Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis.

The prevalence of autoantibodies in multiple sclerosis (MS) patients and their clinical associations differ between various studies. This study investigated antiphospholipid and antinuclear antibodies in 85 patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) with regard to their association with demographic features, MS specific clinical features and symptoms of connective tissue diseases. Autoantibodies tested included antinuclear antibodies (ANA) with their specificities and anticardiolipin (aCL) and anti-beta-2-glycoprotein I (anti-ß2GPI) antibodies. Antinuclear antibodies were more prevalent in MS patients than in controls (63.5% vs. 3.3%; p < 0.01) and in 19% of patients specific antinuclear antibodies were detected. Anti-ß2GPI IgM antibodies were more frequent in MS patients than in the control group (20% vs. 3.3%; p < 0.05). The frequency of anticardiolipin antibodies did not differ between MS patients and controls. MS patients seropositive for ANA and extractable nuclear antigens (ENA) had significantly shorter disease duration than seronegative patients (p < 0.05) and a lower disability score (Expanded Disability Status Score; EDSS) (p < 0.05). Anti-ß2GPI antibodies were more frequent in patients with secondary progressive MS (SP-MS) and specific ANA antibodies were more frequent in patients with clinically isolated syndrome (CIS) (p < 0.05). The presence of autoantibodies was not associated with the predominant site of neurological involvement or the clinical features of connective tissue diseases.

Autonomic dysfunction in primary Raynaud's phenomenon.

AIM: The pathogenesis of Raynaud's phenomenon is still unclear. Neural and intravascular mechanisms are thought to be involved in the pathological process. The role of the autonomic nervous system is continually discussed, with particular attention to over-reactivity of the sympathetic part. The aim of this study was the clinical and electrophysiological analysis of autonomic nervous system function in patients with primary Raynaud's phenomenon. METHODS: Thirty four patients with primary Raynaud's phenomenon and 31 sex and age-matched controls were examined. Neurological examination, modified Low's Questionnaire, orthostatic and sustained handgrip tests, conduction velocity study in three nerves, sympathetic skin response (SSR), and heart rate variability (HRV) during deep breathing and at rest with the fast Fourier transform were performed. RESULTS: In the clinical examinations, 35.3% of the primary Raynaud's patients presented sensory neuropathy, but this was not confirmed in the standard conduction velocity tests. The modified Low's Questionnaire revealed dysautonomy in 82% of the patients. Autonomic regulation during the orthostatic and handgrip tests were within the normal limits. HRV at rest and the E/I ratio were significantly lower in the patient group than in the controls, while HRV spectrum analysis revealed the predominance of the low-frequency band in the patients. CONCLUSIONS: These results indicate the presence of sympathetic dysregulation and impairment of parasympathetic modulation of heart function in primary Raynaud's patients. The different cardiovascular and sudomotor functions are not affected to the same degree. These observations might support the theory of a central impairment of autonomic function in primary Raynaud's phenomenon. Peripheral nerve lesion as a coexisting cause of the observed dysautonomy remains uncertain.

Different patterns of activation markers expression and CD4+ T-cell responses to ex vivo stimulation in patients with clinically quiescent multiple sclerosis (MS).

Patients with relapsing-remitting (RR) and secondary progressive (SP) forms of multiple sclerosis (MS), although in long-term clinical remission, showed different patterns of increased expressions of the activation markers: CD69, CD40L, and both membrane/surface and cytoplasmic CTLA-4 (mCTLA-4 and cCTLA-4, respectively) in freshly isolated peripheral blood (PB) CD4+ T cells compared with controls. Also observed were dysregulated responses to ex vivo stimulation in both groups of MS patients accompanied by increased IFN-gamma synthesis. Our findings may suggest that the mechanisms leading to each clinical form of the disease may be heterogeneous.

HLA antigens and susceptibility to myasthenia gravis.

HLA-A, -B, -C and -DR antigen frequencies determined in a group of 73 myasthenia gravis (MG) patients were compared with those of a control group of 205 subjects. The strongest positive association with MG was found antigens B8 and DR3 (relative risks 9.56 and 8.84 respectively). Analysis of our data indicates that both antigens, independently from their linkage disequilibrium, are involved in susceptibility to MG. No relationship between HLA antigens on thymic pathology was observed in our material. In male MG patients the association with DR3 was weaker than in female patients. The difference in DR3 frequency between male and female patients was statistically significant; no significant difference was found for antigen B8. It appears that DR3 contributes to development of MG only in females. In male patients aged more than 30 years at the onset of disease, MG was not associated with B8 or DR3. In contrast, in female patients aged more than 30 years at the onset of disease there was a strong association of B8 and DR3 with the disease.

[Aspergillus spondylodiscitis]. / Spondylodiscite aspergillaire.

Four weeks after an Amanita phalloides poisoning, a 29-year-old man presented an ocular aspergillosis. One month later he developed a bilateral L5-S1 radicular syndrome. The diagnosis of aspergillar spondylodiscities was established on the basis of x-ray, CT-scan, MRI and pathology findings. Clinical and radiological improvement was obtained with fluconazole.

[Hemorrhagic manifestation of moyamoya disease in a 19-year-old woman with mental retardation]. / Krwotoczna manifestacja choroby moyamoya u 19-letniej kobiety z uposledzeniem umyslowym.

The paper presents a case of moyamoya disease, with first clinical sign subarachnoid haemorrhage in a 19-year old woman with mental impairment. The CT screen shows the presence of ischaemic areas of haemorrhagic type. MR, angio-MR and classical angiography confirmed the presence of ischaemic areas with contraction of the distal parts of the internal carotid arteries and left anterior cerebral artery. Authors call attention to the diagnostic problems of the case and accent the very important role of MR and MR angiography in the diagnosis of moyamoya disease.

[Catamnestic studies of patients with aphasia after stroke]. / Badania katamnestyczne chorych z afazja po udarze mózgu.

In 28 patients with aphasia after stroke speech ability was studied twice at intervals of 1-4 years. A comparison of the initial results with those after follow-up showed that the process of return of speech ability (especially in case of motor aphasia) is not limited to the early post-stroke period of several weeks to several months, but takes a much longer time. This justifies logopedic treatment of aphatic patients (also in sanatorium) even many months after stroke.

[Visual and somatosensory evoked potentials in workers exposed to metallic mercury vapors]. / Wzrokowe i somatosensoryczne potencjaly wywolane u pracowników narazonych na dzialanie par rteci metalicznej.

Thirty-seven workers occupationally exposed to metallic mercury vapours were subjected to neurological examination and determination of visual (WPW) and somatosensory (SSPW) evoked potentials. In 6 cases slight sings of damage to the central nervous system was demonstrated. Prolonged WPW latency was noted in 15 cases. SSPW abnormalities were observed most frequently in the cortical components (13 cases), less frequently in the brainstem components (4 cases). Simultaneous WPW and SSPW changes were present in 10 cases. In the group of workers with changes of evoked potentials the mean urinary mercury levels were higher and the duration of exposure was longer than in the remaining workers. The use of multimodal electrophysiological methods increases the effectiveness of the diagnosis of subclinical damage to the nervous system in chronic mercury intoxication.

[Cortical and spinal evoked potentials in parkinsonism. Part I. Visual potentials evoked with a checkerboard pattern]. / Korowe i rdzeniowe potencjaly wywolane w parkinsonizmie. Czesc I. Wzrokowe potencjaly wywolane odwracalnym wzorcem szachownicy.

In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).

[Changes in blink reflex (OM) after lesions of the nervous system in various locations]. / Zmiany odruchu mrugania (OM) w uszkodzeniu ukladu nerwowego o róznej lokalizacji.

Electrically evoked blink reflex (BR) as a one of the non-invasive methods is used to diagnose function of central nervous system, specially of brainstem. It seems that this method is not fully appreciated in neurological practice. On the basis of literature and own experience the authors present typical pictures of BR on EMG analysis related to the lesions of respective parts of reflex arc and suprasegmental structures involving pyramidal and extrapyramidal tracts.

[Usefulness of the "token test" in the diagnosis of aphasia]. / Przydatnosc testu "token" w diagnostyce afazji.

The authors describe a method of aphasia examination, so called Token test, not known in Poland. The method is particularly useful for evaluation of speech perception disturbances, and it may also be used in cases of aphasia with expression disturbances. Speech examination by the Token test was carvied out in 45 patients with damage to the predominating hemisphere caused by stroke and the obtained results were compared with qualitative-quantitative aphasia estimation by the conventional method (determination of spontaneous speech, ordinate speech, denomination, repetition, reading, writing and understanding). A considerable agreement of the results obtained by both methods (correlation coefficient 0.80) indicates the usefulness of the test for clinical practice, especially in cases of diagnostically uncertain aphasia.

[Clinical-electrophysiological characteristics of Alzheimer's dementia and cerebrovascular dementia based on determination of cerebral refraction time]. / Kliniczno-elektrofizjologiczna charakterystyka otepienia alzheimerowskiego i naczyniopochodnego w oparciu o badanie czasu refrakcji mózgowej.

The aim of the study was an electrophysiologic assessment of cerebral refractory period in relation to chosen clinical parameters, EEG and CT in patients with dementia of various origin. The study included 30 patients (11 female, 19 male) aged 50-75: 15 with dementia of Alzheimer type (DAT) and 15 with vascular dementia (VD), and 15 age-matched healthy controls. Cerebral refractory period (CRP) was assessed by means of somatosensory evoked potentials with the use of paired stimulation with varying interstimulus interval, applied to the median nerve. Interstimulus interval, with which one somatosensory response was obtained to paired stimuli, was determined as absolute refractory period. CRP was significantly prolonged in demented patients, when compared to the control group, with no significant difference between groups with DAT and VD. CRP correlated negatively with age and positively with Mini Mental State Examination results, assessing the degree of mental deterioration. Prolonged CRP was noted in patients with vast lesions shown in CT. No relationship between CRP and EEG changes was found. CRP is a sensitive parameter, which may contribute to electrophysiological assessment of cerebral function.

[Clinical course and changes of soluble interleukin-2 receptor and soluble forms of intercellular adhesion molecule-1 (ICAM-1) in serum of multiple sclerosis patients]. / Przebieg kliniczny a stezenie rozpuszczalnego receptora interleukiny-2 i rozpuszczalnej formy miedzykomórkowej czasteczki adhezyjnej (ICAM-1) w surowicy krwi w stwardnieniu rozsianym.

UNLABELLED: Changes were assessed in serum levels of soluble interleukin-2 receptor (sIL-2R alpha) and soluble intercellular adhesion molecule-1 (sICAM-1), indirect indices of activation of immunological system, in the course of multiple sclerosis (ms). 12 patients (av. age 39.2 +/- 9.4 y.) with the first relapse that fulfilled criteria of clinical probable ms acc. to Poser Committee were included into the study. Blood samples were taken at the beginning of the relapse and then every 2-month periods. Simultaneously, neurological impairment (EDSS scale) was assessed. When the next relapse occurred examination was repeated from the beginning. The total time of observation was between 12 and 18 months. The levels of both soluble molecules were examined with ELISA test. In relapse mean serum levels of sIL-2R alpha and sICAM-1 were significantly elevated in comparison to the results obtained in remission (respectively: p < 0.001 and p = 0.03). Changes in serum level of both soluble molecules during the first 2 months after relapse were significantly higher than in subsequent 2-month periods (p < 0.001). Each relapse was accompanied by elevation of serum levels of sIL-2R alpha and sICAM-1. There was no obtainable correlation between improvement in EDSS scale and changes in sIL-2R alpha level during the whole time of observation. Improvement in EDSS scale was correlated with lowering of sICAM-1 but only during the first two months after relapse. CONCLUSIONS: Serum level of sIL-2R alpha and sICAM-1 in ms patients during relapse is significantly higher in comparison to the results obtained during remission. Each relapse is accompanied by elevation of sIL-2R alpha and sICAM-1 in serum, during remission serum levels of both molecules do not changed significantly.

[Thyroid activity in patients with myasthenia]. / Czynnosc tarczycy u chorych na miastenie

In 27 patients with myasthenia thyroid function tests were done using radioassay methods. The levels of thyroxine (T4), triiodothyronine (T3), thyroxine-binding protein (BT4) and thyrotrophic hormone (TSH) were determined simultaneously in the serum. In 4 myasthenics the levels of T3 and T4 were determined after administration of exogenous TSH (Ambinon). The control group comprised 13 subjects without thyroid function disturbances. The investigations demonstrated a statistically significant decrease of T4 (at p less than 0.05) and T3 (at p less than 0.01) in myasthenia as compared with the control group. Administration of TSH raised the T3 level by 40% and that of T4 by 6%. The results obtained by the authors indicate presence of secondary hypothyroidism in myasthenia possibly due, to failure of the hypophyseo-hypothalamic system.

[Evaluation of language therapy in aphasia after stroke]. / Testowa ocena wyników reedukacji mowy u chorych z afazja po udarze naczyniowym mózgu.

In 27 patients with aphasia and hemiparesis following strokes speech was tested before and after completion of sanatorium treatment. After three weeks of speech re-education aphasia improved in various degrees in 19 patients. The best results of logopedic treatment were obtained in patients with medium-grade or slight aphasia subjected to rehabilitation treatment during the first three months after stroke. Effective motor rehabilitation conducted parallelly with re-education exercises in early period after stroke has a favourable effect on advance in therapy and later resocialization of patients.

[Cortical and spinal evoked potentials in parkinsonism. Part II. Somatosensory potentials evoked form the posterior tibial nerve]. / Korowe i rdzeniowe potencjaly wywolane w parkinsonizmie. Czesc II. Somatosensoryczne potencjaly wywolane z nerwu piszczelowego tylnego.

In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.

[Multiple intracranial meningiomas in a patient with asymptomatic syringomyelia]. / Mnogie oponiaki sródczaszkowe u chorej z bezobjawowa jamistoscia rdzenia kregowego.

A rare coexistence of multiple intracranial neoplasms of mesodermal origin with asymptomatic syringomyelia is reported. The clinical findings were documented by NMR and CT results. The histological examination of the tumours removed surgically is included.

[Visual and somatosensory evoked potentials in the patients with non-Hodgkin lymphoma]. / Wzrokowe i somatosensoryczne potencjaly wywolane u chorych z chloniakiem nieziarniczym.

Visual (VEPs) and somatosensory (SEPs) evoked potentials in a group of 33 patients (mean age 49 years) with non-Hodgkin lymphoma (n-HL) without CNS involvement were recorded. There were 24% of patients with pathological VEPs and 30% of patients with pathological SEPs. Pathological VEPs and SEPs were both recorded in 42% of patients. In comparison to the controls the statistically significant prolongation of mean latencies of VEPs, SEPs and transit time to cortex were found in the group of n-HL patients. These abnormalities were noted much more often in patients with long duration of the disease and with intermediate type of malignancy. In the untreated patients evoked potentials were normal. In 6 patients despite normal neurological status and normal eeg the evoked potentials were abnormal. The evoked potentials examination seems to be very sensitive method of afferent pathways involvement estimation and can be used for diagnosis and prognosis in n-HL patients. This method reveals CNS lesions more often than physical examination or eeg.

[Effect of abstinence on visual evoked potentials in alcoholics]. / Wplyw abstynencji na wzrokowe potencjaly wywolane u osób uzaleznionych od alkoholu.

Visual evoked potentials (VEP) were studied in 61 alcohol-dependent subjects analysing the amplitude and latency of the first major positive wave (P100) and carrying out the determinations three times, in the 1st, 2nd and 3rd weeks of abstinence. The results were compared with similar ones obtained in healthy subjects without a history of alcohol abuse. In the acute stage of alcohol withdrawal a significant rise was observed in the amplitude of the cortical P100/N120 complex. With regression of the clinical symptoms of withdrawal syndrome the amplitude of visual potentials decreased and demonstrated partial normalization. The mean P100 latency was significantly longer in relation to the control group and was not changed during the withdrawal period. Amplitude increase was regarded as an evidence of hyperexcitability of the central nervous system, and latency prolongation as a result of the toxic effects of alcohol and nicotine on the optic nerve.