Objective To observe the ocular manifestations and therapeutic effect of multiple sclerosis (MS) and neuromyelitis optica (NMO) with ocular symptoms.Methods The clinical data of 107 patients who was diagnosed with MS and NMO with ocular symptoms in our hospital were retrospectively analyzed, including 81 MS patients and 26 NMO patients.The counting of erythocytes and leukocyte，protein content and oligoclonal bands were detected by MRI and cerebrospinal fluid (CSF) in order to ensure the clinical diagnosis with MS and NMO. All the patients had undergone regular ophthalmologic examination of visual acuity，slit lamp microscope and fundus examination.In addition，visual field and visual evoked potential (VEP) examination were performed to analyze the clinical characteristics of ocular manifestations.The patients were received therapy with large dose methylprednisolone or activating blood and dissolving stasis and trophic nerve by chinese medicine. The effects of three methods on ocular manifestations were analyzed. All the patients were followed up for one month to five years. Results Among 81 MS patients，retrobulbar neuritis occurred in 24 patients (29.6%), the other common symptoms included paralytic strabismus and diplopia（30.3%）. Among 26 NMO patients，acute papillitis occurred in 12（46.2%），while retrobulbar neuritis occurred in 14 (53.8%). The most common symptom of both MS and NMO was impaired vision and high abnormal rate. The results of MRI showed that demyelinating lesions beside ventricle was the most performance in MS patients，while abnormalities in spinal cord were found in NMO patients.The results of CSF showed that the positive oligoclonal bands was 75.3% and 19.2% in MS and NMO patients respectively. The potential time delay and (or) amplitude declination were observed by VEP. Large dose methylprednisolone can improve vision and diplopia in a short period.Conclusion The abnormal ocular manifestations of MS and NMO patients are common and complicated. Ocular symptoms has important reference value in the early diagnosis of MS and NMO.
ObjectiveTo observe the features of the manifestations of fundus fluorescein angiography （FFA） in multiple sclerosis （MS） and their value in clinical diagnosis.MethodsThe clinical data of 42 patients (84 eyes) with MS diagnosed by magnetic resonance imaging (MRI) and examination of cerebrospinal fluid (CSF) were retrospectively analyzed. The clinical data included visual acuity, ocular fundus examined by direct ophthalmoscope after mydriasis, FFA, visual field, CSF，visual evoked potential (VEP) and MRI examination.ResultsIn 42 patients (84 eyes),the positive detectable rate of examination of direct ophthalmoscope, CSF, visual field, VEP, and MRI was 36.9%, 21.4%, 71.4%, and 83.3% respectively. Abnormal results of FFA were found in 44 eyes (52.38%), including papillitis in 4 eyes（4.76%）at the early stage with extended physiological scotoma and central scotoma; neuroretinitis in 7 eyes （8.33%）at the medium stage with central or para-central scotoma; optic atrophy in 33 eyes（39.29%） at the late stage with centripetal constriction and even tubular visual field. ConclusionThe main angiographic features of MS are papillitis, neuroretinitis and optic atrophy. The manifestations of FFA combined with the results of examination of CSF，visual field, VEP and MRI is helpful for comprehensive and exact diagnosis of MS.(Chin J Ocul Fundus Dis, 2005,21:300-302)
Objective To evaluate the efficacy and safety of FTY720 (fligolimod) in different dosages in the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS), so as to provide references for clinical practice. Methods Such databases as MEDLINE, EMbase, The Cochrane Liabrary, CBM and CNKI were searched for collecting randomized controlled trials (RCTs) of FTY720 in the treatment of RRMS, which were published from January 1, 2001 to December 31, 2010. The studies were retrieved and the data were extracted according to the predefined inclusion and exclusion criteria, the quality of included studies was evaluated with improved Jadad scale, and the Meta-analyses were performed with RevMan5.1 software. Results Three high quality RCTs were included. The Meta-analyses showed that: a) compared with the control group, orally taking FTY720 could obviously decreased the annualized relapse rate (OR=-6.67, 95%CI -10.75 to -2.60, P=0.001), the confirmed disability progression rate (OR=0.64, 95%CI 0.47 to 0.87, P=0.004), and the incidence rate of intensified lesion on T2-weighted magnetic resonance imaging scans (OR=0.28, 95%CI 0.21 to 0.37, Plt;0.00001); b) There was no significant difference (P=0.55) between the small dosage (0.5mg/d) group and the big dosage (1.25mg/d) group of FTY720; and c) The incidence of adverse events was significantly different among the 3 dosage groups (5mg/d, 1.25mg/d and 0.5mg/d), and the minimum dosage group (0.5mg/d) was safer than the other groups. Conclusion FTY720 is safe to treat RRMS, and it can obviously decrease the annualized relapse rate, confirmed disability progression rate and incidence rate of intense lesion on T2-weighted magnetic resonance imaging scans. There is no dosage-effect relationship found in treating RRMS with FTY720 in different dosages, but the 0.5mg/d FTY720 as the minimum dosage is the safest.
Objective To evaluate the efficacy and safety of different doses of intravenous immunoglobulin (IVIG) in the treatment of relapsing-remitting multiple sclerosis (RRMS). Methods We searched for randomized controlled trials of different doses of IVIG in the treatment of RRMS. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses with The Cochrane Collaboration’s Revman 4.2.0 software. Results Three randomized controlled trials of different dose of IVIG in the treatment of RRMS were included. One was of high quality and the other two were of lower quality. Heterogeneity was identified in one study which reported IVIG in postpartum RRMS. Two studies reported the relapsefree rate and no significant difference was noted between IVIG and placebo. Two studies reported the annual relapse rate, and no significant difference was observed (OR -0.00, 95% CI -0.36 to 0.36, P=0.98). Two studies reported the MRI lesions, and no difference was identified, either. The incidence of adverse events was similar between IVIG and placebo. Conclusion There is insufficient evidence to support the dose-effect relationship of IVIG in the treatment of RRMS. Therefore, an individualized dosing regimen should be applied according to patients’ tolerance and economic status.
Objective To study the regulations of visual evoked potential(VEP) changes in 30 patients with multiple sclerosis (MS). Methods VEP were performed in 30 MS patients,and the results were compared with normal subjects. Results The abnormality rate of VEP were 76.7%. 82.6% of patients with abnormal VEP showed clinical visual symptoms; 17.4% among those patients have no clinical visual symptoms. Conclusion The rate of VEP abnormal in MS patients is more high. It may help more in the diagnosis of MS.
Randomized controlled trials (RCTs) are the gold standard for the design of clinical trials. Because of some practical difficulties, more and more researchers think that the appropriate use of non-randomized controlled trials may make up for the weakness of RCT and will achieve the same research purpose. Therefore, non-RCTs are also very important. Taking studies on multiple sclerosis for example, this article briefly introduces the significance of non-randomized contolled trials.
ObjectiveTo study whether the pattern visual evoked potential (P-VEP) under different spatial frequency in patients with multiple sclerosis (MS) is different from normal people. MethodsP-VEP examination under high (15') and low (60') spatial frequency was performed on 18 MS patients (36 eyes) treated in our department from September 2011 to April 2012 and 20 normal volunteers (40 eyes). Then, we analyzed the difference between the two groups under the above-mentioned two kinds of spatial frequency. ResultsThe latency of P100 of P-VEP under high spatial frequency in MS patients was (120.50±13.04) ms which was significantly different from (109.21±5.38) ms of normal volunteers (P < 0.05). The latency of P100 of P-VEP under low spatial frequency in MS patients was (109.57±12.87) ms, which was also significantly different from (103.31±5.45) ms of normal volunteers (P < 0.05). The amplitude of P100 of P-VEP under high spatial frequency in MS patients was (9.17±5.69)μV and it was significantly lower than that[(15.69±8.45)μv] of normal volunteers (P < 0.05). The amplitude of P100 of P-VEP under low spatial frequency in MS patients was (11.93±16.75)μV and it was not significantly different from normal volunteers[(13.47±9.24μV)]. Based on different corrected vision, the MS patients were divided into two groups (vision≥1.0 and vision < 1.0). For patients with vision≥1.0, the latency of P100 and the amplitude of P100 of P-VEP under high spatial frequency was (113.43±8.28) ms and (12.94±5.46)μV; the latency of P100 and the amplitude of P100 of P-VEP under low spatial frequency was (111.13±11.50) ms and (11.57±5.60)μV. For patients with vision < 1.0, the latency of P100 and the amplitude of P100 of P-VEP under high spatial frequency was (126.69±13.49) ms and (5.87±3.43)μV; the latency of P100 and the amplitude of P100 of P-VEP under low spatial frequency was (108.26±14.11) ms and (12.24±5.82)μV. There was no significant difference in the latency and amplitude of P100 under low spatial frequency between the two groups with different corrected vision (P > 0.05), but the latency and amplitude of P100 under high spatial frequency were both significantly different between those two groups (P < 0.05). ConclusionsCompared with normal people, MS patients feature latency delay and amplitude reduction of the P-VEP, which was more severe under high spatial frequency. P-VEP under high spatial frequency may become an important evidence to evaluate visual function of MS patients.
ObjectiveTo investigate the morphology of brain regions undergoing multiple sclerosis (MS) MRI, and furthermore, to investigate possible diagnostic values of MRI for MS. MethodsMRI images of 42 MS patients (34 females and 8 males, aged between 35 and 81 years old, averaging at 58) who visited the hospital during the time from December 2007 to December 2013 were collected and analyzed. Routine T1, T2 and fluid attenuated inversion recovery (FLAIR) scans were performed on all the 42 patients. Sagittal T1, T2 and FLAIR scans were performed when necessary. Contrast-enhanced MRI was performed on 9 of the 42 patients. The abnormal findings from MRI scans of all the 42 patients were analyzed. The analysis was further concluded to yield general characteristics of MS patients under MRI. ResultsA total of 286 lesions were identified in 42 patients. Ninety (31.6%) of the 286 lesions (seen in 35 patients) were found to locate around lateral ventricles; 67 (23.4%) at centrum semiovale (seen in 29 patients); 59 (20.6%) in deep white matter (seen in 28 patients); 46 (16.1%) around corpus callosum (seen in 30 patients); 21 (7.3%) in brain stem, basal ganglia and cerebellar hemispheres (seen in 9 patients); and 3 (1.0%) at cervical spinal cord. In routine MRI images, the lesions showed up as low T1 signal, high T2 signal and high FLAIR signal with the shape of ovoid or round. No mass effect was observed in lesions. In the contrast-enhanced MRI images, the 25 observed lesions showed mild enhancements with the shape of ring, semi-ring and arc. ConclusionCertain characteristic features can be observed in MS MRI images. MRI is an effective diagnostic method for multiple sclerosis diagnosis.
ObjectiveTo systematically review the efficacy of cognitive behavioral therapy (CBT) for improving mental health and social functions in patients with multiple sclerosis (MS). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 4, 2016), CBM and CNKI from inception to May 2016, to collect randomized controlled trials (RCT) about CBT on mental health and social function in patients with MS. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 11 RCTs involving 1 102 patients were included. The results of meta-analysis showed that, the HADS scores (depression: MD=-1.28, 95%CI-2.07 to-0.48, P=0.002; anxiety: MD=-1.52, 95%CI-2.99 to-0.06, P=0.04), BDI scores (MD=-9.11, 95% CI-15.82 to-2.40, P=0.008), HRDS scores (MD=-7.23, 95% CI-13.65 to-0.82, P=0.03), Chalder scores (MD=-4.88, 95% CI-6.61 to-3.16, P < 0.000 01), MFIS scores (MD=-2.98, 95% CI-4.52 to-1.44, P=0.000 2) and GHQ-12 scores (MD=-3.61, 95%CI-5.20 to-2.02, P < 0.000 01) in the CBT group were lower than that in the control group. No significant difference was found in WSAS scores (MD=-1.98, 95%CI-4.88 to 0.93, P=0.18) between two groups. ConclusionCBT may be effective for improving the negative mental experience, fatigue and quality of life in MS. No evidence to support CBT has benefits in social functions. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality studies.
ObjectiveTo evaluate the magnetic resonance imaging (MRI) manifestations, pathological and clinical characteristics, and treatment outcomes of multiple sclerosis (MS) patients with new lesion in medulla oblongata (MO).MethodsPubMed, EBSCO, and Springer databases between January 1st, 2000 and May 1st, 2018 were searched with the combined keywords of " multiple sclerosis” and " medulla oblongata”. Furthermore, the MS patients’ MRI manifestations, pathological and clinical characteristics, and treatment outcomes were summarized.ResultsA total of 18 papers were involved, in which 26 patients were included. The lesions in MO were mainly showed by wedge-shape (9/20), and round or oval-shape (9/20) in axial head MRI. Inflammatory cells infiltration and acute demyelination in the new lesions of MO had been displayed by autopsy reports of two MS patients. The new lesions in MO mainly referred to various types of nystagmus (9/26), left ventricular apical ballooning syndrome (LVABS) (8/26), neurogenic pulmonary edema (NPE) (6/26), and acute heart failure (6/26). Nucleus tracts solitaries (NTS), along with dorsal motor nucleus of the vagus nerve and medial reticular formation (MRF), was related to LVABS and NPE. Intercalatus nucleus, Roller nucleus and/or autonomic nerve structure were related to various types of nystagmus.ConclusionsIn axial head MRI, the new MS lesions in MO were mainly wedge-shape and round or oval-shape. Beyond that, the new MS lesions in MO could involve NTS, dorsal motor nucleus of the vagus nerve, MRF, intercalatus nucleus, Roller nucleus and/or autonomic nerve structure, resulting in special clinical features, such as, nystagmus, LVABS, NPE, and acute heart failure. Corticosteroid is still the main treatment to relieve the clinical manifestations caused by new MS lesions in MO.