Impact of fatigue in multiple sclerosis: the Fatigue Impact Scale for Daily Use (D-FIS).

OBJECTIVE: The Fatigue Impact Scale for Daily Use (D-FIS) is an eight-item instrument designed to measure subjective daily experience of fatigue. This study sought to determine the metric properties of the D-FIS in multiple sclerosis (MS) patients. METHODS: Sixty-eight patients with operationally-defined MS and fatigue (54.8% of the sample) underwent the D-FIS. Usual clinical measures for MS, the Montgomery-Asberg Depression Rating Scale (MADRS) and the Functional Assessment of Multiple Sclerosis (FAMS) were also applied. In addition, patients with fatigue completed the Fatigue Descriptive Scale, the Multidimensional Fatigue Inventory (MFI), a Visual Analogue Scale for Fatigue (VAS-F), and a Global Perception of Fatigue Scale (GPF). RESULTS: Full computable data, 95.6%; both floor and ceiling effect=1.54%; item-total correlation=0.62 (item 1) to 0.84 (item 6); Cronbach's alpha=0.91; item homogeneity =0.55; standard error of measurement=3.18; convergent validity with other fatigue measures=-0.57 (VAS-F); 0.52 (GPF); and 0.46 (MFI-general fatigue). Test-retest reliability (ICC)=0.81. There was a strong association between health-related quality of life (HRQoL) (FAMS) and D-FIS (rS=0.70). CONCLUSIONS: In this study, D-FIS proved to be a feasible and valid instrument for measuring MSrelated fatigue, a frequent symptom associated with deterioration of patients' HRQoL.

[Psychotic crisis symptomatic of an outbreak of multiple sclerosis]. / Crisis psicótica sintomática de un brote de esclerosis múltiple.

Mental disorders (especially depression and dementia) are highly prevalent among multiple sclerosis (MS) patients. Schizophrenic-type psychosis has been reported only rarely most often in advanced cases and its possible pathophysiological and even causal relation to the demyelinating disease is disputed. We describe a woman with MS who experienced 2 episodes of acute psychosis after having had only one prior episode of focal neurological dysfunction. The coincidence of psychiatric symptoms and the appearance of new white matter lesions in both hemispheres was confirmed by CT and MRI during the second episode. We suggest that in this patient the psychotic symptoms do not depend on the strategic anatomical location of plates, but rather on the effect of nonspecific lesions in a patient previously predisposed to psychiatric disorder.

[Generalized idiopathic epilepsy with refractory absence seizures in the adult]. / Epilepsia generalizada idiopática con ausencias rebeldes en el adulto.

The prognosis for generalized epilepsy with absence seizures starting in childhood and adolescence (GEA) must be given cautiously because of the possibility that seizures may persist into adulthood and occur along with tonic-clonic seizures. Such an unfavorable course may be due to factors that are intrinsic to the various epileptic syndromes involving absences and/or to individual patient characteristics. An additional factor of particular importance in GEA is inadequate treatment. We describe 15 adult patients with GEA whose mean age when examined was 41.3 years. All had experienced absence seizures since childhood and 12 had had convulsive seizures. Most were following haphazardly combined therapies. An average of 4 years was needed to modify treatment and achieve remission of seizures in 11 of the 13 cases followed for more than 1 year. We emphasize the efficacy of valproate (in 14 of 15 patients) and its combination with ethosuximide (4 patients). GEA should not be considered refractory until appropriate use of these drugs has been tried; rather it is a syndrome that may go into remission even after decades of persistent seizures.

[Multifocal encephalopathy as the principle manifestation of an occult cancer]. / Encefalopatía multifocal como principal manifestación de un cáncer oculto.

We present a patient with an occult adenocarcinoma which manifested clinically as a confusional syndrome due to multiple cerebral infarctions associated to pericarditis and immunological abnormalities. Neurological involvement was secondary to nonbacterial thromboembolic endocarditis (NBTE) which did not provoke cardiac murmurs nor was detected in type B echocardiogram. Malignant cells were not observed in the pericardial effusion or in the pericardial biopsy (1.5 x 1 cm). The clinical picture mimicked an atypical lupous syndrome. The positive diagnosis was established on necropsy. The cardiovascular complications are not frequent in cancer. NBTE usually shows up clinically as a neurologic syndrome due to multiple cerebral infarctions: the normality of complementary exams and the lack of demonstration of an underlying disease do not rule out its diagnosis. When suspecting an NBTE treatment with heparin should be promptly started.

[Pure sensory hemisyndromes caused by infarctions in the pons]. / Hemisíndromes sensitivos puros por infartos en la protuberancia.

This study reports 3 cases of pure hemisensory syndrome due to lacunar infarction at the pons, demonstrated by magnetic resonance. In all patients somatosensory evoked potentials were abnormal. In two out of the 3 cases these potentials remained abnormal even after clinical exploration normalized. Due to the distribution of the sensitive pathways it may be assumed that the hemisensory syndrome would be caused by lesions located from the cortex to the pons. By means of clinico-pathological correlations the hemisensory syndrome was attributed to lesions exclusively located at the cerebral cortex or at the thalamus. However, in 1984 the first case of hemisensory syndrome due to pontine infarction was demonstrated by computerized tomography. After this report a series of approximately 10 patients have been published in the english and french literature. None of them had data on somatosensory potentials. In our experience the study of somatosensory evoked potentials has a high sensitivity. It appears that the distribution of the sensitive defect is independent of the location of the structural lesion.