Multiple Sclerosis and CNS Inflammatory Disorders E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: NIP- Neurology in Practice
• Sprache: Englisch

Seitenzahl: 490

Veröffentlichungsjahr: 2014

Beschreibung

Multiple Sclerosis and CNS Inflammatory Disorders is a practical guide to effective care of patients with multiple sclerosis and other neuroimmunologic and CNS inflammatory disorders.

It provides the scientific basis of multiple sclerosis including etiology, epidemiology, and pathogenesis. It covers the diagnostic process, the course of the disease and prognosis, and the use of MRI in diagnosis and disease monitoring. Disease-modifying  treatment algorithms for relapsing-remitting multiple sclerosis, switching therapy, and progressive multiple sclerosis treatment algorithms are all discussed in detail. It also addresses multiple sclerosis in childhood and pregnancy and includes assessment of alternative therapies.

This new addition to the Neurology in Practice series contains practical guidance and learning features:

• Algorithms and guidelines

• “Tips and Tricks” boxes on improving outcomes

• “Caution” warning boxes to avoiding problems

• “Science Revisited”—quick reminders of the basic science principles necessary for understanding

Multiple Sclerosis and CNS Inflammatory Disorders is an ideal reference for neurologists in practice and training.

Leseprobe

CONTENTS

Cover

Title page

Copyright page

Contributors

Series Foreword

Preface

1 Etiology

Background

Genes

Gender effects: Genetic or biologic?

The role of the environment

Combining risk factors

Conclusion

Acknowledgment

References

2 Immunopathogenesis of Multiple Sclerosis

What does the neuropathology of MS tell us about its pathogenesis?

Gray matter pathology

Multiple sclerosis as an autoimmune disease

Candidates for the self-antigen in multiple sclerosis

Antigen spreading

Epitope spreading

Outside-in versus inside-out?

Lymphocyte trafficking into the CNS

Role of T cells in MS

Role of B cells and humoral immunity

Role of microglia and macrophages

Role of other cells: Dendritic cells and astrocytes

Role of cytokines

What might trigger autoimmunity?

Further Reading

3 Diagnostic Process

Introduction

Clinical features of MS

Diagnostic evaluation of MS

Conclusion

Further Reading

4 MRI in Diagnosis and Disease Monitoring

Introduction

MRI at presentation

MRI diagnostic criteria

MRI consensus protocol

MRI for monitoring disease and treatment

Limitations

Nonconventional MRI

Conclusions

Acknowledgments

References

5 Relapsing MS: Disease Staging and Therapeutic Algorithms

Introduction

Window

Prognostic factors

Therapy

Initiation

Suboptimal response

Combination therapy

Rescue therapy

Escalation

Rapid advancement

Conclusion

Newer oral agents

Further Reading

6 Progressive MS Treatment Algorithms

Background

Challenges to clinical trials in progressive MS

Clinical trials in progressive MS

Monitoring progressive MS in clinical practice

Treatment of progressive MS in clinical practice

Stopping disease-modifying therapy

Neuroprotective strategies

Other treatment considerations

Further Reading

7 Sex-Determined Issues in Multiple Sclerosis

Epidemiology of MS and gender

Basic science of sex hormone and chromosome differences seen in MS

Reproductive issues in MS

Pregnancy and the MS patient

Breastfeeding

Female cancers

Male sex hormones and concerns for the male patient

Acknowledgments

References

8 Pediatric Multiple Sclerosis

Introduction

Definitions

Clinical outcome following a first demyelinating attack

Epidemiology and risk factors

Clinical presentation

Disease course

Diagnostic considerations

Differential diagnosis

Treatment of acute demyelinating attacks

Disease-modifying therapy

Escalation of care for severe MS

Symptomatic therapy

Cognitive dysfunction and quality of life considerations

Conclusions and future directions

Further Reading

9 Complementary and Alternative Medicine

Introduction

Terminology

Unconventional medicine use

CAM therapies

Conclusion

Further Reading

10 Symptomatic Management of MS

Bladder dysfunction

Bowel dysfunction

Sexual dysfunction

Pain

Impaired gait

Spasticity

Tremor

Further Reading

11 Invisible Symptoms of MS

Introduction

Fatigue

Cognition

Depression

Summary

Reference

Further Reading

12 Rehabilitation

Introduction

Physical rehabilitation

Organ rehabilitation: Bladder and bowel management

Cognitive rehabilitation

Summary

References

13 Psychosocial Adaptation to Multiple Sclerosis

Introduction

Coping and adaptation

Stages and phases in the adaptation process

Acknowledgments

References

14 Transverse Myelitis and Acute Disseminated Encephalomyelitis

Introduction

Transverse myelitis

Acute disseminated encephalomyelitis (ADEM)

References

15 Neuromyelitis Optica

Introduction

Diagnosis

Differential diagnosis

Treatment

Prognosis and follow-up

References

Further Reading

16 Neurosarcoidosis

Introduction

General principles of diagnosis

General principles of treatment

Dosages

Specific presentations

Cranial neuropathy

Peripheral neuropathy and myopathy

Prognosis and long-term monitoring

Further Reading

17 Lyme Neuroborreliosis

Introduction

Borrelia burgdorferi infection

Conclusion

Acknowledgments

References

Further Reading

18 Neuro-Behçet Syndrome

Introduction

Epidemiology

Diagnosis and systemic manifestations of Behçet disease

Pathology and etiopathogenesis of Behçet syndrome

Nervous system involvement in Behçet disease: Neuro-Behçet syndrome

Diagnostic studies in NBS

Treatment

References

Index

End User License Agreement

List of Tables

Chapter 03

Table 3.1 Common Presenting Symptoms in MS

Table 3.2 MRI Features That Suggest Against a Diagnosis of MS

Table 3.3 Differential Diagnosis of MS

Table 3.4 Historical Features Suggesting Against MS

Table 3.5 Examination Findings Suggesting Against MS

Chapter 04

Table 4.1 2010 MRI Criteria for Multiple Sclerosis

Table 4.2 Consensus Brain MRI Protocol for Clinical Evaluation of MS

Table 4.3 Consensus Spinal Cord MRI Protocol for Clinical Evaluation of MS

Chapter 05

Table 5.1 Current DMD Administration, MoA, Adverse Reactions, and Pivotal Study

Table 5.2 Pre- and Postmedication Laboratory Tests

Chapter 06

Table 6.1 Summary of Disease-Modifying Therapy Clinical Trials

Chapter 07

Table 7.1 DMTs—Pregnancy Safety Categories

a

Table 7.2 Symptom Management Medications—Pregnancy Safety Categories

Chapter 08

Table 8.1 MRI Features on Baseline Scan That Predict Subsequent MS Diagnosis in Children

Table 8.2 Description of Pediatric-Specific Diagnoses That Can Mimic Pediatric MS

Table 8.3 Pediatric Dosing Regimens for Commonly Used Symptomatic Medications in Patients Weighing Less Than 40 kg

Chapter 09

Table 9.1 NIH Classification of CAM Therapies with Representative Examples

Table 9.2 Risk–Benefit Profiles of MS-Relevant CAM Therapies

Chapter 10

Table 10.1 Anticholinergic Agents for Detrusor Hyperreflexia

Table 10.2 PDE-5 Inhibitors for ED

Table 10.3 TN Treatments

Table 10.4 Dysesthesia Treatments

Table 10.5 Pharmacologic Management of Spasticity

Table 10.6 Pharmacologic Management of Tremor

Chapter 14

Table 14.1 Timing of MRI Based on the Last Time a Patient’s Myelopathic Symptoms Progressed

Table 14.2 Standard Evaluation of TM Patients

Table 14.3 Clinical Presentations of ADEM Patients

Chapter 16

Table 16.1 Selected Differential Diagnosis for NS According to Localization

Table 16.2 Reported Treatments

Table 16.3 CSF in NS versus MS

Chapter 18

Table 18.1 Criteria for diagnosis of Behçet’s disease

a

Table 18.2 Suggested Diagnostic Criteria for NBS

a

Table 18.3 The Neurological Spectrum of Behçet Disease

Table 18.4 Classical Presentation and Features of a Patient with Intra-axial (Parenchymal) NBS

Table 18.5 The Differential Diagnosis of MS and Intra-axial (CNS) NBS

List of Illustrations

Chapter 03

Figure 3.1 Disease courses of MS. These drawings illustrate how disability evolves with time in the different courses of the disease. (a) In RRMS, subjects may have complete recovery from intermittent relapses, or they may have partial recovery with some residual disability. (b) Subjects may have progressive disability without relapses in SPMS, or they may have some continuing relapses early in SPMS superimposed on an underlying progressive course. (c) PPMS can progress at a steady rate or may fluctuate in terms of rate of decline, in either event without any clear relapses. (d) In PRMS, there are both relapses and progressive decline from the onset of the disease, and recovery from relapses may be partial or complete.

Chapter 04

Figure 4.1 Brain images of a 43-year-old man with active relapsing–remitting MS, performed on a 3 T scanner. (a) Proton density. (b) T2-FLAIR. (c) T1 without contrast. (d) T1 after injection of 0.1 mmol/kg gadobutrol. The arrows denote an enhancing lesion that was not present on the prior scan 1 month earlier. Note that the plane of section for the proton density image (a) is slightly different from that of the other images.

Figure 4.2 Cervical spinal cord images of a 55-year-old woman with secondary progressive MS, performed on a 3 T scanner. (a) Sagittal T2. (b) Sagittal STIR. (c) Sagittal T1. (d) Axial T2* at the C1–C2 disk level. The arrows denote a lesion in the right lateral column on all images.

Figure 4.3 Brain images of a 51-year-old woman with active relapsing–remitting MS, performed on a 3 T scanner. (a) T2-FLAIR. (b) T1 after injection of 0.1 mmol/kg gadopentetate dimeglumine. Note the presence of four enhancing lesions, one of which is denoted by an arrow. (c) T2-FLAIR after contrast injection. Enhancing lesions are brighter than their nonenhancing counterparts. (d) MTR. Both enhancing and nonenhancing lesions are hypointense, probably due to a combination of demyelination and increased water content (edema).

Figure 4.4 Brain images of a 64-year-old woman with primary progressive MS, performed on a 3 T scanner. (a) T2-FLAIR after injection of 0.1 mmol/kg gadobutrol showing an enhancing periventricular lesion. (b) T2* (susceptibility) image showing the presence of a vein (arrow) within the lesion. (c) Mean diffusivity map showing facilitated diffusion of water within the enhancing lesion. (d) Relative cerebral blood volume map showing elevated perfusion within the enhancing lesion.

Chapter 05

Figure 5.1 MS: Pathology versus clinical course of the disease.

Chapter 06

Figure 6.1 Approach to treatment of progressive MS.

Chapter 07

Figure 7.1 ARR in the year before pregnancy, during pregnancy, and in the 2 years after delivery among 227 women with MS (vertical bars represent means and 95% confidence intervals).

Chapter 08

Figure 8.1 MRI in ADEM. (a) Axial FLAIR image showing bilateral cerebellar and brainstem lesions with patchy, indistinct borders. (b) Axial FLAIR image showing left thalamic and occipital lesions. (c) Axial FLAIR image showing large hyperintense lesions that are patchy and without periventricular predominance.

Figure 8.2 MRI in pediatric MS. (a) Axial FLAIR image with distinct, small brainstem hyperintense lesions. (b) Axial FLAIR image with numerous hyperintense lesions that have a periventricular predominance and distinct borders. (c) Axial T1 contrast-enhanced image showing a small left juxtacortical contrast-enhancing lesion. (d) Axial T1 imaging with several periventricular T1 hypointense lesions (black holes) that correlate with image (b).

Figure 8.3 Treatment algorithm.

Chapter 10

Figure 10.1 Algorithm for management of bladder symptoms in MS. ISC, intermittent straight catheterization.

Figure 10.2 Algorithm for management of TN in MS.

Figure 10.3 Abnormal gait.

Chapter 11

Figure 11.1 Algorithm for the treatment of fatigue.

Chapter 12

Figure 12.1 Common gait abnormalities in MS patients. (a) Foot slap due to mild ADF weakness, (b) knee instability with buckling leading to a fall, (c) Trendelenburg (compensated on the right) finding secondary to hip abduction weakness, and (d) steppage gait with moderate to severe ADF weakness. Each abnormality is aligned with its corresponding phase of the gait cycle.

Figure 12.2 AFOs. (a) Posterior leaf spring, (b) double metal upright, (c) ground reaction force, and (d) carbon fiber AFOs.

Figure 12.3 ADs for ambulation. (a) Single-point canes, (b) quad cane, (c) forearm crutches, (d) axillary crutches, (e) four-point folding walker, (f) front-wheeled walker, (g) four-wheeled walker with seat and active braking system, and (h) four-wheeled walker with seat and passive braking system (U-Step walker).

Chapter 13

Figure 13.1 Time phases of MS.

Chapter 14

Figure 14.1 Categorization of CNS demyelinating conditions based on temporal course and lesion distribution.

Figure 14.2 Recommended diagnostic pathway for myelopathic patients.

Figure 14.3 FLAIR MRI sequence from a pediatric patient with ADEM.

Chapter 15

Figure 15.1 Sagittal spinal cord MRI T2-weighted sequence of an NMO patient with acute myelitis. A longitudinally extensive thoracic lesion is present.

Figure 15.2 Coronal brain MRI T1-weighted sequence after gadolinium administration of an NMO patient with acute bilateral ON. Swelling and gadolinium enhancement of the optic nerves and optic chiasm is visible.

Chapter 16

Figure 16.1 Algorithm for diagnosis of neurosarcoidosis.

Figure 16.2 FLAIR MRI of a patient initially diagnosed as MS with a history of steroid-responsive optic neuritis in 1989 followed 2 years later by a right internuclear ophthalmoplegia. The patient developed biopsy-proven pulmonary sarcoidosis 6 years after her optic neuritis and stopped beta-interferons at that time due to a strong suspicion of NS. The patient was then followed long term for a total of 19 years from onset without further relapse or change in MRI.

Chapter 17

Figure 17.1 The distribution of pareses.

Figure 17.2 Antibody responses to the I. dammini spirochete in 41 serial serum samples from 12 patients with different clinical manifestations of Lyme disease, as compared with the responses found in 40 control subjects, determined by ELISA. Antibody titers were determined by serial dilutions of each serum (left), and antibody responses, shown in units, were calculated from a single dilution compared with a standard curve (right). The horizontal bar indicates the geometric mean response for each group, and the shaded areas indicate the range of responses generally observed in controls. Arth = arthritis, mono = infectious mononucleosis.

Chapter 18

Figure 18.1 (a–d) Flair MR images of a patient with intra-axial NBS showing a brainstem lesion involving the dorsal pons and midbrain and extending to the diencephalic–basal ganglia region on the left.

Figure 18.2 T1W images with gadolinium of the same patient showing sparse enhancement in the lesion.

Figure 18.3 (Experience-based) Treatment algorithm for intra-axial neuro-Behçet disease.MP: methylprednisolone; IVMP, intravenous methylprednisolone.

Guide

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NEUROLOGY IN PRACTICE:

SERIES EDITORS: ROBERT A. GROSS, DEPARTMENT OF NEUROLOGY, UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY, USA

JONATHAN W. MINK, DEPARTMENT OF NEUROLOGY, UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NY, USA

Multiple Sclerosis and CNS Inflammatory Disorders

EDITED BY

Lawrence M. Samkoff, MD

Associate Professor of Neurology

Neuroimmunology Unit

Department of Neurology

University of Rochester School of Medicine and Dentistry

Rochester, NY, USA

Andrew D. Goodman, MD

Professor of Neurology

Chief, Neuroimmunology Unit

Department of Neurology

University of Rochester School of Medicine and Dentistry

Rochester, NY, USA

This edition first published 2014 © 2014 by John Wiley & Sons, Ltd

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

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Library of Congress Cataloging-in-Publication Data

Multiple sclerosis and CNS inflammatory disorders / edited by Lawrence M. Samkoff, Andrew D. Goodman.  p. ; cm. Includes bibliographical references and index.

 ISBN 978-0-470-67388-1 (pbk.) I. Samkoff, Lawrence M., 1958– editor. II. Goodman, Andrew D., 1952– editor. [DNLM: 1. Multiple Sclerosis. 2. Central Nervous System Diseases–immunology. 3. Neurogenic Inflammation–physiopathology. WL 360] RC377 616.8′34–dc23       2014007073

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © iStockphoto.com/EraxionCover design by Sarah Dickinson Design

Contributors

Brenda Banwell MDDepartment of Pediatrics (Neurology)The Hospital for Sick ChildrenToronto, Ontario, Canada

Allen C. Bowling MDColorado Neurological InstituteEnglewood, CO, USA

Leigh E. Charvet PhDDepartment of NeurologyStony Brook MedicineStony Brook, NY, USA

Jeffrey A. Cohen MDMellen Center for Multiple Sclerosis Treatment and ResearchNeurological Institute, Cleveland ClinicCleveland, OH, USA

Anne H. Cross MDDepartment of NeurologyWashington University School of MedicineSt Louis, MO, USA

Mark Freedman MSc, MD, FAAN, FRCP(C)Multiple Sclerosis Research UnitUniversity of OttawaOttawa, Ontario, Canada

María I. Gaitán MDNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD, USAandDr. Raúl Carrea Institute for Neurological ResearchFLENI, Buenos Aires, Argentina

Barbara Giesser MDDepartment of Neurology, MS DivisionUCLA School of MedicineLos Angeles, CA, USA

Andrew D. Goodman MDNeuroimmunology UnitDepartment of NeurologyUniversity of Rochester School of Medicine and DentistryRochester, NY, USA

Benjamin M. Greenberg MD, MHSDepartment of Neurology and NeurotherapeuticsandDepartment of PediatricsUniversity of Texas SouthwesternDallas, TX, USA

Megan H. Hyland MDNeuroimmunology UnitDepartment of NeurologyUniversity of Rochester School of Medicine and DentistryRochester, NY, USA

Mohsen Khoshnam MDMultiple Sclerosis Research UnitUniversity of OttawaOttawa, Ontario, Canada

Benzi Kluzer MDDepartment of NeurologyUniversity of ColoradoDenver, CO, USA

George H. Kraft MD, MSDepartment of Rehabilitation Medicineand NeurologyInstitute for Stem Cell and Regenerative MedicineUniversity of WashingtonSeattle, WA, USA

Lauren B. Krupp MDDepartment of NeurologyStony Brook MedicineStony Brook, NY, USA

Eric Logigian MDDepartment of NeurologyUniversity of Rochester Medical CenterRochester, NY, USA

Marcelo Matiello MD, MScDepartment of NeurologyMassachusetts General Hospital and Brigham and Women’s HospitalHarvard Medical SchoolBoston, MA, USA

Nesanet S. Mitiku MD, PhDDepartments of Rehabilitation Medicine and NeurologyandCorinne Goldsmith Dickinson Center for Multiple SclerosisIcahn School of Medicine at Mount SinaiNew York, NY, USA

Callene Momtazee MDDepartment of Neurology, MS DivisionUCLA School of MedicineLos Angeles, CA, USA

Ellen M. Mowry MD, MCRDepartment of NeurologyJohns Hopkins UniversityBaltimore, MD, USA

Paul O’Connor MDDivision of NeurologyInstitute of Medical ScienceandSt Michael's HospitalUniversity of TorontoToronto, Ontario, Canada

Erica Patrick MDDepartment of NeurologyUniversity of Rochester Medical CenterRochester, NY, USA

Laura Piccio MD, PhDDepartment of NeurologyWashington University School of MedicineSt Louis, MO, USA

Daniel S. Reich MD, PhDNational Institute of NeurologicalDisorders and StrokeNational Institutes of HealthBethesda, MD, USA

David J. Rintell EdDPartners Multiple Sclerosis CenterBrigham and Women’s HospitalandPartners Pediatric MS CenterMassachusetts General HospitalHarvard Medical SchoolBoston, MA, USA

Jessica Robb MDNeuroimmunology UnitDepartment of NeurologyUniversity of Rochester Schoolof Medicine and DentistryRochester, NY, USA

Dalia Rotstein MDDivision of Neurology Institute of Medical ScienceandSt Michael’s Hospital University of TorontoToronto, Ontario, Canada

Sabahattin Saip MDDepartment of NeurologyCerrahpaşa School of MedicineIstanbul UniversityCerrahpaşa, Turkey

Lawrence M. Samkoff MDNeuroimmunology UnitDepartment of NeurologyUniversity of Rochester School of Medicine and DentistryRochester, NY, USA

Alexius E. G. Sandoval MDMaine Rehabilitation Outpatient CenterBangor, ME, USA

Thomas F. Scott MDDepartment of NeurologyDrexel University College of MedicineandAllegheny MS Treatment CenterPittsburgh, PA, USA

Aksel Siva MDDepartment of NeurologyCerrahpaşa School of MedicineIstanbul UniversityCerrahpaşa, Turkey

Sonya U. Steele MScDepartment of NeurologyJohns Hopkins UniversityBaltimore, MD, USA

Robert Thompson Stone MDDepartment of NeurologyUniversity of Rochester Medical CenterRochester, NY, USA

Brian G. Weinshenker MD, FRCP(C)Department of NeurologyMayo ClinicRochester, MN, USA

Series Foreword

The genesis for this book series started with the proposition that, increasingly, physicians want direct, useful information to help them in clinical care. Textbooks, while comprehensive, are useful primarily as detailed reference works but pose challenges for uses at the point of care. By contrast, more outline-type references often leave out the “hows and whys”—pathophysiology, pharmacology—that form the basis of management decisions. Our goal for this series is to present books, covering most areas of neurology, that provide enough background information to allow the reader to feel comfortable, but not so much as to be overwhelming, and to associate that with practical advice from experts about care, combining the growing evidence base with best practices.

Our series will encompass various aspects of neurology, with topics and the specific content chosen to be accessible and useful.

Chapters cover critical information that will inform the reader of the disease processes and mechanisms as a prelude to treatment planning. Algorithms and guidelines are presented, when appropriate. “Tips and Tricks” boxes provide expert suggestions, while other boxes present cautions and warnings to avoid pitfalls. Finally, we provide “Science Revisited” sections that review the most important and relevant science background material, and references and further reading sections that guide the reader to additional material.

We welcome feedback. As additional volumes are added to the series, we hope to refine the content and format so that our readers will be best served.

Our thanks, appreciation, and respect go out to our editors and their contributors, who conceived and refined the content for each volume, assuring a high-quality, practical approach to neurological conditions and their treatment.

Our thanks also go to our mentors and students (past, present, and future), who have challenged and delighted us; to our book editors and their contributors, who were willing to take on additional work for an educational goal; and to our publisher, Martin Sugden, for his ideas and support, for wonderful discussions and commiseration over baseball and soccer teams that might not quite have lived up to expectations. We would like to dedicate the series to Marsha, Jake, and Dan, and to Janet, Laura, and David. And also to Steven R. Schwid, MD, our friend and colleague, whose ideas helped to shape this project and whose humor brightened our lives; but he could not complete this goal with us.

Robert A. Gross

Jonathan W. Mink

Rochester, NY, USA