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Severe Relapse (severe + relapse)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

CIDP associated with lung cancer: a paraneoplastic disease?

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2004
R Fazio
We describe a 65-year-old smoker male followed for five years for a pure motor demyelinating peripheral neuropathy. The patient had a monthly motor relapse with severe weakness restricting him to a wheelchair, so he needed monthly high dose IVIg. On EMG the MCV were very slowed (30 m/sec) without evidence of conduction blocks while SCV were in the normal range. CSF disclosed a high protein level. Laboratory findings did not reveal any other abnormality except for the presence of monoclonal gammopathy IgMk and high titer anti GD1a serum IgM antibodies (1:5000). In March 2003 he had the most severe relapse with flaccid tetraplegia and respiratory failure so severe that he required ventilatory support. A total body CT scan revealed a nodular lung lesion with diffuse lymphangiitis. Biopsy disclosed a lung adenocarcinoma with a severe infiltration of CD8 cells. Surgical eradication of the tumor caused the last severe relapse. At the moment the patient is relapse-free and no more treatment was administered. The clinical course of the motor demyelinating relapsing neuropathy suggests a possible paraneoplastic pathogenesis of the neurological illness also supported by the severe inflammatory infiltration of the tumor. [source]

Multiple sclerosis relapses: a multivariable analysis of residual disability determinants

ACTA NEUROLOGICA SCANDINAVICA, Issue 2 2009
M. Vercellino
Background,,, Recovery from multiple sclerosis (MS) relapses is variable. The factors influencing persistence of residual disability (RD) after a relapse are still to be thoroughly elucidated. Aims of study,,, To assess RD after MS relapses and to define the factors associated with persistence of RD. Methods,,, Data were retrospectively collected for all relapses in a population of relapsing,remitting MS patients during 3 years. Relapse severity and RD after 1 year were calculated on Expanded Disability Status Scale basis. A multivariable analysis for factors influencing RD and relapse severity was performed (variables: age, gender, disease duration, oligoclonal bands, relapse severity, monosymptomatic/polysymptomatic relapse, immunomodulating treatment, incomplete recovery at 1 month). Results,,, A total of 174 relapses were assessed. RD after 1 year was observed in 54.5% of the relapses. Higher risk of RD was associated with occurrence of a severe relapse (P = 0.024). Incomplete recovery at 1 month was highly predictive of RD at 1 year (P < 0.0001). Risk of a severe relapse was associated with age , 30 years (P = 0.025) and inversely associated with the use of immunomodulating treatment (P = 0.006). Conclusions,,, Incomplete recovery at 1 month is a predictor of long-term persistence of RD. Higher relapse severity is associated with higher risk of RD. Risk of severe relapses is lower in patients treated with immunomodulating drugs. [source]

EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses

EUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2005
F. Sellebjerg
Relapses, exacerbations or attacks of multiple sclerosis are the dominating feature of relapsing-remitting multiple sclerosis (MS), but are also observed in patients with secondary progressive MS. High-dose methylprednisolone is the routine therapy for relapses at present, but other treatments are also in current use. The objective of the task force was to review the literature on treatment of MS relapses to provide evidence-based treatment recommendations. Review was carried out on the literature with classification of evidence according to the EFNS guidelines for scientific task forces. Short-term, high-dose methylprednisolone treatment should be considered for the treatment of relapses of MS (level A recommendation). The optimal glucocorticoid treatment regimen, in terms of clinical efficacy and adverse events, remains to be established. A more intense, interdisciplinary rehabilitation programme should be considered as this probably further improves recovery after treatment with methylprednisolone (level B recommendation). Plasma exchange is probably efficacious in a subgroup of patients with severe relapses not responding to methylprednisolone therapy, and should be considered in this patient subgroup (level B recommendation). There is a need for further randomized, controlled trials in order to establish the optimal treatment regimen for relapses of MS. [source]