Concurrent Multiple Sclerosis Research Articles

Clinical implications for the association of psoriasis and multiple sclerosis: an observational study.

Multiple sclerosis (MS) and psoriasis (PsO) are distinct chronic autoimmune conditions with varying impacts on patients' lives. While the co-occurrence of MS and PsO has been reported, the underlying pathogenic link remains unclear. This study aimed to investigate the prevalence of PsO in a MS outpatient clinic population and explore the potential interplay between these conditions. 316 MS patients who had at least one visit at our MS center in the last year, were selected from our outpatient MS Clinic electronic database and were e-mailed in August 2023 and inquired about a previous diagnosis of PsO. Demographic and MS history data were retrospectively gathered for two groups: MS patients without and with PsO. Information about MS phenotype, Expanded Disability Status Scale (EDSS) score at the diagnosis and at last follow-up, disease modifying therapy (DMT) were collected retrospectively from our MS data set. PsO diagnosis was confirmed by an experienced dermatologist and severity was assessed with the Psoriasis Area and Severity Index (PASI). Among 253 respondents, 5.85% reported a PsO diagnosis that was confirmed after the dermatological evaluation Among patients with psoriasis 66.67% had progressive course of MS (p = 0.032) and the onset of PsO typically occurred after MS diagnosis. 9 out 15 patients had a PASI score of 0 and 6 are currently undergoing treatment with an anti-CD20 therapy. Notably, a subset of our patients were on anti-CD20 therapy and did not experience a worsening of dermatological symptoms. The prevalence of PsO in our outpatient MS population aligns with previous studies. Treatment approaches should be tailored to individual patient needs, emphasizing collaboration between neurologists and dermatologists. Medications like dimethyl fumarate, effective in both conditions, could be considered. The data from our study also suggest that anti-CD20 therapy may be a viable option for some patients with concurrent MS and mild PsO, without a significant worsening of dermatological symptoms. Further research is needed to elucidate the complex relationship between MS and PsO and to develop more effective therapeutic strategies for patients with both conditions.

Concurrent gliomas in patients with multiple sclerosis

BackgroundConcurrent malignant brain tumors in patients with multiple sclerosis (MS) constitute a rare but paradigmatic phenomenon for studying neuroimmunological mechanisms from both molecular and clinical perspectives.MethodsA multicenter cohort of 26 patients diagnosed with both primary brain tumors and multiple sclerosis was studied for disease localization, tumor treatment-related MS activity, and molecular characteristics specific for diffuse glioma in MS patients.ResultsMS neither predisposes nor protects from the development of gliomas. Patients with glioblastoma WHO grade 4 without isocitratdehydrogenase (IDH) mutations have a longstanding history of MS, whereas patients diagnosed with IDH-mutant astrocytoma WHO grade 2 receive multiple sclerosis diagnosis mostly at the same time or later. Concurrent MS is associated with a lesser extent of tumor resection and a worse prognosis in IDH-mutant glioma patients (PFS 32 vs. 64 months, p = 0.0206). When assessing tumor-intrinsic differences no distinct subgroup-defining methylation pattern is identified in gliomas of MS patients compared to other glioma samples. However, differential methylation of immune-related genetic loci including human leukocyte antigen locus on 6p21 and interleukin locus on 5q31 is found in MS patients vs. matched non-MS patients. In line, inflammatory disease activity increases in 42% of multiple sclerosis patients after brain tumor radiotherapy suggesting a susceptibility of multiple sclerosis brain tissue to pro-inflammatory stimuli such as ionizing radiation.ConclusionsConcurrent low-grade gliomas should be considered in multiple sclerosis patients with slowly progressive, expansive T2/FLAIR lesions. Our findings of typically reduced extent of resection in MS patients and increased MS activity after radiation may inform future treatment decisions.

Optic Neuritis After COVID-19 Vaccination: An Analysis of the Vaccine Adverse Event Reporting System.

To investigate the association of optic neuritis (ON) after the COVID-19 vaccines. Cases of ON from Vaccine Adverse Event Reporting System (VAERS) were collected and divided into the prepandemic, COVID-19 pandemic, and COVID-19 vaccine periods. Reporting rates were calculated based on estimates of vaccines administered. Proportion tests and Pearson χ 2 test were used to determine significant differences in reporting rates of ON after vaccines within the 3 periods. Kruskal-Wallis testing with Bonferroni-corrected post hoc analysis and multivariable binary logistic regression was used to determine significant case factors such as age, sex, concurrent multiple sclerosis (MS) and vaccine manufacturer in predicting a worse outcome defined as permanent disability, emergency room (ER) or doctor visits, and hospitalizations. A significant increase in the reporting rate of ON after COVID-19 vaccination compared with influenza vaccination and all other vaccinations (18.6 vs 0.2 vs 0.4 per 10 million, P < 0.0001) was observed. However, the reporting rate was within the incidence range of ON in the general population. Using self-controlled and case-centered analyses, there was a significant difference in the reporting rate of ON after COVID-19 vaccination between the risk period and control period ( P < 0.0001). Multivariable binary regression with adjustment for confounding variables demonstrated that only male sex was significantly associated with permanent disability. Some cases of ON may be temporally associated with the COVID-19 vaccines; however, there is no significant increase in the reporting rate compared with the incidence. Limitations of this study include those inherent to any passive surveillance system. Controlled studies are needed to establish a clear causal relationship.

S3093 Monotherapy for Multiple Autoimmune Diseases: The Novel Use of Ofatumumab for Concurrent Multiple Sclerosis and Autoimmune Hepatitis

Introduction: Autoimmune hepatitis (AIH) is a rare acute or chronic inflammatory liver disease, that can be associated with a variety of extrahepatic disorders, such as multiple sclerosis (MS). AIH has been reported both during and after treatment with immunomodulatory drugs for MS, such as interferon-beta and steroids, with its incidence in MS being 10-fold higher than the general population. Typically, those patients are treated with steroids and azathioprine as the first line of treatment according to AIH guidelines. However, in comparison to newer disease-modifying therapies (DMTs) for MS, azathioprine is less effective and requires further study. Notably, several studies have suggested a role for B-cell-driven autoimmune liver injury in AIH, and there have been reports of refractory AIH being successfully treated with rituximab, an anti-CD20 monoclonal antibody. Based on these results and the well-known role of B-cells in the underlying pathophysiology of MS, we postulated that anti-CD20 therapy may be effective in treating patients with concurrent MS and AIH, thereby helping to limit steroid duration and avoid the use of azathioprine. Case Description/Methods: We report the case of a 49-year-old previously healthy female who presented with symptoms and magnetic resonance imaging (MRI) findings consistent with relapsing-remitting MS (RRMS). On routine labs at initial presentation, she was incidentally found to have ALT/AST in the 500's range. An extensive work-up was completed, including a liver biopsy that showed a centrilobular necroinflammatory injury pattern suggest of early AIH without cirrhosis. The patient was started on oral budesonide followed by ofatumumab, an anti-CD20 monoclonal antibody approved for treatment of RRMS, as steroids were weaned. The patient’s liver enzymes returned to normal ranges within 12 weeks and have remained so now for approximately 8 months. Additionally, she has had no new clinical or imaging findings suggestive of MS disease activity. We present this as the first-reported case of the use of an anti-CD20 monoclonal antibody to treat both MS and AIH concurrently. Discussion: This case furthers our understanding of AIH by suggesting that the pathophysiology contributing to AIH is predominately B-cell related as this patient’s AIH was successfully treated with ofatumumab and a short course of budesonide. It highlights a possible alternative treatment modality for AIH that avoids a prolonged course of steroids and/or azathioprine. More research is still needed however.

Jak léčit pacienty s psoriázou a současnou roztroušenou sklerózou?

Roztroušená skleróza a psoriáza jsou autoimunitní onemocnění s určitými společnými imunopatologickými rysy. Byť není zatím jednoznačně prokázáno, že by byla koincidence těchto onemocnění vyšší, většina metaanalýz tomu nasvědčuje. V současné době je v České republice schválen v léčbě pouze jeden preparát, u kterého byla prokázána účinnost u obou těchto onemocnění, a tím je dimethyl-fumarát. Bezpečnost a možný pozitivní efekt na obě onemocnění byly prokázány u secukinumabu a ustekinumabu, které ale nejsou schváleny k léčbě roztroušené sklerózy. V případě středně těžké či těžké psoriázy s nutností systémové léčby je možné v léčbě roztroušené sklerózy zahájit léčbu glatiramer-acetátem, který nemá imunosupresivní efekt a má nízké riziko interakcí s biologickou léčbou. V přídatné léčbě s interferonem beta byla prokázána i bezpečnost methotrexátu, který lze užít v systémové léčbě psoriázy. Vhodné je užití fototerapie, která zvyšuje hladinu vitaminu D. Nevhodné jsou u pacientů s demyelinizačním onemocněním inhibitory tumor necrosis faktoru, u kterých existuje reálné riziko vyvolání či zhoršení demyelinizačního onemocnění jak periferního, tak i centrálního nervového systému. V případě těžkého průběhu psoriázy a roztroušené sklerózy (což se zdá být dle dostupných populačních studií relativně vzácný jev) je nutná spolupráce neurologa, dermatologa a imunologa vzhledem k riziku farmakodynamických interakcí při polyterapii imunomodulační léčby.

Multiple sclerosis is not associated with an increased risk for severe COVID-19: a nationwide retrospective cross-sectional study from Germany

BackgroundSince the coronavirus disease 2019 (COVID-19) has risen, several risk factors have been identified, predicting a worse outcome. It has been speculated that patients with Multiple sclerosis (MS) have an increased risk for a severe course of COVID-19 due to a suspected higher vulnerability. Therefore, we aimed to analyze the impact of comorbid MS on the outcome of patients with COVID-19 in Germany.MethodsWe conducted a retrospective cross-sectional study using the administrative database of all hospitalized patients diagnosed with PCR-confirmed COVID-19 (n = 157,524) in Germany during 2020. The cohort was stratified according to the presence (n = 551) or absence (n = 156,973) of comorbid MS, including discrimination of MS subtypes. Primary outcome measures were admission to the intensive care unit (ICU), use of invasive or non-invasive ventilation, and in-hospital mortality. Differences were investigated using rates and odds ratios as estimates. Pooled overall estimates, sex-stratified estimates, age-group stratified estimates, and MS subtype stratified estimates were calculated for all outcomes under the random-effects model.ResultsAmong 157,524 patients hospitalized with COVID-19, 551 had a concurrent MS diagnosis (0.3%). Overall, univariate analysis showed lower rates of ICU admission (17.1% versus 22.7%, p < 0.001), lower use of ventilation (9.8% versus 14.5%, p < 0.001) and lower in-hospital mortality (11.1% versus 19.3%, p < 0.001) among COVID-19 patients with comorbid MS. This finding was stable across the subgroup analysis of sex and MS subtype but was attenuated by age-stratification, confirming equal odds of in-hospital mortality between COVID-19 patients with and without MS (log OR: 0.09 [95% CI: − 0.40, 0.59]).ConclusionsAlthough there might be differences in risk within the MS patients’ population, this large-scale nationwide analysis found no evidence for a worse outcome of COVID-19 in patients with comorbid MS compared to non-MS individuals.

Coexistence of multiple sclerosis and brain tumors: a literature review.

Concurrent development of primary brain tumors and multiple sclerosis is quite rare. Only a few dozens of such comorbidity have been reported. Nevertheless, given the fact that such pathologies are characterized by similar clinical picture and neuroimaging findings, issues about diagnosis and differential diagnosis of such conditions often arise, which makes the problem relevant. A literature review was conducted using PubMed, by selecting articles on concurrent multiple sclerosis and brain tumors, particularly glial origin tumors, over the past 20 years (1989 to 2019). The search was performed in English, Russian, and Ukrainian using the following key words and terms: comorbidity, concomitance, multiple sclerosis, brain tumor, glioma, astrocytoma, glioblastoma. The analysis included all articles on etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, neuroimaging, and pathomorphological assessment. After identifying all the articles that met the inclusion criteria and removing duplicate data, 35 literature sources on concurrent primary brain tumors and multiple sclerosis were selected. The conclusion on whether concurrent primary brain tumors and multiple sclerosis develop randomly or have common pathophysiological mechanisms is still under discussion. Potential causes of pathogenesis of both diseases include viral infection, chronic inflammation, neoplastic transformation, and involvement of neurotropic growth factors. The likelihood that two processes, demyelinating and neoplastic, can develop in parallel will never be underestimated. In such cases, strong clinical suspicion arises due to atypical clinical picture characterized by aggressive and rapidly growing neurological symptoms such as aphasia, spastic hemiparesis, epileptic seizures, or signs of intracranial hypertension. In MRI diagnosis, pathological findings such as single lesion of more than 2 cm; mass effect, edema, signal amplification in the form of ring-shaped shadow are the reasons for a more thorough examination and applying additional diagnostic methods: CT, MR spectroscopy, PET, CSF tests to determine oligoclonal antibodies and other markers content, cerebral biopsy. According to the literature, cases of concurrent primary brain tumors and multiple sclerosis are rare though described. Atypical clinical signs, neuroimaging data, and cerebral biopsy which is currently considered as the only method for making accurate diagnosis are helpful in the diagnostic process.

Headache Prevalence in Multiple Sclerosis at Al-Azhar Multiple Sclerosis Unit

People with multiple sclerosis (MS) have an increased incidence of headaches, although the comorbidity of headaches and MS is poorly understood. Lifetime prevalence are variable with incidence ranging from 4% to 58%. Evidence suggests that headaches may vary based on MS form and lesion location. MS patients with migraines have a more symptomatic clinical course of the disease. This study conducted on 100 Egyptian patients coming to MS clinic at Al-azhar university hospitals (75 female and 25 male) diagnosed as clinically definite multiple sclerosis according to Mc Donald criteria for Multiple Sclerosis 2017.The survey was conducted from May 2017 till May 2019. Patients with MS underwent baseline and 2-year follow-up scans. All patients underwent an examination by MS specialist neurologist. Patients completed a 28-item questionnaire about headache. Only MS patients with a self-identified history of headaches were asked to participate. For patients with more than 3-months history of headache,patients were invited to complete this survey in the waiting room. To ensure anonymity, no names or other patient identifiers were recorded. From the responses, we examined in detail each patient's demographics, medications use, headache characteristics, frequency, location, duration, pain description, modifying factors, triggers, and impact on patient functioning. We also assessed headache features in relation to MS diagnosis, disease exacerbations, and physiological conditions such as pregnancy and menses. Patients who reported the presence of headaches before the start of their MS symptoms were 70% (P < .013). Out of them, 40% reported that they had headaches at least once a week (P < .001), with the majority stating that their headaches were severe at least some of the time. 60% of the patients reported that their headaches lasted for more than 4 hours without medication (P < .001). If they took medication immediately after headache onset, many patients reported a reduction in headache duration (P < .001), although for 17% headaches continued to last for more than 4 hours. Among patients who waited until headaches became severe to take medication, far fewer received considerable benefits in headache reduction. 25 % of patients who had headaches before MS onset had migraine with aura. However, 60 % of the patients who did not experience headaches before MS reported the presence of aura. Headache severity was increased during MS exacerbation: only 8 % of patients who never or rarely experienced severe headaches had worsening upon MS exacerbation. The most common lesions locations were cortex (33.3%) and cortex plus brainstem (43.%). Among headache-positive MS patients, there were 31 (45.6%) patients with cortical and brainstem lesions, 20 (29.4%) patients with cortical lesions, 16 (23.5%) patients with cortical plus brainstem and spinal cord lesions and 1 (1.5%) patient with spinal cord and cortical lesions. The majority of headaches reported in our study were migraine, although tension-type headache (TTH) is also commonly observed. Although the mechanisms of this correlation were unknown, several theories were suggested. The first was that migraine could initiate an inflammatory response in the brain that would be associated with greater numbers of T1- and T2-enhancing MS lesions. Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing g headache and MS relapses merits further investigation. Therefore, we suggest that headache should be investigated during examination of MS patients and a concurrent MS attack should be suspected at the time of headache in MS patients.

Microvascular Decompression for Trigeminal Neuralgia in Patients with Multiple Sclerosis: Predictors of Treatment Success

Microvascular decompression (MVD) is highly effective in managing the neuropathic facial pain of trigeminal neuralgia (TN). Its utility in patients with TN and concurrent multiple sclerosis (MS) has been a subject of debate. The goal of this study was to identify demographic and perioperative variables associated with favorable outcome after MVD over the past 20 years in patients from our institution. A retrospective analysis of our cohort of 33 patients diagnosed with MS and TN who underwent MVD between 1997 and 2017 to treat neuropathic facial pain was performed. Perioperative variables included MS disease burden, findings on preoperative magnetic resonance imaging (MRI), TN pain severity, and the presence of intraoperative neurovascular compression. MS disease burden was quantified using the Expanded Disability Status Scale. Preoperative and postoperative pain severity was quantified using the Barrow Neurological Institute (BNI) pain severity scale. A total of 33 patients with TN and MS were treated with MVD at our institution (out of the 632 total MVDs performed) between 1997 and 2017. Twenty-two patients (67%) maintained a reduction in pain at a mean follow-up of 53.5 months. Higher preoperative BNI pain intensity score was associated with unfavorable outcome after MVD (P= 0.006). No associations were identified between MS disease burden, presence of neurovascular compression or pontine demyelinating plaques on MRI, or intraoperative findings of neurovascular compression and treatment outcomes. MVD is a reasonable treatment option for patients with TN and MS, although the rate of freedom from pain is lower than that for the general TN population. Preoperative pain severity may be a predictor of treatment success.

Multiple Sclerosis and the Choroid Plexus: Emerging Concepts of Disease Immunopathophysiology

BackgroundThe coexistence of multiple sclerosis and intracranial neoplasms is very rare, and whether this occurrence can be explained by a causal relationship or by coincidence remains a matter of debate. Possible roles of the choroid plexus as a site of tumor cell invasion and lymphocyte infiltration into the central nervous system have been hypothesized in recent studies. MethodsWe describe a 13-year-old boy with concurrent multiple sclerosis and choroid plexus papilloma, then review the published literature with a focus on the pathophysiologic mechanisms of neuroinflammation in multiple sclerosis and the potential role of the choroid plexus in this process. ResultsA growing body of evidence suggests that both physical and functional dysregulation of the choroid plexus may be a common mechanism underlying the pathophysiology of central nervous system inflammation. ConclusionsIn multiple sclerosis, the choroid plexus could act as a gateway for lymphocyte entry from the peripheral blood into the central nervous system at its earlier stages. However, future studies are needed to identify whether structural alterations of the choroid plexus play a role in the pathophysiology of multiple sclerosis and to provide suitable models to determine their consequences.

Surgical management of patients with coexistent multiple sclerosis and cervical stenosis: A systematic review and meta-analysis

Multiple sclerosis (MS) and cervical stenosis (CS) are two unique pathologies that can present with overlapping symptoms. In patients with concurrent MS and CS, the exact cause for worsening of symptoms is often difficult to decipher. In this study, we aimed to review the medical literature on the benefits of surgical decompression surgery in patients with coexisting CS and MS. We systematically reviewed the literature for articles published prior to December 1st, 2018 describing outcomes (improvement of symptoms of radiculopathy, myelopathy, and neck pain) in patients with coexisting MS and CS undergoing cervical decompression surgery. Effect sizes were calculated demonstrating the effect of surgical decompression on improving symptoms. We identified eight articles that satisfied our selection criteria, of which six provided data regarding symptoms after surgery. Our meta-analysis indicates that cervical decompression surgery in patients with coexisting MS and CS is beneficial in improving symptoms of myelopathy (ES 0.74, 95% CI 0.38–1.10, p < 0.0001), radiculopathy (ES 1.29, 95% CI 0.15–2.42, p < 0.001), and neck pain (ES 1.66, 95% CI 1.02–2.31, p < 0.0001). Our meta-analysis indicates that there is paucity of high level of evidence studies regarding the benefit of cervical decompression surgery in patients with concomitant CS and MS. However, the literature suggests that cervical decompression may be beneficial to such patients, providing stabilization or improvement in symptoms of myelopathy, radiculopathy, and neck pain. Spine surgeons must carefully delineate the cause of symptoms in patients to decide whether this is the optimal treatment for each individual patient.

The Gray Area of Dueling Immunity: Clinical Challenges in Treating Concurrent Multiple Sclerosis and Primary Brain Tumor (P6.127)

The Gray Area of Dueling Immunity: Clinical Challenges in Treating Concurrent Multiple Sclerosis and Primary Brain Tumor (P6.127)

Demographics and clinical characteristics of episodic hypothermia in multiple sclerosis

Background: Episodic hypothermia (EH) can occur in multiple sclerosis (MS). The putative mechanism is impairment of thermoregulation due to a presumed demyelinating hypothalamic lesion. Objective: To describe a cohort of patients with MS, who developed EH. Methods: Patients were identified through review of the Mayo Clinic electronic medical record (1996 to July 2015). Search terms were [multiple sclerosis] or [MS] within the diagnoses field and [hypothermia] within any field. We reviewed records for accuracy of diagnoses and abstracted relevant data. Magnetic resonance imaging (MRI) was reviewed for presence of hypothalamic lesions. Results: Of 156 patients, 34 had concurrent MS and hypothermia. Thirty-two (94%) had progressive disease at EH onset. Median MS duration was 19.9 years, and median expanded disability status scale (EDSS) was 8.0. Most patients presented with alterations in consciousness. Infection was suspected as the precipitating factor in 19 (56%), but clinically/laboratory supported in only 9 (28%). MRI lesions were evident within the hypothalamus in only 4 (14%). Conclusion: EH occurs predominantly in patients with advanced secondary progressive MS. The major manifestation is altered consciousness. Infection is often suspected as causal, but infrequently confirmed. Although commonly implicated, hypothalamic lesions were rarely evident on MRI and were absent in two post-mortem evaluations.

Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson’s Disease?

A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment.

Association of postoperative outcomes with preoperative magnetic resonance imaging for patients with concurrent multiple sclerosis and cervical stenosis

Background contextDifferentiating between multiple sclerosis (MS) and cervical stenosis (CS) can be difficult because of their overlapping symptoms. Although studies have shown preoperative imaging criteria that are predictive of outcomes in either MS or CS individually, no studies have investigated these factors in patients that have concurrent MS and CS. PurposeTo investigate the associations between preoperative magnetic resonance imaging (MRI) findings and postoperative outcomes in patients with concurrent MS and CS with myelopathy. Study designA retrospective review. Patient sampleAll patients presenting with myelopathy who underwent cervical decompression surgery at a single tertiary-care institution between January 1996 and July 2011, diagnosed with concurrent MS and CS. Outcome measuresPre- and postoperative severity of myelopathy was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. MethodsPreoperative imaging was assessed for stenosis, lesions, signal intensity (graded low, intermediate, or high), extent of lesion (focal or diffuse), and cord atrophy. Imaging was then correlated with postoperative myelopathy outcomes. ResultsForty-eight patients with MS and CS were reviewed for an average follow-up of 53 months. In the short term after surgery, there were 24 patients (50%) who showed improvement in the mJOA myelopathy score and 24 (50%) who did not improve. Significantly greater percentage of patients in the improvement group had high-intensity lesions on preoperative MRI as compared with the no-improvement group (p=.03). At long-term follow-up, there were 18 patients (37.5%) who showed postoperative improvement and 30 patients (62.5%) with no improvement. No significant differences were identified on preoperative imaging between those who improved postoperatively and those who did not. ConclusionsAlthough certain characteristic preoperative MRI findings are associated with postoperative outcomes in cohorts of either MS or CS patients, we did not find this to be the case in patients with concurrent MS and CS. Accordingly, the treatment of the MS/CS patient population should be unique as their outcomes may not be as good as those with CS but no MS.

Concurrent multiple sclerosis and amyotrophic lateral sclerosis: where inflammation and neurodegeneration meet?

The concurrence of multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) is exceedingly rare and the pathological features have not been examined extensively. Here we describe the key pathological features of a 40 year old man with pathologically confirmed concurrent MS and ALS.This is the most pathologically illustrative case of coincident MS and ALS demonstrating inflammatory and neurodegenerative features characteristic of each disease, and is the first to exhibit the presence of TDP-43 inclusions in this clinical entity. The intricate relationship between neuroinflammation and neurodegeneration in these diseases is discussed.

Analysis of the Pathogenesis of Experimental Autoimmune Optic Neuritis

Optic neuritis associated with multiple sclerosis has a strong association with organ-specific autoimmune disease. The goal of our research is to establish an optimal organ-specific animal model to elucidate the pathogenetic mechanisms of the disease and to develop therapeutic strategies using the model. This paper is divided into five sections: (1) clinical picture of optic neuritis associated with multiple sclerosis, (2) elucidation of pathogenesis using animal models with inflammation in optic nerve and spinal cord, (3) clinical relevance of concurrent encephalomyelitis in optic neuritis model, (4) retinal damage in a concurrent multiple sclerosis and optic neuritis model, and (5) development of novel therapies using mouse optic neuritis model. Advanced therapies using biologicals have succeeded to control intractable optic neuritis in animal models. This may ultimately lead to prevention of vision loss within a short period from acute onset of optic neuritis in human. By conducting research flexibly, ready to switch from the bench to the bedside and from the bedside to the bench as the opportunity arises, this strategy may help to guide the research of optic neuritis in the right direction.

Case Report: Multiple Sclerosis and Amyotrophic Lateral Sclerosis

We present a case of concurrent multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS). Five other similar cases that have been reported in the literature are also reviewed. This rare and interesting case illustrates the importance of careful follow-up of patients with MS to avoid attributing every new neurologic symptom to the previously diagnosed disease and the maintenance of suspicion for unrelated emerging diseases.

Muscle atrophy associated with multiple sclerosis: A benign condition or the onset of amyotrophic lateral sclerosis?

When muscular atrophy develops in multiple sclerosis (MS) patients, its etiology may vary from benign to serious. We describe an individual with a 24-year history of MS who developed amyotrophic lateral sclerosis (ALS). The literature is reviewed with particular attention to the clinical and electrophysiologic characteristics of patients with MS and muscular atrophy and to those rare patients with concurrent MS and ALS. Circumstances warranting a heightened suspicion for concurrent ALS are discussed and careful evaluation of similar patients is encouraged.

Evidence for central nervous system demyelination in chronic inflammatory demyelinating polyradiculoneuropathy.

It is unclear whether sporadic reports of concurrent multiple sclerosis (MS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represent coincidence or whether these two demyelinating disorders are pathogenically related. We utilized the sensitivity of magnetic resonance imaging (MRI) in detecting central nervous system (CNS) lesions to investigate 16 patients with CIDP. Six of the 16 had periventricular, subcortical, and brainstem white matter lesions indistinguishable from those seen in MS. Three of these patients had definite clinical and laboratory evidence of MS; three others with abnormal MRIs had no findings indicative of CNS disease. Previous reports have indicated that a significant number of MS patients have peripheral nerve demyelination. Our study suggests that many CIDP patients have concurrent CNS demyelination. Taken together, these observations support the existence of a central-peripheral inflammatory demyelinating syndrome. Whether this combined demyelinating syndrome lies on a spectrum between MS and CIDP or is a separate pathogenic entity will require further investigation.