Multiple Sclerosis

230 Pages·1997·4.13 MB·English

by  J&uuml

In Western industrialized sodeties at least one in 800 of the population
is affected by multiple sclerosis (MS). If the disease is recognized early
and treated adequately the prospects are now better than ever for im-
proving both the quality and length of life for people with MS.
This condse, abundantly illustrated text provides a complete overview
of MS for the internist, general neurologist and therapist. Including
recent research findings in genetics, immunology and pathophysiol-
ogy, the authors provide reliable and up-to-date guidance on the epi-
demiology, diagnosis, prognosis and treatment of MS.
Of particular interest to neuroscientists and neurologists will be the
reviews of experimental models of MS, pathology of the demyelinated
plaque, HLA assodations and the role of immune mechanisms. Envi-
ronmental factors in the etiology of MS are examined, including the
possible role of infectious agents. The clinical sections of the book in-
clude discussion of neurological, sexual, psychological and cognitive
disturbances, and rehabilitation measures are given spedal attention.

Multiple sclerosis

Multiple sclerosis
Edited by
]iirg Kesselring
Head of the Department of Neurorehabilitation
Rehabilitation Center
Valens, Switzerland
Foreword by Professor W. I. McDonald
National Hospital for Neurology and Neurosurgery, London
CAMBRIDGE
UNIVERSITY PRESS
PUBLISHED BY THE PRESS SYNDICATE OF THE UNIVERSITY OF CAMBRIDGE
The Pitt Building, Trumpington Street, Cambridge CB2 IRP, United Kingdom
CAMBRIDGE UNIVERSITY PRESS
The Edinburgh Building, Cambridge CB2 2RU, United Kingdom
40 West 20th Street, New York, NY 10011-4211, USA
10 Stamford Road, Oakleigh, Melbourne 3166, Australia
© Cambridge University Press 1997
This book is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.
First published 1997
An updated and adapted translation of the German edition
published by W. Kohlhammer GMBH, D-70549, Stuttgart, Germany,
as Multiple Sklerose, second edition, by Jurg Kesselring.
Printed in the United States of America
Typeset in Palatino
Library of Congress Cataloging-in-Publication Data
Multiple Sklerose. English.
Multiple sclerosis / edited by Jiirg Kesselring.
p. cm.
Includes bibliographical references and index.
ISBN 0-521-48018-3 (hardback)
1. Multiple sclerosis. I. Kesselring, Jiirg.
[DNLM: 1. Multiple Sclerosis. WL 360 M9618m 1996a]
RC377.M83713 1996
616.8'34-dc20
DNLM/DLC
for Library of Congress 96-6151
A catalog record for this book is available from the British Library
ISBN 0 521 48018 3 hardback
Contents
Foreword by W. I. McDonald vii
List of contributors ix
List of abbreviations xi
Part I General aspects
Chapter 1 Historical perspective 3
Jiirg Kesselring
Chapter 2 Pathology and experimental models 7
Hans Lassmann
Chapter 3 Genetics and immunology 30
Walter Fierz
Chapter 4 Epidemiology 49
Jiirg Kesselring
Chapter 5 Pathogenesis 54
Jiirg Kesselring and Hans Lassmann
Chapter 6 Pathophysiology of impaired neural
transmission 63
Christian Hess
Part II Clinical aspects
Chapter 7 Symptomatology 71
Jtirg Kesselring
Chapter 8 Diagnosis 87
Jiirg Kesselring and Christian Hess
Chapter 9 Disease course 116
Jtirg Kesselring
Chapter 10 Prognosis 121
Jtirg Kesselring
vi Contents
Chapter 11 Differential diagnosis 125
Jiirg Kesselring
Chapter 12 Assessment of performance, ability,
and disability 131
Jiirg Kesselring
Part III Management and therapy
Chapter 13 Symptomatic treatment and nutrition 135
Jtirgen Mertin
Chapter 14 Therapy 148
Ludivig Kappos
Appendix: Assessment Scales 169
References 179
Index 208
Foreword
In the past two decades we have witnessed a Much has been learned about cellular mecha-
remarkable growth in our understanding of nisms involved in pathogenesis and repair, and
multiple sclerosis, and we are now on the the evolution of the lesion is now much better
threshold of an era in which effective treatment understood through the exploitation of mag-
seems possible. Though the aetiology of the netic resonance imaging (MRI) and spectro-
disease is not yet fully understood, evidence for scopy. A secure early diagnosis can be made
an interaction between an environmental factor earlier in the course of the disease through the
(perhaps viral) with a genetic susceptibility fac- application of MRI, evoked potentials, and ce-
tor has grown. Four new studies just published rebrospinal fluid analysis.
(Ebers et al. 1996; Haines et al. 1996; Kuok- Developments in MRI have produced power-
kanen et al. 1996; Sawcer et al. 1996) have con- ful new tools for monitoring the effectiveness of
firmed that the latter implicates several chro- treatment. As a result, putative therapeutic
mosomes; again, the HLA region of the 6th agents can be screened relatively quickly to see
chromosome emerges as the most important.+ whether they have an influence on at least
some aspects of the pathological process. One of
•Ebers GC, Kukay K, Bulman DE, Sadovnick AD, the most encouraging developments has been
Rice G, Anderson C, Armstrong H, Cousin K,
the demonstration that a number of agents-
Bell RB, Hader W, Paty DW, Hashimoto S, Oger
most notably the beta-interferons-reduce the
J, Duquette P, Warren S, Gray T, O'Connor P,
Nath A, Auty A, Metz L, Francis G, Paulseth JE, frequency of acute pathological activity, and
Murray TJ, Pryse-Phillips W, Nelson R, Freed- that this can be reflected in a modest decrease
man M, Brunet D, Bouchard J-P, Hinds D, Risch
in relapse rate. Convincing evidence for a use-
N. A full genome search in multiple sclerosis.
ful effect on disability (surely the most impor-
Nature Genetics 13 (1996): 472-476.
tant criterion for an effective treatment) is still
Haines JL, Ter-Minassian M, Bazyk A, Gusella JF,
Kim DJ, Terwedow H, Pericak-Vance MA, awaited. But the progress over the past five
Rimmler JB, Haynes CS, Roses AD, Lee A, years gives grounds for optimism.
Shaner B, Menold M, Seboun E, Fitoussi RP,
In this timely book, the background to these
Gartioux C, Reyes C, Ribierre F, Gyapay G,
Weissenbach J, Ilauser SL, Goodkin DE, Lincoln advances is described; the areas of greater and
R, Usuku K, Garcia-Merino A, Gatto N, Young lesser certainty are delineated and the pros-
S, Oksenberg JR. (The Multiple Sclerosis Genet- pects for future progress are laid out; and the
ics Group). A complete genomic screen for
practical management of the patient as well as
multiple sclerosis underscores a role for the ma-
jor histocompatability complex. Nature Genetics of the disease are detailed. This is an exciting
13 (1996): 469-471. time for the study of multiple sclerosis, and Dr.
Kuokkanen S, Sundvall M, Terwilliger JD, Tienari PJ, Kesselring and his colleagues show why.
Wikstrom J, Holmdahl R, Pettersson U, Pelt-
onen L. A putative vulnerability locus to
W. I. McDonald
multiple sclerosis maps to 5pl4-pl2 in a region
syntenic to the murine locus Eae2. Nature Genet- National Hospital for Neurology and Neurosurgery
ics 13 (1996): 477-480. London, England
Sawcer S, Jones HB, Feakes R, Gray J, Smaldon N,
Chataway J, Robertson N, Clayton D, Good-
fellow PN, Compston A. A genome screen in
multiple sclerosis reveals susceptibility loci on
chromosome 6p21 and 17q22. Nature Genetics 13
(1996): 464-468.