Relapse in multiple sclerosis

Galea, Ian; Ward-Abel, Nicki; Heesen, Christoph

doi:10.1136/bmj.h1765

Cited by 51 publications

(30 citation statements)

References 89 publications

(66 reference statements)

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“…High-dose short-term GCs are prescribed to manage relapses although the opinions of neurologists and national guidelines on dose and duration of GC treatment vary (130, 131). In brain endothelial cells, GCs upregulate AnxA1 that regulates endothelial barrier integrity (86, 88).…”

Section: Endothelial Response To Gcs In Multiple Sclerosismentioning

confidence: 99%

Endothelial Response to Glucocorticoids in Inflammatory Diseases

et al. 2016

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The endothelium plays a crucial role in inflammation. A balanced control of inflammation requires the action of glucocorticoids (GCs), steroidal hormones with potent cell-specific anti-inflammatory properties. Besides the classic anti-inflammatory effects of GCs on leukocytes, recent studies confirm that endothelial cells also represent an important target for GCs. GCs regulate different aspects of endothelial physiology including expression of adhesion molecules, production of pro-inflammatory cytokines and chemokines, and maintenance of endothelial barrier integrity. However, the regulation of endothelial GC sensitivity remains incompletely understood. In this review, we specifically examine the endothelial response to GCs in various inflammatory diseases ranging from multiple sclerosis, stroke, sepsis, and vasculitis to atherosclerosis. Shedding more light on the cross talk between GCs and endothelium will help to improve existing therapeutic strategies and develop new therapies better tailored to the needs of patients.

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Section: Endothelial Response To Gcs In Multiple Sclerosismentioning

confidence: 99%

Endothelial Response to Glucocorticoids in Inflammatory Diseases

et al. 2016

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“…Particularly in some of infection-triggered relapses, fluctuations may be observed or, increases or decreases in symptoms may interweave in polysymptomatic relapses. In this case, it is difficult to distinguish whether symptoms are related to a single relapse or multiple relapses (7). Therefore, there should be at least 30 days after any previous attack or a stable period to be considered as two separate relapses (26).…”

Section: The Definition and Features Of Relapsementioning

confidence: 99%

“…Higher number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem and spinal cord involvement are poor prognosis indicators. Conversely, sensory relapses, fewer relapses, and relapses with optic neuritis and recovery without sequelae are good prognostic features (6,7).…”

Section: Introductionmentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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“…The probability of a drug‐induced liver injury (DILI) was assessed by the Roussel UCLAF Causality Assessment Method (RUCAM) that depends on the value of R ‐ratio and assigns a score to factors such as time to onset, course, risk factors, concomitant drugs, nondrug causes of liver injury, previous information on the hepatotoxicity of the drug and response to rechallenge; briefly, RUCAM indicate that a drug is a possible (Berkovich, ; Galea et al., ; Lublin et al., ), probable (Citterio et al., ; Schäcke et al., ; Sellebjerg et al., ), or highly probable (>8) cause of liver injury (Hayashi & Fontana, ).…”

Section: Methodsmentioning

confidence: 99%

Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

Nociti

Biolato

Fino³

et al. 2018

Brain and Behavior

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ObjectivesHigh‐dose pulsed methylprednisolone‐related liver injury cases have been reported in the literature, but a prospective study in patients with multiple sclerosis (MS) has never been performed. The aim of this study was to evaluate the prevalence and severity of liver injury in patients with MS after pulsed methylprednisolone therapy.MethodsWe performed a prospective observational single‐center study on patients with MS treated with i.v. methylprednisolone 1,000 mg/day for 5 days. We tested the liver functionality before and 2 weeks after the treatment. In case of severe liver injury, defined according to “Hy's law,” a comprehensive hepatologic workup was performed.ResultsDuring a 12‐month observation period, we collected data on 251 cycles of i.v. steroid treatment of 175 patients with MS. After excluding eight cycles presenting a basal alteration of the biochemical liver tests, we observed a prevalence of 8.6% of liver injury in MS patients treated with pulsed methylprednisolone for clinical and neuroradiological relapses. In 2.5% of the patients, the liver injury was severe according to Hy's law; after a comprehensive hepatologic workup, three of them received a diagnosis of drug‐induced liver injury and the other three of autoimmune hepatitis.ConclusionsLiver injury after pulsed methylprednisolone therapy in patients with MS is not infrequent, and a close monitoring of aminotransferase level before treatment and 2 weeks later seems advisable.

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Relapse in multiple sclerosis

Cited by 51 publications

References 89 publications

Endothelial Response to Glucocorticoids in Inflammatory Diseases

Endothelial Response to Glucocorticoids in Inflammatory Diseases

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

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