Diagnosis and treatment of multiple sclerosis

“…Interferon-β and Glatiramer Acetate (Murray, 2006). In addition, new reagents such as Tysabri or FTY720 have proven to efficiently ameliorate MS in clinical trials (Fontoura et al, 2006).…”

Section: Multiple Sclerosis and Its Animal Model Experimental Autoimmmentioning

confidence: 99%

Glucocorticoids in the control of neuroinflammation

Tischner

Reichardt

2007

Molecular and Cellular Endocrinology

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Glucocorticoids are a class of steroid hormones that are endowed with profound antiinflammatory and immunosuppressive activities. Endogenous glucocorticoids are key players in the modulation of the immune system and establish an endocrine basis of many inflammatory diseases. In addition, synthetic glucocorticoids are amongst the most commonly prescribed drugs worldwide for the treatment of autoimmune disorders. In this review we summarize our present knowledge on the mechanisms by which glucocorticoids impact on multiple sclerosis (MS), a highly prevalent neuroinflammatory disease, and its animal model experimental autoimmune encephalomyelitis (EAE). In spite of the new methodologies that have become available during recent years, we are still far from a comprehensive picture of the mechanism by which glucocorticoids control neuroinflammation. Keywords: Glucocorticoids; Multiple Sclerosis; Experimental AutoimmuneEncephalomyelitis; Apoptosis; Blood-brain barrier Page 2 of 33A c c e p t e d M a n u s c r i p t -3 IntroductionGlucocorticoids (GCs) are a class of steroid hormones that are commonly used to treat acute and chronic inflammatory disorders (Tuckermann et al., 2005). They exert most of their functions by binding to the glucocorticoid receptor (GR), which controls gene expression and signalling cascades through genomic as we ll as non-genomic mechanisms. By this means, GCs modulate the survival, differentiation, migration and various effector functions of leukocytes and other cell types and thereby impact both, innate and adaptive immunity. W hilst GCs administered at pharmacological concentrations are considered purely immunosuppressive, fluctuations in the levels of endogenous GCs, e.g. during stress, result in more complex immunomodulatory effects (Elenkov and Chrousos, 1999).One major application of GCs is the treatment of neuroinflammatory disorders, in particular multiple sclerosis (MS), the most prevalent chronic autoimmune disease of the central nervous system (CNS) in the Western world (Noseworthy et al., 2000). MS is characterized by infiltrating autoreactive T-cells in the CNS that initiate aninflammatory cascade involving leukocytes and humoral components (Sospedra and Martin, 2005). This causes demyelination and axonal loss, which eventually leads to severe functional deficits. While GCs have no positive effect on the long-term prognosis of MS, optic neuritis and other acute relapses are widely treated with high doses of methylprednisolone (Milligan et al., 1987). Still, such a therapy may lead to severe complications or incomplete recovery. Furthermore, it is known that the course of MS is influenced by the level of endogenous GCs (Elenkov and Chrousos, 1999). Women in the third trimester of pregnancy and Cushing syndrome patients often experience remission of the disease. This is explained by a polarization of the immune system towards T H 2 dominated responses as a consequence of increased Page 3 of 33A c c e p t e d M a n u s c r i p t -4 cortisol synthesis. Thus, fluctuations in G...

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“…Kapsamlı bir fizik muayeneden sonra manyetik rezonans görüntüleme (MRG), beyin omurilik sıvısı (BOS) incelemesi ve uyarılmış potansiyellerin de dikkatlice değerlendirilmesi gerekmektedir. Tüm bu incelemelere rağmen bazı hastalarda kesin tanı konulamamaktadır (2,3 Kadınlarda daha sık görülmektedir (7). Genç hastalarda, akut-subakut gelişen nörolojik semptomlarda öncelikle demiyelinizan hastalıklar akla gelmelidir.…”

Section: Introductionunclassified

Kistik İntraserebral Görüntüleme Örneği İle Başvuran Multiple Skleroz Hastalığı: Olgu Sunumu

Eren¹,

Öngün²,

Gezer³

et al. 2018

GenelTipDer

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ÖzMultipl skleroz (MS) tanısında ve ayırıcı tanısında bazı olgularda çeşitli güçlükler yaşanmaktadır. Klinik belirti ve bulgular yanında, manyetik rezonans görüntüleme (MRG), beyin omurilik sıvısı (BOS) incelemesi ve uyarılmış potansiyeller tanıyı kesinleştirmek için önemlidir. Tüm bunlara rağmen bu testlerin tanısal duyarlılık ve özgüllüğü sınırlıdır. Elli yedi yaşında tavuk çiftliği işletmecisi olan erkek hasta, 35 gün önce başlayan sağ yüz yarısında uyuşma ve denge bozukluğu yakınması ile başvurdu. Sağ yüz yarısında objektif hipoestezi ve sağda Babinski bulgusu saptandı. Beyin MRG incelemesindeki; 2 cm çapında, halkasal kontrast tutulumu olan homojen lezyon öncelikle kistik bir oluşumu düşündürdü. BOS ve görsel uyarılmış potansiyel neticesinde hastanın MS olduğu anlaşıldı. Bu hastaların klinik ve nörogörüntüleme ile takibi ayırıcı tanıda değerli bilgiler sağlayabilmektedir.Anahtar Kelimeler: Multiple skleroz, kist, manyetik rezonans görüntüleme AbstractThere are several difficulties in diagnosing of multiple sclerosis (MS) and differential diagnosis in some cases. In addition to clinical signs and symptoms, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and evoked potentials are important to confirm the diagnosis. Despite all these, the diagnostic sensitivity and specificity of these tests is limited. The male patient, a poultry farmer at the age of fifty-seven, applied with complaints of numbness of right facial area and balance disorder which started 35 days ago. Objective hypoesthesia in the right half of the face and Babinski finding in the right were detected. Brain MRI study; a homogeneous lesion of 2 cm in diameter with annular contrast enhancement was thought to be primarily a cystic formation. The patient was diagnosed with MS as a result of CSF and visual evoked potential. Clinical and neuroradiologic evaluation of these patients can provide valuable information on differential diagnosis.

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Diagnosis and treatment of multiple sclerosis

Cited by 169 publications

References 14 publications

Improving Multiple Sclerosis Plaque Detection Using a Semiautomated Assistive Approach

Improving Multiple Sclerosis Plaque Detection Using a Semiautomated Assistive Approach

Glucocorticoids in the control of neuroinflammation

Kistik İntraserebral Görüntüleme Örneği İle Başvuran Multiple Skleroz Hastalığı: Olgu Sunumu

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