Cerebrospinal fluid IgM index correlates with cranial MRI lesion load in patients with multiple sclerosis.

In multiple sclerosis intrathecal IgM synthesis correlates with an unfavourable disease course. Whether this reflects a pathogenic role of IgM, possibly in conjunction with complement, is a matter of debate. In a cross-sectional study we measured intrathecal synthesis of IgM and the complement component C3, and on cranial MRI lesion load and central brain atrophy in clinically active patients, 17 relapsing-remitting, 16 secondary progressive. Correlative analysis showed that in relapsing-remitting patients CSF IgM index correlated with cranial MRI T2 and T1 lesion load, and central brain atrophy; and the C3 index correlated with T2 lesion load. In secondary progressive patients CSF IgM index correlated with periventricular T2 lesion load. Our data are in favour of a pathogenic role of IgM in multiple sclerosis.

Daily negative interactions and mood among patients and partners dealing with multiple sclerosis (MS): the moderating effects of emotional support.

Negative interactions with intimate partners may have adverse consequences for well-being, especially for individuals dealing with chronic illness. However, it is not clear whether negative interactions affect both dimensions of positive and negative well-being and factors that may moderate this effect have not been well-described. The aim of the present study was to examine the association between daily received negative responses from the partner and end-of-day positive and negative mood in patients with multiple sclerosis (MS) and their intimate partners. Further, the moderating role of receiving emotional support from the partner on the same day was examined. Sixty-one MS patients and their intimate partners were approached via one MS centre and the neurology department of one hospital in the Netherlands and completed computerized diaries for 14 days. Both partners filled out diaries at the end of each day, recording received negative responses, emotional support and end-of-day positive and negative mood. In line with a domain specific model, patients or partners who reported receiving negative responses on a day had higher end-of-day negative mood, whereas received negative responses were unrelated to end-of-day positive mood. Further, for both patients and partners, the adverse effect of received negative responses on end-of day mood was moderated by receiving emotional support on the same day.

Psychiatric onset of multiple sclerosis.

We present a patient with psychotic disorder as onset of relapsing-remitting multiple sclerosis (MS). In this patient, a 26-year-old female, neurological examination revealed only minor abnormalities. As cranial CT scan was normal, her psychosis was diagnosed as psychogenic. Literature on psychiatric onset of MS is reviewed paying special attention to clinical and MRI aspects. It is concluded that psychiatric onset of MS may occur in up to 1% of patients, and that in previously healthy persons with acute psychotic disorder even the slightest neurological abnormality justifies a cranial MRI examination.

Costs and quality of life in multiple sclerosis in The Netherlands.

This cost-of-illness analysis based on information from 1.549 patients in The Netherlands is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients from three specialized MS centres participated in the survey by answering a mail questionnaire (response rate, 52%). In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, early retirement and informal care as well as QOL (expressed as utility). The mean age of the cohort was 47 years, and 7.6% of patients were 65 years of age or more. Forty-eight percent of patients had mild disease [Expanded Disability Status Scale (EDSS) score of 0-3], 40% moderate disease (EDSS score of 4-6.5) and 11% severe disease (EDSS score of 7 and above). The mean EDSS score in the sample was 3.9 (median 4.0), with a utility of 0.61. Costs and utility are highly correlated with disease severity. Workforce participation decreases from around 75 to 80% in early disease to less than 5% in the very late stages. Hospitalization is very infrequent in early disease, representing less than euro 500 per year for patients at EDSS scores below 6, but increases steeply for patients at an EDSS score of 7 and above. Ambulatory care increases fivefold between early and late disease, while services rise from basically no cost to almost euro 8.000 per year at an EDSS score of 7 and euro 19.000 per year at EDSS scores of 8-9. Productivity losses are multiplied by 10 in late disease, while informal care increases from euro 300 per year at EDSS scores of 0-1 to nearly euro 15.000 per year at EDSS scores of 8-9. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from euro 9.300 per year at EDSS scores of 0-1 to euro 50.000 per year at an EDSS score of 7 and euro 78.000 per year at EDSS scores of 8-9. The same is true for utility, which decreases from 0.85 to 0.05 as the disease becomes severe. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.4 at EDSS scores of 5-6), leading to an estimated annual loss of 0.24 quality-adjusted life-years (QALYs) per patient. Relapses for patients with an EDSS score below 5 are associated with a cost of around euro 2.800 and a utility loss of 0.15 during the quarter in which they occur.