Predictors of attack severity and duration in multiple sclerosis: a prospective study.

OBJECTIVE: To evaluate predictors of severity and duration of early Multiple Sclerosis (MS) attacks. METHODS: We analyzed 248 attacks in 95 patients in a prospective study. Severity: the difference between the EDSS score at the day of maximum worsening and the EDSS score before the onset of the attack. DURATION: the time between the date of onset of the first symptom and the date of maximum improvement of the last symptom. RESULTS: The number of involved Functional Systems (FS), FS type (brainstem and pyramidal), and total attack duration were linked to severity. Number of FS involved, FS type (sphincteric and sensory), and severity of the attack were related to duration. Neither severity nor duration were correlated to other predictors: gender, age and season at attack onset, speed of onset, infections in the preceding month, age at first attack, season of birth and first attack, CSF examination, first brain MRI, recovery from the first attack. In the multivariate analysis, the Odds Ratio (OR) and Confidence Intervals (CI) for severe attacks was 3.6, 1.7-7.7 for involvement of pyramidal FS, 2.6, 1.2-6.0 for brainstem and 2.5, 1.2-5.3 for long attack duration. Sphincteric (4.4; 1.7-11.0) and sensory FS (1.8; 1.0-3.2) were the only variables explaining duration. The probability of a second moderate/severe or long attack was not influenced by severity or duration of the first. CONCLUSION: FS are predictive of severity and duration of early MS attacks. Severity and duration of the first attack do not predict severity and duration of the second.

[Progress of labor and neonatal morbidity in primiparity with breech presentation]. / Der Geburtsverlauf und die neonatale Morbidität bei Erstgebärenden mit Beckenendlage.

Progress of labour in 100 consecutively delivered term ( > or = 37 weeks) primiparous breech births was analysed and correlated with fetal outcome according to different durations of first and second stages. All women had sonographic biometry prior to admission and epidural anaesthesia (PDA) early in established labour. Women with nonreassuring fetal heart rate tracings during any stage of labour were delivered by caesarean section, and were excluded. Birth weights were between 1980 g and 4090 g. There was no perinatal mortality, but eight neonates sustained birth associated trauma (6 Erb's palsies, two fractured long bones), all of which regressed spontaneously. Risk of neonatal trauma and of reduced Apgar scores was significantly associated with duration of the first stage but not of the second stage. It appears that short first stage duration (i.e. up to six hours) or a cervical dilatation rate of no less than 1 cm/h is associated with a very low risk of fetal trauma. In contrast, no upper limit of a second stage duration associated with low trauma risk could be seen in this group of parturients with effective continuous epidural anaesthesia. Assumptions regarding risks in primiparous labour progress for term breech labour may need to be reevaluated. The data presented are suitable for comparison with those from other centres and for metaanalyses.

Withdrawal-like effects of pentylenetetrazol and valproate in the naive organism: a model of motivation produced by opiate withdrawal?

Pentylenetetrazol (PTZ) and sodium valproate (VPA) produce acutely in the naive rat various behavioural effects resembling signs of opiate withdrawal in the morphine-treated subject. Suggestions in the literature that these substances may activate directly some of the neural consequences of opiate and drug withdrawal prompted us to look for and examine possible aversive effects of these substances at non-toxic doses. With a sensitive two-flavour, three-trial taste aversion procedure, relatively low doses of PTZ and VPA (5 and 160 mg/kg, respectively) do indeed have aversive effects. The maximum aversions were produced by 10 and 20 mg/kg PTZ and 320 mg/kg VPA and were equivalent to those of morphine withdrawal precipitated by 0.01-0.03 mg/kg naloxone in a morphine pellet-implanted animal. Moreover, the maximum aversions with PTZ and VPA were significantly higher than the maximum aversions seen with naloxone in the drug-naive animal under the same training conditions. Thus, the data from the present study confirmed the notion that low doses of PTZ and VPA in the naive animal may activate processes activated by drug withdrawal, including those important for the motivational effect of withdrawal. However, it was also pointed out that the lowest dose VPA producing aversion was higher than that found here to produce writhes and ataxia (80 mg/kg) but the same as that required for shaking (160 mg/kg), while the PTZ aversion was at a dose lower than that known to produce a PTZ cue. Implications were discussed for using withdrawal-like phenomena as a model in the non-treated organism of clinically-relevant withdrawal effects.

What cervical dilatation rate during active labour should be considered abnormal?

The present study tested the common notion of slow labour that only dilatation rates of 1 cm/h and above lead to normal (intervention free) delivery. We examined all primiparous spontaneous term labours cared for in our hospital over a 1 year period when a protocol for intervention in the case of slow dilation rate was not in place. Of 505 consecutive singleton labours, 105 (20.6%) progressed at an overall cervical dilatation rate of less than 1 cm/h. However, only those progressing at 0.5 cm/h and less (n = 52 or 10.3% of the total) had significantly increased rates of oxytocin usage and of caesarean section. The data suggest that there may be a more conservative definition of slow labour.