agents, patients need therapeutic plans that improve their daily quality of life and enhance functioning (through neurofunctional enhancers). Advances in ongoing clinical trials for multiple sclerosis-related spasticity and pain are highlighted. The realistic clinical vignette provides practical, easy-to-apply lessons in patient management. Off-label uses of therapy are discussed. References used in this review and in prior updates have been cited selectively.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Multiple sclerosis: neurobehavioral aspects

In this clinical summary, Dr. Alfredo Ardila of Florida International University discusses the neurobehavioral aspects of multiple sclerosis, which include both cognitive disturbances and neuropsychiatric disorders. Cognitive difficulties in multiple sclerosis involve memory retrieval, mental processing speed, reasoning and goal-oriented behavior, verbal fluency, and visuospatial skills. Cognitive slowing has been observed to be significantly associated with brain volume loss and global gray matter atrophy, and hippocampal atrophy correlates with memory encoding impairments. Neuropsychiatric disturbances are primarily mood disorders. Depression may present as an early sign in multiple sclerosis and may be followed by cognitive impairment before physical disability appears. Severity of cognitive impairment significantly correlates with physical disability and with depression severity.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Multiple sclerosis: biological differences in children and adults

The behavior of the immune system in children with multiple sclerosis appears to parallel that in children with other chronic inflammatory diseases. Children with multiple sclerosis represent a group in whom a strategy of induction of remission and maintenance of remission is likely to prevent long-term disability. The developing nervous system is a particularly susceptible target of the immune system; at the same time, the potential for enhanced neural plasticity in children provides a unique opportunity for functional recovery along with long-term disability prevention. In this clinical summary, Dr. Susan Kim of Sacramento VA Medical Center and Dr. Mark Agius of UC Davis Medical Center describe the biological differences in children and adults with multiple sclerosis.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.