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Clinical Disability (clinical + disability)
Selected AbstractsImaging Spinal Cord Damage in Multiple SclerosisJOURNAL OF NEUROIMAGING, Issue 4 2005M. A. Rocca MD ABSTRACT During the past 2 decades, the considerable improvement of magnetic resonance (MR) technology and the development of new MR strategies capable of providing an in vivo overall assessment of multiple sclerosis (MS) pathology have allowed us to obtain important novel pieces of information on disease evolution in the brain. However, despite this, the correlation between brain MR imaging metrics and clinical disability are still suboptimal. A reason for this discrepancy might be the involvement of clinically eloquent structures, such as the spinal cord, which owing to technical challenges have not been extensively studied using MR imaging until very recently. An objective and accurate estimate of the presence and extent of spinal cord damage might indeed contribute to increasing the strength of the correlations between clinical and MRI metrics. This review summarizes the main results obtained from the application of conventional and modern MR-based techniques for the evaluation of spinal cord damage in MS. [source] Clinical measures of progression in Parkinson's disease,MOVEMENT DISORDERS, Issue S2 2009Werner Poewe MD Abstract Despite all recent advances in symptomatic therapy Parkinson's disease (PD) continues to be a relentlessly progressive neurodegenerative disorder. Therefore therapies that will slow or hold disease progression are a major medical unmet need in PD. Clinical measures of disease progression that have been used in disease modification trials so far have focused on indices of progression of cardinal motor features like bradykinesia, rigidity, and tremor as captured by the UPDRS and the emerging need for effective dopaminergic symptomatic therapy. Progression of global disability in PD, however, is driven by additional factors beyond progressive nigrostriatal denervation leading to increasing severity of cardinal motor features. Progressive pathology in extranigral sites in the brain or peripheral autonomic nervous system contribute to poorly levodopa responsive motor symptoms like postural instability, freezing and falls or nonmotor symptoms. In addition treatment-induced motor complications also impact on PD disability. Although it is widely accepted that clinical progression of PD is multidimensional and in addition includes effects of aging, there is no consensus how to best implement more clinically meaningful endpoints for disease progression trials that would reflect these complex interactions impacting on the evolution of global disability in PD. There is an urgent need for biomarkers for disease progression that would faithfully reflect advancing neurodegeneration and resulted clinical disability in PD and that could be used in shorter term clinical trials testing putative disease modifying agents. © 2009 Movement Disorder Society [source] Diffusion tensor imaging in spinal cord: methods and applications , a reviewNMR IN BIOMEDICINE, Issue 7-8 2002Chris A. Clark Abstract The spinal cord is a clinically eloquent site within the central nervous system, containing important sensorimotor tracts confined within a small cross-sectional area. Damage to the spinal cord may be caused by a wide range of pathologies, and can result in profound functional disability. Characterization of the structural integrity of the spinal cord can be assessed using diffusion tensor imaging methods. Development and application of this technique may improve our understanding of the nature and evolution of structural damage in spinal cord disease. Possible developments include improved detection of ischaemic lesions, clarification of the relationship between clinical disability and structural damage to the cord and monitoring of anti-inflammatory or neuroprotective therapies. In this review current technical aspects, clinical applications and the suggested future development of spinal cord diffusion imaging are discussed. Copyright © 2002 John Wiley & Sons, Ltd. [source] Wallerian Degeneration: A Major Component of Early Axonal Pathology in Multiple SclerosisBRAIN PATHOLOGY, Issue 5 2010Tomasz Dziedzic Abstract Axonal loss is a major component of the pathology of multiple sclerosis (MS) and the morphological basis of permanent clinical disability. It occurs in demyelinating plaques but also in the so-called normal-appearing white matter (NAWM). However, the contribution of Wallerian degeneration to axonal pathology is not known. Here, we analyzed the extent of Wallerian degeneration and axonal pathology in periplaque white matter (PPWM) and lesions in early multiple sclerosis biopsy tissue from 63 MS patients. Wallerian degeneration was visualized using an antibody against the neuropeptide Y receptor Y1 (NPY-Y1R). The number of SMI-32-positive axons with non-phosphorylated neurofilaments was significantly higher in both PPWM and plaques compared to control white matter. APP-positive, acutely damaged axons were found in significantly higher numbers in plaques compared to PPWM. Strikingly, the number of NPY-Y1R-positive axons undergoing Wallerian degeneration was significantly higher in PPWM and plaques than in control WM. NPY-Y1R-positive axons in PPWM were strongly correlated to those in the lesions. Our results show that Wallerian degeneration is a major component of axonal pathology in the periplaque white matter in early MS. It may contribute to radiological changes observed in early MS and most likely plays a major role in the development of disability. [source] Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS , 3.5ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2003R. M. Ruggieri Objectives , Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS , 3.5), so as to quantify this deficit when the illness does not yet interfere with daily living and the ability to work. Methods , Fifty patients and 50 healthy controls were submitted to a wide neuropsychological battery, including Wechsler Memory Scale , I- (WMS), Benton Visual Retention Test , D- (BVRT), Raven Coloured Progressive Matrices (RCPM), Kohs' test (KT), Judgement of Lines Orientation , H- (JLO), Facial Recognition (FR) and Aachner Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI). Results , The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085). Conclusion , Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning. [source] | ||||||||||