The utility of MRI in suspected MS [RETIRED]

Frohman, Elliot M.; Goodin, Douglas S.; Calabresi, Peter A.; Corboy, John R.; Coyle, Patricia K.; Filippi, Massimo; Frank, Joseph A.; Galetta, S. L.; Grossman, Robert I.; Hawker, Kathleen; Kachuck, Norman J.; Levin, Michael C.; Phillips, J. Theodore; Racke, Michael K.; Rivera, Víctor M.; Stuart, William H.

doi:10.1212/01.wnl.0000082654.99838.ef

Cited by 171 publications

(61 citation statements)

References 45 publications

(129 reference statements)

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“…This segment comprised the periventricular areas, the major white matter tracts as well as the optic tract and optic chiasma. Multiple sclerosis is a disease of the white matter, the cortical lesions are typically periventricular in 80% of patients [13].…”

mentioning

confidence: 99%

Failure of the vascular hypothesis of multiple sclerosis in a rat model of chronic cerebrospinal venous insufficiency

Zakaria¹,

Mikhael²,

Hussein³

et al. 2017

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A b s t r a c t Chronic cerebrospinal venous insufficiency (CCSVI) is a series of stenotic malformations in the cerebrospinal venous outflow routes, which is postulated to cause multiple sclerosis (MS). The hypotheses assumed that CCSVI leads to iron deposition which triggers inflammation and demyelination in MS. Invasive endovascular treatment of CCSVI was initiated based on the previous theory. The present study was designed to validate this hypothesis using a rat model of CCSVI. Bilateral jugular vein ligation (JVL) was performed on female albino rats (n = 15), and sham-operated rats (n = 15) were used as a control group. The rats were followed clinically for eight months and neurological examination detected no weakness or paralysis in the operated

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mentioning

confidence: 99%

Failure of the vascular hypothesis of multiple sclerosis in a rat model of chronic cerebrospinal venous insufficiency

Zakaria¹,

Mikhael²,

Hussein³

et al. 2017

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“…The most common symptoms on initial presentation are optic neuritis, ocular motor syndromes (internuclear ophthalmoparesis, nystagmus), ataxia, dysarthria, sensory or motor signs, partial myelitis, and bladder or bowel dysfunction. 19 Many patients with a CIS will have already have lesions on an MRI scan. 19 To improve diagnosis of CIS, the 2005 revisions to the McDonald criteria placed greater significance on the presence of spinal cord lesions on MRI.…”

Section: Methodsmentioning

confidence: 99%

“…19 Many patients with a CIS will have already have lesions on an MRI scan. 19 To improve diagnosis of CIS, the 2005 revisions to the McDonald criteria placed greater significance on the presence of spinal cord lesions on MRI.…”

Section: Methodsmentioning

confidence: 99%

Current and Future Directions in MS Management: Key Considerations for Managed Care Pharmacists

Lipsy

Schapiro²,

Prostko³

2009

JMCP

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This educational activity discusses several medications that are in phase III clinical trials and have not been approved by the FDA for treatment or management of multiple sclerosis at the time of publication. This list of medications includes cladribine, dimethyl fumarate, fingolimod, laquinimod, teriflunomide, fampridine, alemtuzumab, daclizumab, and rituximab. AcknowledgementsThe authors wish to thank Frank L. Urbano, MD, FACP, of PRIME ® for his assistance with the development of this publication. Alexandria, VA 22314; 703.683.8416; 703.683.8417 (fax F a c u l t y Supplement Policy Statement Standards for Supplements to the Journal of Managed Care PharmacySupplements to the Journal of Managed Care Pharmacy are intended to support medical education and research in areas of clinical practice, health care quality improvement, or efficient administration and delivery of health benefits. The following standards are applied to all JMCP supplements to ensure quality and assist readers in evaluating potential bias and determining alternate explanations for findings and results. 1. Disclose the principal sources of funding in a manner that permits easy recognition by the reader. 2. Disclose the existence of all potential conflicts of interest among supplement contributors, including financial or personal bias. 3. Describe all drugs by generic name unless the use of the brand name is necessary to reduce the opportunity for confusion among readers. 4. Identify any off-label (unapproved) use by drug name and specific off-label indication. 5. Strive to report subjects of current interest to managed care pharmacists and other managed care professionals. 6. Seek and publish content that does not duplicate content in the Journal of Managed Care Pharmacy. 7. Subject all supplements to expert peer review. S1 Introduction S3 Results of Educational Needs Assessment S3 Immunopathology of MS S4 Diagnosis of MS S4 Clinically Isolated Syndrome S5 Is the Current Definition of CIS Adequate? S6 Imaging Modalities in MS S7 Treatment of Patients with CIS: Overview of Clinical Trials S8 Key Implications of Clinical Trials for Managed Care Pharmacists S9 Emerging Therapies for MS S9 Oral Agents S12 Monoclonal Antibodies S12 Key Implications of Emerging Therapies for Managed Care Pharmacists S13 Summary S16 Continuing Education: CE/CME Submission Instructions and Posttest QuestionsTarget Audience This activity is intended for managed care pharmacists and managed care physicians. This is an application-based learning activity. Learning ObjectivesUpon completion of this program, participants will be able to:1. Evaluate data submitted by managed care pharmacists pertaining to current pharmacy practice trends in multiple sclerosis (MS) management.2. Assess newest evidence in MS diagnosis and treatment impacting pharmacy practice.3. Identify paradigm shifts in MS treatment and management and the rapidly evolving role of the managed care pharmacist. Funding and Original Presentation of This Learning ActivityThis supplement was sponsored by P...

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“…[29][30][31] Between 50% and 80% of patients with CIS have 1 or more clinically silent T2-bright abnormalities on their baseline brain MRI. 5,6,32,33 Both the presence and the number of clinically silent lesions reflect older subclinical disease activity and are predictive of development of MS in the next 5 to 14 years. 6,32,[34][35][36] A protocol with MRI brain 3 plane scout, sagittal fast FLAIR, axial fast spin echo proton density/T2, axial fast FLAIR, and axial gadolinium (Gd)-enhanced T1 is recommended by the Consortium of Multiple Sclerosis Centers (CMSC) to evaluate patients presenting with a possible CIS.…”

Section: Radiology In the Diagnosis Of Cismentioning

confidence: 99%

Updates on Clinically Isolated Syndrome and Diagnostic Criteria for Multiple Sclerosis

Marcus

Waubant

2012

The Neurohospitalist

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Clinically isolated syndrome (CIS) is a central nervous system demyelinating event isolated in time that is compatible with the possible future development of multiple sclerosis (MS). Early risk stratification for conversion to MS helps with treatment decisions. Magnetic resonance imaging (MRI) is currently the most useful tool to evaluate risk. Cerebrospinal fluid studies and evoked potentials may also be used to assess the likelihood of MS. Four clinical trials evaluating the benefits of either interferon b (IFN-b) or glatiramer acetate (GA) within the first 3 months after a high-risk CIS demonstrate decreased rates of conversion to clinically definite MS (CDMS) and a lesser degree of MRI progression with early treatment. In the 3-, 5-, and 10-year extension studies of 2 formulations of IFN-b, the decreased conversion rate to CDMS remained meaningful when comparing early treatment of CIS to treatment delayed by a median of 2 to 3 years. Diagnostic criteria have been developed based on the clinical and MRI follow-up of large cohorts with CIS and provide guidance on how to utilize clinical activity in combination with radiographic information to diagnose MS. The most recent 2010 McDonald criteria simplify requirements for dissemination in time and space and allow for diagnosis of MS from a baseline brain MRI if there are both silent gadolinium-enhancing lesions and nonenhancing lesions on the same imaging study. The diagnostic criteria for MS require special consideration in children at risk for acute disseminated encephalomyelitis (ADEM), in older adults who may have small vessel ischemic disease, and in ethnic groups that more commonly develop neuromyelitis optica (NMO).

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The utility of MRI in suspected MS [RETIRED]

Cited by 171 publications

References 45 publications

Failure of the vascular hypothesis of multiple sclerosis in a rat model of chronic cerebrospinal venous insufficiency

Failure of the vascular hypothesis of multiple sclerosis in a rat model of chronic cerebrospinal venous insufficiency

Current and Future Directions in MS Management: Key Considerations for Managed Care Pharmacists

Updates on Clinically Isolated Syndrome and Diagnostic Criteria for Multiple Sclerosis

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