Clinical Neurology and Neurosurgery RSS feed: Current Issue. Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide. Professor Peter Paul De Deyn, Scientific Director of the Institute Born-Bunge at the University of Antwerp, Belgium, is the Editor-in-Chief. The journal has a broad international perspective. Types of Papers: • Reviews • Neurological progress, concerning new developments in the field of clinical neurology and neurosurgery • Special articles, written by invited authors • Original articles, full-length papers devoted to the scope and purpose of the journal • Case histories, reporting unusual clinical syndromes or diseases. These papers should be no less than 3 pages print, not including illustrations and tables • Letters to the Editor, comments on articles in Clinical Neurology and Neurosurgery • Book reviews • Announcements are carried at the Editor's and Publisher's discretion. http://www.clineu-journal.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Clinical Neurology and Neurosurgery0303-84671127September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clineu-journal.com/article/PIIS030384671000212X/abstract?rss=yesEditorial Board10.1016/S0303-8467(10)00212-XClinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5iihttp://www.clineu-journal.com/article/PIIS0303846710000661/abstract?rss=yesAbstract: Gilles de la Tourette is now known for the disease which now bears his name, but his activities in the management of hysterics and in hypnotism, which gained him most of his lifetime reputation, have been largely forgotten. As one of the closest followers of Jean-Martin Charcot, he always remained faithful to his mentor's views, and was one of the most vehement defenders of La Salpêtrière school during the quarrel with Hippolyte Bernheim and the Nancy school on the question of the specificity of hypnotic susceptibility in hysteria. This controversy became critical during medico-legal assessment of crimes supposedly committed under hypnotic suggestion. Gilles de la Tourette's involvement in criminal hypnotism was striking, as shown by his own experiments, the most famous of which being his suggested poisoning of a colleague by Blanche Wittman, the celebrated Charcot's hysteric patient in the 1887 Brouillet's painting. Gilles de la Tourette also acted as expert in murder trials, and his Épilogue in the Gouffé’s trunk case, where he affirmed that no murder in real life could be due to hypnotism, and considered that Gabrielle Bompard, the murderer's accomplice, was not under hypnotic suggestion, had a considerable impact. Finally, he was confronted to the issue of murder under hypnotism in his private life, since in 1893, a former patient, Rose Kamper, came and shot him in the head at his home, claiming that hypnotism sessions had changed her own person, and that she had been hypnotized “at distance”. These acts from three very different “hysterical” women highlight the Salpêtrière's theories on hypnotism and their inner contradictions in the fin de siècle ambiance, a few years before Joseph Babinski renewed the concepts on hysteria.Gilles de la Tourette's criminal women: The many faces of fin de siècle hypnotismJulien Bogousslavsky, Olivier Walusinski10.1016/j.clineuro.2010.03.008Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Discussion549551http://www.clineu-journal.com/article/PIIS0303846710000594/abstract?rss=yesAbstract: Objectives: Acute subdural hematoma (SDH) normally appears as a panhemispheric collection of blood with a crescent configuration. However, a number of SDH show lentiform appearances, mimicking acute epidural hematoma (EDH). In this study, we reported our experiences with this special disease entity. Radiological features that aided in the accurate localization of the hematoma were also addressed.Patients and methods: From among 51 acute SDH cases who were surgically treated between July 2007 and April 2008, five cases whose SDH had a localized convex appearance were enrolled. Surgical records and CT images were retrospectively reviewed. Important CT features that could differentiate lentiform SDH from EDH were especially analyzed.Results: Subdural adhesions were major causes of localized SDH in four out of five patients, all of whom had previous neurosurgical interventions or radiotherapy. Though those hematomas appeared as biconvex on CT scans, four differential features could be identified in favor of SDH. These included a crescentic tail, an obtuse angle at the margin of the hematoma, a dural line above the hematoma and a direct connection to the underlying intracerebral hematomas.Conclusions: Biconvex localized SDH might be misinterpreted as acute EDH if the diagnosis is based on the shape of the hematoma alone. This study emphasized that a detailed evaluation of surgical histories and CT features are mandatory in differentiating lentiform SDH and EDH.Differential CT features of acute lentiform subdural hematoma and epidural hematomaI-Chang Su, Kuo-Chuan Wang, Shih-Hao Huang, Chien-Hsun Li, Lu-Ting Kuo, Jin-Er Lee, Ham-Min Tseng, Yong-Kwang Tu10.1016/j.clineuro.2010.03.001Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Original articles552556http://www.clineu-journal.com/article/PIIS0303846710000727/abstract?rss=yesAbstract: Introduction/Aim: Health-conditioned quality of patients’ life is equally a result of their subjective perception of the disease and their objective condition. The aim of this paper is to evaluate the quality of life of surgically treated lumbar radiculopathy patients by using a generic and a lumbar disease-specific questionnaire.Methodology: 50 patients were evaluated (average age: 44.9 years; 52 male and 48 female). Two questionnaires were used for this purpose: the SF36 generic questionnaire, measuring eight quality of life domains divided into two sub-domains (overall physical and overall mental health), and the NASS LBP lumbar disease-specific questionnaire measuring four domains (pain and disability, motor and sensory neurogenic symptoms, expectations from the treatment and satisfaction with it). The results of the physical domain (SF36-PHYS) are low at the beginning of monitoring (25.7); they increase over the following 6 months (46.4) and drop insignificantly after 4 years (45.9). The mental health value (40.4) remained unchanged as compared to that of the general population. Values of the physical functioning domain reach that of the general population (80.0) after 6 months. Neurogenic symptoms domain results (NASS LBP-NS) do not correlate with other scales and domains. The conclusion is that the quality of life of patients after a lumbar microdiscectomy deteriorates significantly from a physical point of view immediately after it. It normalizes over the following 6 months, though a certain degree of physical damage still remains. Mental health alteration is not specific for lumbar radiculopathy. The neurogenic symptoms domain is the least improved dimension of their quality of life: it is very specific and to be evaluated with a special test set.The quality of life of patients after a lumbar microdiscectomy: A four-year monitoring studyK. Bošković, T. Cigić, M. Grajić, S. Todorović-Tomašević, A. Knežević10.1016/j.clineuro.2010.03.014Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Original articles557562http://www.clineu-journal.com/article/PIIS0303846710001393/abstract?rss=yesAbstract: Objectives: The aim of the study is to assess the clinical value of 16-row multislice computed tomographic angiography (CTA) for detection and treatment of intracranial aneurysms.Patients and methods: Between January 2005 and October 2008, 388 patients were included and successively underwent 16-slice CTA for suspected intracranial aneurysms. Three neuroradiologists independently reviewed CTA and DSA images. The combined interpretations of digital subtraction angiography (DSA) and surgical findings were considered as the ultimate reference standard against which the diagnostic accuracy of CTA and DSA were compared.Results: The reference standard revealed 287 aneurysms in 256 patients. There was no statistically significant difference in accuracy between 16-slice CTA and conventional DSA. The sensitivity, specificity, and accuracy of 16-slice CTA in detecting all aneurysms were 98.3, 97.0, and 97.9%, respectively, on a per-aneurysm basis. The sensitivity of 16-slice CTA was 90.0% for reader 1 and 93.3% for reader 2 for less than 3mm aneurysms. One hundred eighty-nine aneurysms were deemed amenable to endovascular therapy on the basis of CTA images, 98% of whom (185) were successfully treated with this method. Forty-eight aneurysms were considered candidates for surgical treatment, and all aneurysms were deemed completely occluded during surgical clipping. Sixteen-slice CTA images provided important preoperative information, which could assist the endovascular and surgical therapy of aneurysms.Conclusions: Sixteen-slice CTA is a highly accurate imaging examination of the first line imaging technique for the detection of intracranial aneurysms, and it can provide sufficient diagnostic information in guiding the surgical and endovascular therapy of aneurysms.Application of multislice computed tomographic angiography in diagnosis and treatment of intracranial aneurysmsWenhua Chen, Yilin Yang, Wei Xing, Jianguo Qiu, Ya Peng10.1016/j.clineuro.2010.04.022Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Original articles563571http://www.clineu-journal.com/article/PIIS0303846710000971/abstract?rss=yesAbstract: Opsoclonus–myoclonus–ataxia (OMA) syndrome is a rare neurological disorder, characterized by a rapid onset of generalized myoclonus in association with chaotic multi-directional eye movements and, less frequently, cerebellar ataxia. OMA is commonly related to a paraneoplastic process, specifically neuroblastoma in children and lung or breast cancer in adults. Nevertheless, OMA may occur in association with various infectious agents, such as Coxsackie virus B3, Epstein-Barr virus, mumps, enterovirus, and streptococcus. We recently encountered two cases of HIV-related OMA syndrome. The first patient developed a sudden onset of OMA at the time of HIV seroconversion. The second patient experienced severe ataxia with a mild degree of myoclonus and opsoclonus, associated with an elevated CD4 count following the initiation of highly active antiretroviral therapy (HAART). We suggest that OMA syndrome may be another rare manifestation of HIV infection at the time of seroconversion or during an immune restoration period.HIV-related opsoclonus–myoclonus–ataxia syndrome: Report on two casesNatlada Kanjanasut, Kammant Phanthumchinda, Roongroj Bhidayasiri10.1016/j.clineuro.2010.03.024Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Case reports572574http://www.clineu-journal.com/article/PIIS0303846710001034/abstract?rss=yesAbstract: Intracerebral hemorrhage (ICH) contributes significantly to the morbidity and mortality of patients suffering from acute leukemia. While ICH is often identified in autopsy studies of leukemic patients, it is rare for ICH to be the presenting sign that ultimately leads to the diagnosis of leukemia. We report a patient with previously undiagnosed acute precursor B-cell lymphoblastic leukemia (ALL) who presented with diffuse encephalopathy due to ICH in the setting of an acute blast crisis. The diagnosis of ALL was initially suspected, because of the hyperleukocytosis observed on presentation, then confirmed with a bone marrow biopsy and flow cytometry study of the peripheral blood. Furthermore, detection of the BCR/ABL Philadelphia translocation t(9:22)(q34:q11) in this leukemic patient by fluorescent in situ hybridization permitted targeted therapy of the blast crisis with imatinib (Gleevec). Understanding the underlying etiology of ICH is pivotal in its management. This case demonstrates that the presence of hyperleukocytosis in a patient with intracerebral hemorrhage should raise clinical suspicion for acute leukemia as the cause of the ICH.Diagnosis of acute lymphoblastic leukemia from intracerebral hemorrhage and blast crisis. A case report and review of the literatureMatthew R. Naunheim, Brian V. Nahed, Brian P. Walcott, Kristopher T. Kahle, Chad P. Soupir, Daniel P. Cahill, Lawrence F. Borges10.1016/j.clineuro.2010.04.001Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Case reports575577http://www.clineu-journal.com/article/PIIS030384671000106X/abstract?rss=yesAbstract: We describe a patient with an intraspinal paraganglioma who presented with normal pressure hydrocephalus. A 70-year-old man presented with a 6-month history of gait disturbance and cognitive dysfunction. Computed tomography of the brain and magnetic resonance imaging of the spine revealed communicating hydrocephalus and a spinal mass at the T12–L1 level which proved to be a paraganglioma of the filum terminale. Radioisotope cisternography revealed a severe delay in cerebrospinal fluid circulation. Symptoms related to communicating hydrocephalus resolved after tumor resection.Paraganglioma of the filum terminale presenting with normal pressure hydrocephalusHak Young Rhee, Dae Jean Jo, Jun-Hwan Lee, Sung Hun Kim10.1016/j.clineuro.2010.04.004Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Case reports578581http://www.clineu-journal.com/article/PIIS0303846710001447/abstract?rss=yesAbstract: In the last two decades MS has changed from an idiopathic condition with only symptomatic treatments to a disease with better characterized pathophysiologic underpinnings and several treatments that modify its long-term course based on specific mechanisms of action. There are now several FDA approved options for therapy at the onset of disease, and discussions have begun on choosing the best treatment in individual patients and what option to choose next in patients who are failing their current treatment. Numerous studies have begun to highlight that the underlying pathology of CNS damage may be different in subsets of patients, raising the possibility that some may respond to a treatment with a mechanism of action that is targeted to ‘their’ MS. Trials are ongoing of numerous new agents with different mechanisms of action and some combination therapies. A better understanding of how each therapy works may guide decisions on initiating, combining or changing therapy in a more rational way to improve patient outcomes. Further knowledge of underlying mechanisms of disease in different patients with ‘the same’ disease may lead to more targeted therapies, as will biomarkers that predict clinical response to therapy. Studies of the effects of various agents used in MS reveal both overlapping and distinct mechanisms of actions that may be relevant to their efficacy and side effects in individual patients. However, it is important to remember that most agents are approved based on their reduction of MRI lesions and relapse rates over a short time frame. These measures only partially correlate with long-term disability, which may be the most relevant clinical outcome for people with MS. Fixed disability requires years to become apparent, and there is a lack of large studies of biomarkers for chronic outcomes. In addition, few large studies correlate response to therapy with cognitive outcomes, which are a major cause of chronic disability.This review will attempt to summarize clinically relevant knowledge of the mechanisms of action of current FDA approved therapies for MS in the context of ongoing clinical trials of combination therapy and address rational approaches to changing therapy in a patient suspected to be ‘unresponsive’ to their current treatment.Overlapping and distinct mechanisms of action of multiple sclerosis therapiesJ.J. Graber, C.A. McGraw, D. Kimbrough, S. Dhib-Jalbut10.1016/j.clineuro.2010.05.002Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference583591http://www.clineu-journal.com/article/PIIS0303846710001125/abstract?rss=yesAbstract: Multiple sclerosis (MS) is the most common disabling chronic disease of the central nervous system among young adults. These patients suffer from variety of symptoms that have a profound affect on their working ability, activities of daily living and general quality of life. Treatment of these symptoms is important in order to relief them and improve daily function and quality of life. Many of these symptoms are often resistant to treatment. Botulinum toxin A (BTX) is mainly used for spasticity and bladder dysfunction in MS. It is an effective treatment option for spasticity of the thigh adductor, pes equinus, striatal toe or adductor of the shoulder joint. BTX injections are effective in reducing incontinence episodes and urinary urgency, daytime frequency and nocturia, as well as sustained improvements in quality of life of MS patients with detrusor overreactivity. In addition, BTX is potentially effective in treating pain, trigeminal neuralgia, tremor, neuro-ophthalmologic complications, facial myokymia, gastroparesis, sialorrhea, and hyperhidrosis, however no studies have confirmed its efficacy in MS patients.The place of the botulinum toxin in the management of multiple sclerosisMario Habek, Arnon Karni, Yakov Balash, Tanya Gurevich10.1016/j.clineuro.2010.04.010Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference592596http://www.clineu-journal.com/article/PIIS0303846710000648/abstract?rss=yesAbstract: Objectives: Spasticity, cognitive impairment, depression and fatigue significantly reduce the quality of life in multiple sclerosis (MS) patients. To find out whether nonpharmalogical treatment approaches can reduce these symptoms we investigated effects of sports climbing (SC) and yoga on spasticity, cognitive impairment, mood change and fatigue in MS patients. Sports climbing (SC) and yoga are aerobic physical activities comprised a series of stretching techniques, implementation of which demands body control and planning of complex movements.Materials and methods: 20 subjects with relapsing–remitting or progressive MS, 26–50 years of age, with EDSS≤6 and EDSS pyramidal functions score (EDSSpyr)>2 were enrolled in a randomized prospective study. The participants were randomly divided into SC and yoga group. We evaluated spasticity, cognitive function, mood and fatigue before and after both programs, that lasted 10 weeks, with standardized assessment methods.Results: There were no significant improvements in spasticity after SC and yoga. In the SC group we found a 25% reduction (p=0.046) in EDSSpyr. There were no differences in executive function after the completion of both programs. There was a 17% increase in selective attention performance after yoga (p=0.005). SC reduced fatigue for 32.5% (p=0.015), while yoga had no effect. We found no significant impact of SC and yoga on mood.Conclusions: Yoga and SC might improve some of the MS symptoms and should be considered in the future as possible complementary treatments.Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosisOrjana Velikonja, Katarina Čurić, Ana Ožura, Saša Šega Jazbec10.1016/j.clineuro.2010.03.006Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference597601http://www.clineu-journal.com/article/PIIS0303846710000946/abstract?rss=yesAbstract: Classification criteria, etiology, pathogenesis, major central nervous system (CNS) manifestations of the antiphospholipid syndrome (APS), as well as diagnostic and therapeutic approach are discussed in the article, supported by several MRI findings to illustrate differential complexity of selected topics. Close interplay of inflammation, autoimmunity, coagulation cascade, vasculature bed, neuron physiology and demyelinization in APS is elaborated. Cerebrovascular disease, multiple sclerosis-like syndrome, seizures, cognitive disfunction, headache and migraine, chorea and catastrophic antiphospholipid syndrome (CAPS) are discussed as the most prominent CNS manifestations of the APS.Antiphospholipid syndrome and central nervous systemMiroslav Mayer, Mislav Cerovec, Marko Radoš, Nada Čikeš10.1016/j.clineuro.2010.03.023Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference602608http://www.clineu-journal.com/article/PIIS0303846710000934/abstract?rss=yesAbstract: Magnetic resonance imaging (MRI) has played a unique role in the diagnosis and management of patients with multiple sclerosis (MS). In the recent years, there have been considerable changes in the diagnostic criteria for MS as MR-based studies demonstrated its power in earlier and more accurate diagnosis of the disease. Moreover, MRI metrics have become key supportive outcome measures to evaluate the efficacy of experimental treatments in randomized, controlled trials. MRI can also be used as a prognostic tool in patients with clinically isolated syndrome. Although advanced quantitative MRI measures such as magnetization transfer, spectroscopy, and diffusion imaging have added much more to our knowledge about pathogenesis and natural history of the disease but their cost, availability, complexity and lack of validation have limited their use in routine clinical practice. Conventional MR techniques including proton density, T1/T2-weighted images and fluid-attenuated inversion recovery sequences are now accepted in standard protocols for diagnosis and treatment outcome measures in clinical trials for MS.The present review will focus on the type, morphology and evolution of MS lesions in conventional MRI and discusses their use for the monitoring of the disease both in daily clinical practice and experimental trials.Role of MRI in diagnosis and treatment of multiple sclerosisMohammad Ali Sahraian, Arman Eshaghi10.1016/j.clineuro.2010.03.022Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference609615http://www.clineu-journal.com/article/PIIS0303846710001022/abstract?rss=yesAbstract: Multiple sclerosis (MS) is a chronic idiopathic inflammatory demyelinating disease that causes neurological disability in young adults. Etiology of the disease is still unknown, but it has an immune-mediated basis and occurs in genetically susceptible individuals. Nutritional status and dietary habits in MS patients have not been extensively studied or reported, however individual findings suggest that many patients suffer from various forms of malnutrition. In patients with MS, malnutrition has been associated with impairment of the immune system; it affects mental function, respiratory muscle strength and increases a risk of specific nutrient deficiencies. These findings emphasize the need for nutritional support in MS patients. On the other hand, several nutritional compounds have been investigated as a possible treatment in MS, mostly polyunsaturated fatty acids and vitamin D, however their role in the treatment is yet to be confirmed. The aim of this review is to present data on the role of nutritional assessment and treatment in patients with MS.Nutrition in multiple sclerosisMario Habek, Iva Hojsak, Vesna V. Brinar10.1016/j.clineuro.2010.03.029Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference616620http://www.clineu-journal.com/article/PIIS0303846710001010/abstract?rss=yesAbstract: Multiple sclerosis (MS) is chronic, inflammatory disease of the central nervous system that mainly affects young adults and is characterized with dissemination of demyelinating lesions in time and space. It is well known that MS is very heterogeneous disease, so biomarkers that would reliably determine disease course, outcome or treatment response in early stages of the disease (preferentially clinically isolated syndrome) are desperately needed. Genome-wide expression analysis represents the profile of all genes in a certain tissue or cell population in a certain time point. Therefore, as the sequence of the human genome is entirely known, it is possible to analyze any given human gene in any given context. This review will discuss results and possible applications of genome-wide expression studies in brain tissue and blood samples of MS patients.Genomics in multiple sclerosisMario Habek, Fran Borovečki, Vesna V. Brinar10.1016/j.clineuro.2010.03.028Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference621624http://www.clineu-journal.com/article/PIIS0303846710001137/abstract?rss=yesAbstract: The diagnosis of multiple sclerosis (MS), despite well defined clinical criteria is not always simple. On many occasions it is difficult to differentiate MS from various non-MS idiopathic demyelinating disorders, specific and infectious inflammatory diseases or non-inflammatory demyelinating diseases. Clinicians should be aware of various clinical and MRI “red flags” that may point to the other diagnosis and demand further diagnostic evaluation. It is generally accepted that atypical clinical symptoms or atypical neuroimaging signs determine necessity for broad differential diagnostic work up. Of the infectious diseases that are most commonly mistaken for MS the clinician should take into account Whipple's disease, Lyme disease, Syphilis, HIV/AIDS, Brucellosis, HHV-6 infection, Hepatitis C, Mycoplasma and Creutzfeld-Jacob disease, among others. Cat scratch disease caused by Bartonella hensellae, Mediterranean spotted fever caused by Riketssia connore and Leptospirosis caused by different Leptospira serovars rarely cause focal neurological deficit and demyelinating MRI changes similar to MS. When atypical clinical and neuroimaging presentations are present, serology on rare infectious diseases that may mimic MS may be warranted. This review will focus on the infectious diseases mimicking MS with presentation of rare illustrative cases.Rare infections mimicking MSVesna V. Brinar, Mario Habek10.1016/j.clineuro.2010.04.011Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference625628http://www.clineu-journal.com/article/PIIS0303846710001113/abstract?rss=yesAbstract: Objective: There are many studies examining cognitive deficits in patients with multiple sclerosis (MS), while significantly less attention has been given to emotional and personality changes. A chronic neurological disorder brings many life stresses and affects the patient's ability to cope with them. This study explored the personality characteristics in a sample of MS patients.Methods: 51 MS patients (13 male and 38 female, mean age: 42.6 years, mean EDSS: 3.2). All participants were administered the Rorschach Test coded by the Comprehensive System.Results: Our findings show that the patients in our sample perceive themselves as being less competent than others, at some cost to their self-esteem. A large percentage relies on an avoidant style of coping with problems.Conclusion: These findings imply that MS patients might have special needs in terms of communication with healthcare providers, decision making and adherence to their treatment plans because of their simplifying style of information processing. We argue that it is important to consider personality as well as cognitive changes in neurological disorders such as MS.Personality characteristics of multiple sclerosis patients: A Rorschach investigationAna Ožura, Philip Erdberg, Saša Šega10.1016/j.clineuro.2010.04.009Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference629632http://www.clineu-journal.com/article/PIIS0303846710001174/abstract?rss=yesAbstract: Background: Paediatric multiple sclerosis accounts for up to 10% of all MS cases. The initial course of the disease is relapsing-remitting in most children, with a relapse rate generally higher than that observed in adult patients. There is published experience on the use of first-line disease modifying therapies in children with MS. However, about 1/3 of paediatric MS cases do not respond to IFN-β or glatiramer acetate and continue to develop relapses and disease progression. These patients could be proposed to a second-line treatment.Methods: A comprehensive review of the published literature related to pharmacologic treatment of MS in adults and paediatric patients was performed. The recent literature has been extracted for new evidence from controlled trials in adult patients, and open treatment studies and reported expert opinion in paediatric patients.Results: No disease modifying drug has been approved for the treatment of children and adolescents with MS, although the currently available first-line therapies for adults seem to be safe and well tolerated in this population. Further studies are required to assess the safety and efficacy of second-line treatments in children with MS.Conclusion: The present article constitutes an update of the existing publications regarding treatment of acute events of CNS demyelination in children and adolescents as well as considerations for the use of immunomodulatory therapies.Therapy of multiple sclerosis in children and adolescentsSilvia N. Tenembaum10.1016/j.clineuro.2010.04.015Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference633640http://www.clineu-journal.com/article/PIIS030384671000137X/abstract?rss=yesAbstract: Interferon (IFN)β has been used over the past decades as an effective first-line therapy against relapsing–remitting multiple sclerosis (RR MS), however its in vivo operative mechanisms of action are not fully understood. Current advances in our understanding of the development of the autoimmune response, including its induction by a recently discovered Th17 cell lineage, may allow us to identify the biomarkers of this effective therapy. Our in vitro human studies have characterized IFNβ’s immunoregulatory effects on Th17 cell differentiation. IFNβ inhibited IL-1β, IL-23 and transforming growth factor (TGF)-β (which induce Th17 cell differentiation), and induced IL-27, IL-12p35 and IL-10 (which suppress it) in dendritic cells (DCs) and B-cells. The effect on IL-1β, IL-23 and IL-27 production in DCs was mediated by the up-regulation of Toll-like receptor (TLR)7 and its downstream signaling molecules. IFNβ’s direct effect on naïve T-cells suppressed in vitro Th17 differentiation by inhibiting Th17 cell lineage markers (retinoic acid-related orphan nuclear hormone receptor (ROR)c, IL-17A, IL-23R and CCR6), and by inducing IL-10 production by CD4 cells, which constrains Th17 cell expansion. Our results have identified novel therapeutic mechanisms of IFNβ, which inhibit Th17 cell differentiation in the context of the autoimmune response in MS.Interferon beta inhibits the Th17 cell-mediated autoimmune response in patients with relapsing–remitting multiple sclerosisXin Zhang, Silva Markovic-Plese10.1016/j.clineuro.2010.04.020Clinical Neurology and Neurosurgery 112, 7 (2010)2010-09-01Clinical Neurology and Neurosurgery2010-09-011127S0303-8467(10)X0007-5Selected papers from the 5th Dubrovnik International Conference641645