Influence of age at disease onset on future relapses and disability progression in patients with multiple sclerosis on immunomodulatory treatment.

BACKGROUND AND PURPOSE: To investigate the relation of age at disease onset and clinical outcomes across the lifespan from adolescence in patients with multiple sclerosis (MS) on disease-modifying therapy (DMT). METHODS: We analysed data from the Swiss Association for Joint Tasks of Health Insurers database containing data from 14 718 patients with MS. Patients were included in this analysis when they were on DMT for at least 1 year. The influence of age at disease onset on future relapses and disability worsening was explored using multivariable Cox proportional hazard regression models. RESULTS: Data from 9705 patients with MS were analysed. Pediatric-onset MS patients (n = 236) had higher relapse rates and marginally slower disability worsening rates compared with adult-onset MS (n = 9469). The risk of relapses was highest in childhood and decreased continuously to about 35 years of age. It remained stable for about a decade and then again continuously decreased. In contrast, disability worsening hazards remained stable from childhood to about 32 years of age and then increased sharply around the age of 45 years. CONCLUSIONS: Age is an important factor independently affecting clinical outcomes in MS. This should be considered when designing clinical trials or choosing DMT.

Serum neurofilament light as a potential marker of illness duration in bipolar disorder.

INTRODUCTION: Investigation on specific biomarkers for diagnostic or prognostic usage in mental diseases and especially bipolar disorder BD seems to be one outstanding field in current research. Serum neurofilament light (sNfL), a marker for neuro-axonal injury, is increased in various acute and chronic neurological disorders, but also neuro-psychiatric conditions, including affective disorders. The aim of our study was to determine a potential relation between a neuron-specific marker like sNfL and different clinical states of BD. METHODS: In the current investigation, 51 patients with BD and 35 HC were included. Mood ratings with the Hamilton depression scale (HAMD) and the Young mania rating scale (YMRS) have been included. Illness duration was defined as the period from the time of diagnosis out of self-report and medical records. sNFL was quantified by a commercial ultrasensitive single molecule array (Simoa). RESULTS: There was a significant positive correlation between the number of manic episodes in the past and sNfL, controlled for age and duration of illness. (R = 0.49, p = 0.03) Depressive episodes were not associated to sNfL values. (R = 0.311, p = n.s.) Patients with >3 years of illness duration showed significantly higher levels of sNfL (M18.59; SD 11.89) than patients with shorter illness duration (M = 12.38, p = 0.03) and HC (M = 11.35, p = 0.02). Patients with <3 years of illness and HC did not differ significantly in sNfL levels. DISCUSSION: Interestingly, individuals with BD and HC did not differ in sNFL levels in general. Nevertheless, looking at the BD cohort more specifically, we found that individuals with BD with longer duration of illness (>3 years) had higher levels of sNfL than those with an illness duration below 3 years. Our results confirm previous reports on the relation of neuro-axonal injury as evidenced by sNfL and illness specific variables in bipolar disorder. Further studies are needed to clarify if sNfL may predict the disease course and/or indicated response to treatment regimes.

[Objective diagnosis of the auriculo-temporal syndrome (author's transl)]. / Zur Objektivierung des aurikulotemporalen Syndroms nach Parotisoperationen.

After 263 operations on the parotid fourteen developed the auriculo-temporal syndrome. It occurs more often after extensive procedures with dissection of the facial nerve than after simple extracapsular shelling out. A method of establishing the diagnosis of the syndrome objectively by measuring the electrical resistance is described. The aetiology ist attributed to parasympathetic nerve fibres regenerating in the wrong direction after surgery.

[The use of vasoconstrictor agents in low concentration as additives to local anesthetics in ambulatory maxillofacial interventions]. / Die Anwendung gering konzentrierter vasokonstriktorischer Zusätze zur Lokalanästhesie bei ambulant-kieferchirurgischen Eingriffen.

The authors studied in several test series the suitability of adrenaline and noradrenaline as vasoconstrictor additives to 2% Xylocitin, in a concentration of 1:100,000. At this concentration, noradrenaline proved well suited in tooth extractions. The vasoconstrictor effect of adrenaline is sufficient in all maxillofacial interventions on an outpatient basis.

[Phantom head used to acquire skill in local anesthesia in the mandibular and maxillary regions (author's transl)]. / Phantomkopf zur Erlernung der Lokalanästhesie im Kieferbereich.

This paper describes a phantom head used to acquire skill in local anesthesia in the mandibular and maxillary regions, thus helping students in putting theoretical knowledge into practice. An electric display device enables the student's proficiency level to be determined objectively. Five years' clinical testing of the phantom in the practical training of students shows the advantages of simulatory methods of training. Although this form of instruction cannot of course be regarded as an alternative to practical anesthetizing exercises on patients, yet it has proved a valuable addition to the various possible ways of putting theoretical knowledge into clinical practice.

[Cardiovascular behavior after local anesthesia in the jaw region with added vasoconstrictor agents]. / Herz-Kreislauf-Verhalten unter Lokalanästhesie mit vasokonstriktorischen Zusätzen im Kieferbereich.

The authors studied the cardiovascular behaviour after injection of different amounts of xylocitin added with adrenalin (1:80 000) and noradrenalin (1:20 000), respectively. The evaluation of the blood-pressure values, pulse rates and electrocardiograms leads to the conclusion that noradrenalin produces considerable side effects at the above-mentioned concentration. The well-known headache phenomena caused by the addition of noradrenalin are analysed.