By M. Filippi, M. Rovaris, G. Comi (auth.), Massimo Filippi, Giancarlo Comi (eds.)
"Why are there no powerful remedies for my ? Why do researchers exclude sufferers with fundamental revolutionary a number of sclerosis from enrolling in scientific trials? Please allow me be aware of if you happen to pay attention of stories that i'd be allowed to go into or remedies that i may test for my situation. " hence, in recent times, the unhappy lament of the sufferer with fundamental revolutionary MS (PPMS). This version, frequently within the guise of a protracted revolutionary myelopathy or, much less quite often, innovative cerebellar or bulbar disorder, frequently responds poorly to corticosteroids and barely turns out to learn to an important measure from extensive immunosuppressive remedies. in recent times, such a lot randomized clin ical trials have excluded PPMS sufferers on counts. scientific worsening devel ops slowly in PPMS and will now not be well-known through the process a 2-or 3-year trial even in untreated keep watch over sufferers. This issue by myself provides to the possibility of a kind 2 mistakes or, no less than, inflates the pattern measurement and period of the trial. furthermore, there's mounting proof that innovative axonal degeneration and neuronal loss (rather than energetic, recurrent irritation) might be very important parts of the pathology during this type of the disorder. even though modern trials are comparing no matter if PPMS sufferers could benefit from therapy with the ~-interferons and glatiramer acetate, initial, out of control medical experi ence means that the implications will not be dramatic.
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Additional info for Primary Progressive Multiple Sclerosis
Example text
Reduced speed of information processing and impaired attention are hallmarks of cognitive dysfunction in MS. Attention is generally compromised before memory deficits appear: therefore, impaired attention can represent a sensitive indicator of incipient cognitive decline in MS patients [1]. Frontal lobe and executive functions are often impaired in MS. Executive functions are higher-level cognitive functions, which include abstract reasoning and concept formation, problem solving, planning, and self-monitoring.
Nevertheless, the information provided by EPs is different from that provided by structural MRI techniques, since EPs are more strictly related to function. Disease severity assessed clinically well correlates with the extent of neurophysiological abnormalities [1,2]. Neurophysiological studies specifically aimed at characterizing the primary progressive (PP) form of MS, particularly with respect to secondary progressive MS (SPMS), are lacking. In this chapter, we discuss the rationale and applications of neurophysiological methods to the study of PPMS.
In areas with partial demyelination, slowing of conduction velocity and a prolonged refractory period with failure in transmitting high-frequency impulses [12] may occur. As a result, EP abnormalities can consist of delayed latency, morphological abnormalities, wave cancellation, amplitude reduction, and increased refractory period [13,14]. Even though EP abnormalities may reveal subclinical lesions [14,17,18], their value in the diagnosis of definite MS still needs to be clarified [17], since it is much lower than that of MRI L.