Methylprednisolone plays an important role in the current treatment of multiple sclerosis (MS), particularly in the acute phase of relapse. It acts in various ways to decrease the inflammatory cycle including: dampening the inflammatory cytokine cascade, inhibiting the activation of T cells, decreasing the extravasation of immune cells into the central nervous system, facilitating the apoptosis of activated immune cells, and indirectly decreasing the cytotoxic effects of nitric oxide and tumor necrosis factor alpha. This paper reviews the most recent observations on these mechanisms both to understand the disease mechanism and its treatment. As more becomes known about these mechanisms, it may become possible to design treatment regimes that are more specific towards both the individual and the disease state.

This study suggests that menarche may be related to the pathogenesis of MS.

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It damages oligodendroglia and axons and may cause paralysis, sensory disturbances, incoordination, visual impairment, and alterations in bowel, bladder, and sexual function.1 The precise etiology of MS has not been elucidated; h o w e v e r, many observations suggest that both genetic susceptibility and environmental factors are implicated.2 ABSTRACT: Background: The incidence and prevalence of multiple sclerosis (MS) in Newfoundland and Labrador (NL) had been reported in 1984 and was considered to be relatively low at that time. This study revisits the incidence and prevalence of MS in NL for the year 2001. Methods: Case searches through patient files of neurologists in NL were conducted. A complete list of patients billed for MS in NL between 1996 and 2003 was obtained and all cases were confirmed via chart review. Results: There were 493 living MS patients yielding a prevalence of 94.4/100,000 which is significantly higher than previously reported. Of the living patients, 330 had relapsing remitting (RRMS), 94 had secondary progressive, 66 had primary progressive (PPMS) and three had unspecified MS. The total female to male ratio was 2.7:1. There was no difference between the female to male ratios for RRMS vs PPMS. Patients with PPMS had a later onset compared to RRMS (p<0.00001). Yearly incidences were relatively constant from 1994 to 2001 (5.6/100,000). Significant delays between first symptoms and final diagnosis were common and the delay time has not changed over the past 15 years. A prevalence of 88.9/100,000 was estimated from survival and incidence trends and was not significantly different than the measured prevalence (p=0.38). Conclusions: The increase in incidence and prevalence are accounted for through both better access to diagnostic facilities and more practicing neurologists. The revised prevalence and incidence are more in keeping with recently reported values throughout Canada.

Canadian province of Newfoundland and Labrador (NL) has recently been completed, demonstrating a population prevalence (MS) of 94.4 per 100,000.1 Newfoundland and Labrador is Canada's easternmost province and its population is unusual in the investigation of complex disease 2 as a result of its settlement history, its subsequent founder effect, and its geographical isolation. 3 The island portion of the province (Newfoundland), lies between latitudes 46 and 52N and longitudes 52 and 59W. It has an area of 108,860 km 2 and a population of 521,986 (49% urban), 4 settled largely along the sea coast. Approximately 60% of the inhabitants live in settlements ABSTRACT: Background: It has been thought that the occurrence of multiple sclerosis (MS) could be associated with daily ultraviolet exposure. In this study we investigated the geospatial association between average daily ultraviolet B (UVB) irradiance and MS prevalence in Newfoundland and Labrador (NL), Canada. Methods: A complete list of patients diagnosed with MS in the province of NL was constructed. Places of habitation from birth to diagnosis were ascertained by mailout survey. Results: A 74% rate of return on the survey results was obtained. A plot of the average daily erythemal UV over the available five years (1998)(1999)(2000)(2001)(2002) shows that the distribution of MS follow a north-south gradient. Average daily UVB measurements are lower in the higher latitudes. A statistically significant negative correlation of MS incidence with erythemal UVB was found that is stronger than the correlation using latitude. This correlation appears to be strongest in the first year of life and declines when subsequent years are examined up to age ten. No significant correlation was found for the subjects' locale of habitation at the time of their first MS attack. Conclusions: This study suggests that UVB radiation may contribute to the pathogenesis of MS. RÉSUMÉ: La relation entre le rayonnement ultraviolet et la sclérose en plaques à Terre-Neuve. Contexte :Certains croient que l'apparition de la sclérose en plaques (SEP) pourrait être associée à l'exposition quotidienne aux rayons ultraviolets. Nous avons étudié l'association géospatiale entre le rayonnement ultraviolet B (UVB) quotidien moyen et la prévalence de la SEP à Terre-Neuve et au Labrador, au Canada. Méthodes : Nous avons établi une liste complète des patients chez qui un diagnostic de SEP a été posé dans cette province. Les lieux de résidence depuis la naissance jusqu'au moment du diagnostic ont été documentés au moyen d'un questionnaire par courrier. Résultats : Le taux de participation a été de 74%. Un diagramme illustrant le rayonnement ultraviolet quotidien moyen provoquant l'érythème au cours des cinq années pour lesquelles l'information était disponible (1998 à 2002) montre que les mesures UVB quotidiennes moyennes sont plus faibles aux plus latitudes élevées. Par contre, la distribution de la SEP a un gradient nord-sud. Nous avons constaté que la corrélation négative entre l'incidence de la SEP e...

The use of a PET management strategy for the staging of breast cancer is expected to remain economically viable in Canada under various economic conditions.