A recent interest in euphoria in multiple sclerosis (MS) has resulted in a wealth of literature on this topic. However, a marked change in the definition of this symptom appears to have taken place since its first descriptions in the mid-19(th) century. This short report will demonstrate that the 'euphoria' being studied today may not be the same state as that originally observed and described in MS patients and some implications of this possibility are discussed.
Two aphasia tests — the Cookie Theft Test and the Boston Naming Test — were adapted to help eliminate western cultural, language and education bias in neurocognitive screening in South Africa. These tests were among the commonly used tests initially chosen for inclusion in a larger neurocognitive screening battery currently being developed and translated for use in South Africa — the Groote Schuur Neurocognitive Battery. The adaptations were made employing quantitative and qualitative converging lines of evidence to evaluate their efficacy. This evidence included consultation with clinicians at Groote Schuur Hospital and translators knowledgeable in Afrikaans and isiXhosa language and culture, qualitative feedback from the research participants, and the results on the tests. The adapted tests were piloted by testing 30 neurocognitively intact controls consisting of equal numbers of Afrikaans, English and isiXhosa speakers, comparing their scores to their performances on the original tests. Three aphasic patients were also briefly tested. Results indicate that the adaptations made to the tests improved the performance of controls over the original versions, and tentatively suggest that the adapted tests should be able to screen for aphasia. This pilot study recommends further changes to the Groote Schuur Naming Test before its introduction into the battery ahead of its validation.
Background. A subgroup of MS patients present with “euphoria.” Classical authors describe this symptom as the predominant mood state of these patients, while contemporary authors regard it as rare. Objective. This study aimed to address these discrepancies and investigate the contributions made by varying operational definitions and measurement instruments. Methods. One hundred MS patients and 100 matched controls completed the classical interview of Cottrell and Wilson and the modern Neuropsychiatric Inventory in a once-off interview. Results. The MS group demonstrated high frequencies of euphoria using the classical measure but low frequencies using the contemporary measure and definition. The matched control group demonstrated significantly higher rates than the MS group using the classical measure and lower rates than the MS group using the contemporary measure. Conclusion. The discrepancies in incidence rates of euphoria noted in the literature do not reflect a change in the incidence of euphoria in MS, but rather in the definition and operationalisation of “euphoria.” Furthermore, these results highlight the importance of characterising what represents pathological euphoria as well as the need for better definitions and instruments of measure.
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