Moving the treatment goalposts

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Moving the treatment goalposts

Postby bromley » Wed Nov 16, 2005 8:53 am

Here is a link to neurologists who met in Australia. It contains lots of video clips which I can't be bothered to watch at the moment. Would be grateful if someone could tell me what the upshot was?

Bromley

http://www.msaustralia.org.au/publications/video.html
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Postby Axiom » Wed Nov 16, 2005 11:46 am

Bromley,
I watched all the MRI clips.

Pretty much same old same old:

initial lesion load is strongly predictive of progression both clinically and pathologically as a whole; however, correlation between # of lesions & disability not so good in an individual.

It all hinges on lesion location.
Patient went from normal to parapalegic within 5 years, later died from heart problems. Had oligoclonal banding but only 1 lesion in spinal chord.
As many as 10 lesions per one clinical symptom depending on their location.

They have a good handle on how an individual lesion acts over time but much more difficult to gauge/predict course when you're looking at anywhere from 4 to 100 lesions in the same person that may each be at a different state of progression.

Don't even bother with the myelin sheath clip :roll:

I did not watch any of the interviews - maybe later.
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Postby bromley » Wed Nov 16, 2005 12:06 pm

Thanks Axiom - one always hopes for a real breakthrough but one is always disappointed.

Bromley

PS Paraplegic certainly falls within the list of MS 'symptoms' where I would be saying goodbye to life. But thinking about it, how does one commit suicide in such circumstances without involving a loved one? Sorry to be so morbid but it's just crossed my mind.
Last edited by bromley on Wed Nov 16, 2005 12:32 pm, edited 1 time in total.
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Postby BioDocFL » Wed Nov 16, 2005 12:23 pm

Has anyone seen any studies on the location of a lesion (or group of lesions) in the brain and the specific symptoms an MSer develops? (i.e. a cluster of lesions in the upper right back of the brain leads to left eye problems). It would seem someone would be trying to make the connections.

Wesley
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Postby Axiom » Wed Nov 16, 2005 3:22 pm

Wesley,

Other than the fact that spinal chord and optic nerve involvement seem to predict type of disability with fairly good correlation, I do seem to remember reading at least one study on lesion mapping (I'm thinking it was out of Canada in 2003 or 2004) saying that they had demonstrated some significant correlations between cerebral lesion location and specific disabilities.

I'm thinking it's interesting and worthwhile from a scientific standpoint, but until someone comes up with a way to either prevent the lesions or to heal them once they've been found... unfortunately does not mean much for those dealing with the disease.

Besides, it seems there's always an exception. In the case study reported on in the video clips they think one small spinal chord lesion (even called it singular sclerosis) resulted in paraplegia, but I know of someone who has multiple active spinal lesions with edema thrown in, yet has minimal disability (one arm slightly affected with numbness/weakness/clumsiness)
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Postby BioDocFL » Thu Nov 17, 2005 7:21 am

Maybe it's a matter of timing also, along with location. Perhaps if a lesion appears at a particular time frame in the brain's development, the brain can compensate. Otherwise if it develops at a later time, the brain is not able to compensate as well.
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Postby Axiom » Thu Nov 17, 2005 8:36 am

Good point

I don't know that I've seen any MS research address that, though it certainly makes sense.

Look at children who have had a hemispherectomy. I'm amazed at how plastic their brains are. Of course a quick search shows that there is disagreement about whether cognitive skills are impacted by the childs age at operation even with that type of procedure.... though I doubt there are many adolescents or adults to use as a comparison.

Of course that does not bode well for my adolescent example above unless we can stop lesion development and soon!
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Postby carolew » Wed Nov 23, 2005 4:52 am

Axion, you mentionned that lesions in optic nerve and spinal cord mean something in terms of prognosis, I didn't know that, Can you explain please, thanks Carole
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Postby OneEyeBlind » Wed Nov 23, 2005 10:08 am

Carolw,

[b]Axion, you mentionned that lesions in optic nerve and spinal cord mean something in terms of prognosis, I didn't know that, Can you explain please, thanks Carole[/b
]

This is what I found.

Initial MS symptoms of visual loss or sensory problems, such as numbness or tingling, are markers for a relatively good prognosis, whereas difficulty walking and weakness are markers for a relatively poor prognosis. Better outcomes are also associated with the presence of only a single symptom at onset, the rapid development of initial symptoms, and the rapid regression of initial symptoms.


http://en.wikipedia.org/wiki/Multiple_Sclerosis

My first symptom was ON and I had a spinal lesion that caused numbness and tingling in my hands/arms. Had a full recovery with both. I found this information on the link above if anyone is interested.

Hope this helps.
Karen (OneEyeBlind) :wink:

* I don't suffer from insanity, I enjoy it!
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Postby carolew » Wed Nov 23, 2005 1:01 pm

Thank you so much Karen. I guess that applies a bit to me.
I had ON 18 yrs ago, before that, only funny tingling in my left leg.
Now, I am on Lipitor because my left leg is worse. I still work full time but need a cane to go shopping. I will read that article. Carole
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Spinal Cord Lesions

Postby DenverCO » Sat Nov 26, 2005 8:46 am

I am concerned about the prognosis of cases in which spinal cord lesions & walking difficulties are the primary problem. Why is disease activity in the spine more detrimental?
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Postby bromley » Sat Nov 26, 2005 9:30 am

Denver,

I think the problem with spinal lesions is that, unlike the brain, there's not a lot of room to work round e.g. find other pathways. I think I had three spinal cord lesions on my MRI but 18 months after my first attack I can still walk fine.

One neuro told me that factors indictating a worse prognosis are (i) male gender (ii) a progressive course from the outset (iii) motor problems at the outset (rather than sensory) (iv) later onset of MS (eg 40+) (v) not making complete recovery from first attack

This didn't really help me as I'm male, was dx at 39 (no previous symptoms), sensory problems rather than motor, RR at dx, never full recovered sensitivity in palm of right hand.

When I saw another neuro on Monday I asked about prognosis. He said it was difficult to say but said that I had a low lesion load which was good.


So I don't think they really have much of a clue. At least I had 38 great years to look back on. My heart really goes out to those dx in their teens and early 20s. A friend's father has been dx with ALS at 80. She is devastated but I think I would swap MS at 39 for something worse at 80 (he was healthy up to then).

I think the lack of prognosis and the uncertainy are one (of many) of the worse symptoms of this disease. In five years time I could be a paraplegic or still walking OK and working! All my friends are very brave - 'look on the positive side etc, etc' but you have to be in this position to really understand how difficult it is.

But of course, the other factor is current / future treatments and how this effects the prognosis. If effective nero-protective agents arrive then we shouldn't (in theory) become any more disabled. Stem cells and treatments to regenerate nerves might result in lost functions being restored.

This probably doesn't help much at all.
Ian
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Postby DenverCO » Sun Nov 27, 2005 11:59 am

Ian,

Thanks for your thoughtful response.

We absolutely need treatment options that will ensure axonal protection until the time when we can put this nightmare behind us and get on with our lives. It goes without saying, but the sooner the better!

Rebekah
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Postby Axiom » Wed Nov 30, 2005 12:05 pm

carolew wrote:Axion, you mentionned that lesions in optic nerve and spinal cord mean something in terms of prognosis, I didn't know that, Can you explain please, thanks Carole


Sorry to be so slow responding - just saw this.
I think there is still a lot of work to be done in this area.

I don't know that it was so much prognosis per se but how lesion location relates to specific symptoms that we were talking about.

Lesions on the optic nerve have a strong correlation to visual disturbances.
(wonder how much $$$ they spent on that study - seems a pretty obvious conclusion)

In general studies do indicate that lesions in the spinal chord are more likely to lead to:

sensory or motor deficits
bowel & bladder disfunction
gait disturbances
ataxia

However, it seems you still can't make the prognosis jump since even with spinal lesions at least one study showed no strong correlation between extent of plaques and the degree of clinical disability.

It would seem that with lesions in the brain there would be more opportunity for other pathways to form, so it would be tougher to predict the type of disability a lesion in a specific location would cause.
I think Wesley made a good point in that timing of the lesion is probably key as well.
As I said, I have not seen any MS studies address this. If anyone has, I'd be interested in taking a look.

So we're back to the question Bromley posed in another thread... what that all important MRI scan really means?

Still far too many unknowns!
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