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Latest & greatest articles for multiple sclerosis
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The effect of corticosteroids for acute optic neuritis on the subsequent development of multiplesclerosis. The Optic Neuritis Study Group. Optic neuritis is often the first clinical manifestation of multiplesclerosis, but little is known about the effect of corticosteroid treatment for optic neuritis on the subsequent risk of multiple sclerosis.We conducted a multicenter study in which 389 patients with acute optic neuritis (and without known multiplesclerosis) were randomly assigned (...) to receive intravenous methylprednisolone (250 mg every six hours) for 3 days followed by oral prednisone (1 mg per kilogram of body weight) for 11 days, oral prednisone (1 mg per kilogram) alone for 14 days, or placebo for 14 days. Neurologic status was assessed over a period of two to four years. The patients in the first group were hospitalized for three days; the others were treated as outpatients.Definite multiplesclerosis developed within the first two years in 7.5 percent of the intravenous
The Canadian cooperative trial of cyclophosphamide and plasma exchange in progressive multiplesclerosis. The Canadian Cooperative MultipleSclerosis Study Group. To find out whether non-specific immunosuppression is beneficial in multiplesclerosis (MS) a randomised, placebo-controlled, single-masked trial was carried out in nine university centres. 168 patients with clinically or laboratory-supported definite MS in progressive phase (deterioration by at least 1.0 on the expanded disability
Double-masked trial of azathioprine in multiplesclerosis. British and Dutch MultipleSclerosis Azathioprine Trial Group. 354 patients with multiplesclerosis were randomised to receive either azathioprine 2.5 mg/kg daily or placebo in a double-masked trial. During follow-up of at least 3 years only small differences emerged between the groups. After 3 years the mean deterioration in Kurtzke disability score was 0.62 in the azathioprine group and 0.80 in the placebo group, a difference of 0.18 (...) recommended for most patients with multiplesclerosis. Analysis of subgroups (by sex, age, severity, rate of progression, HLA status, relapsing or progressive course) has not revealed any that have shown clear clinical benefit.
1988LancetControlled trial quality: predicted high
Multicentre double-blind study of effect of intrathecally administered natural human fibroblast interferon on exacerbations of multiplesclerosis. In this randomised, double-blind, placebo-controlled, 2-year multicentre study intrathecally administered natural human fibroblast interferon (IFN-B) was effective in reducing exacerbations of multiplesclerosis (MS) in patients with exacerbating/remitting disease. The mean reduction in exacerbation rate of 34 patients who received IFN-B (recipients
Exacerbations of multiplesclerosis in patients treated with gamma interferon. In an open, randomised study, 18 patients with clinically definite, relapsing-remitting multiplesclerosis (MS) received 1 microgram, 30 micrograms, or 1000 micrograms doses of recombinant gamma interferon (IFN-gamma), given by intravenous infusion twice a week for four weeks. 7 patients had exacerbations during treatment. This exacerbation rate, compared retrospectively with the pretreatment rate and prospectively
A pilot trial of Cop 1 in exacerbating-remitting multiplesclerosis. Cop 1 is a random polymer (molecular weight, 14,000 to 23,000) simulating myelin basic protein. It is synthesized by polymerizing L-alanine, L-glutamic acid, L-lysine, and L-tyrosine. It suppresses but does not induce experimental allergic encephalomyelitis, an animal model of multiplesclerosis. It is not toxic in animals. In a double-blind, randomized, placebo-controlled pilot trial, we studied 50 patients (...) with the exacerbating-remitting form of multiplesclerosis, who self-injected either 20 mg of Cop 1 dissolved in 1 ml of saline or saline alone daily for two years. Six of 23 patients in the placebo group (26 percent) and 14 of 25 patients in the Cop 1 group (56 percent) had no exacerbations (P = 0.045). There were 62 exacerbations in the placebo group and 16 in the Cop 1 group, yielding two-year averages of 2.7 and 0.6 per patient, respectively. Among patients who were less disabled on entry (Kurtzke disability
Effect of total lymphoid irradiation in chronic progressive multiplesclerosis. Total lymphoid irradiation (TLI; 1980 cGy) or sham irradiation was given to 40 patients with chronic progressive multiplesclerosis (MS) in a prospective, randomised, double-blind study. During mean follow-up of 21 months, MS patients treated with TLI had less functional decline than sham-irradiated MS patients (p less than 0.01). A significant relation was noted between absolute blood lymphocyte counts in the first
Hyperbaric oxygen and multiplesclerosis: short-term results of a placebo-controlled, double-blind trial. In a study of 120 patients with chronic multiplesclerosis the effects of treatment with 100% oxygen at 2 atmospheres absolute for 90 min daily for a total of 20 exposures were compared with those of normal air at normal pressure for a similar length of time within the same compression chamber. No patient in either group showed any improvement on the Kurtzke disability status scale. 12 (...) of 51 patients in the hyperbaric-oxygen group and 3 of 47 control patients improved on the Kurtzke functional systems scale on the subjective bowel/bladder parameter only. Such a degree of improvement can also be achieved with medication for urinary symptoms, but none of the patients in this study received such medication. The short-term results of this trial do not support the claims made for hyperbaric oxygen in the management of multiplesclerosis.
Intensive immunosuppression in progressive multiplesclerosis. A randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. Fifty-eight patients with severe, progressive multiplesclerosis were prospectively randomized to one of three treatments: 20 received intravenous ACTH, 20 received high-dose intravenous cyclophosphamide plus ACTH, and 18 were placed on a regimen consisting of plasma exchange, low-dose oral cyclophosphamide, and ACTH. The three groups (...) ; and in the plasma exchange group, 11 of 18 at six months and 9 of 18 at one year. High-dose cyclophosphamide plus ACTH was most effective in halting progression of the disease at both 6 and 12 months (at 12 months, cyclophosphamide-ACTH vs. ACTH, P = 0.0004; cyclophosphamide-ACTH vs. plasma exchange, P = 0.087). Thus, progressive multiplesclerosis may be stabilized by short-term, intensive immunosuppression with cyclophosphamide plus ACTH.
Hyperbaric-oxygen treatment of multiplesclerosis. A randomized, placebo-controlled, double-blind study. Several uncontrolled studies have suggested a beneficial effect of hyperbaric oxygen on multiplesclerosis. We studied 40 patients with advanced chronic multiplesclerosis who were randomly divided into two matching groups. The experimental group received pure oxygen, and the placebo group received a mixture of 10 per cent oxygen and 90 per cent nitrogen; both groups were treated (...) ) in the oxygen group, neither of whom had had an initial response, and in 11 patients (55 per cent) in the placebo group, one of whom had had a positive initial response (P less than 0.0008). Minor ear problems and reversible myopia were the only side effects observed. These preliminary results suggest a positive, though transient, effect of hyperbaric oxygen on advanced multiplesclerosis, warranting further study. This therapy cannot be generally recommended without longer follow-up periods and additional
Double-blind controlled trial of immunosuppression in the treatment of multiplesclerosis: final report. In a double-blind controlled trial 43 patients with relapsing-remitting multiplesclerosis were treated either with anti-lymphocyte globulin, prednisolone, and azathioprine, or with placebo preparations. Treatment began with a combination of the three medicaments but after 1 month was continued for another 14 months with azathioprine (3 mg/kg dialy) only. There was a marginally beneficial
Transfer factor in treatment of multiplesclerosis. A 2-year prospective double-blind trial of the treatment of multiplesclerosis patients with the leucocyte extract, transfer factor (TF), obtained from leucocytes of relatives living with the patient, was conducted. 60 patients with definite MS, of whom 58 completed the trial, were divided into two equal groups, one of which received TF and the other placebo. The groups were evenly balanced with respect to sex ratios, disability, duration
Double-blind, controlled trial of immunosuppression in treatment of multiplesclerosis. 30 multiplesclerosis patients in a double-blind, controlled trial were given immunosuppressive treatment consisting of antilymphocyte globulin, prednisolone, and azathioprine, or placebo. After 15 months of treatment the immunosuppressed group had a reduction in the number of relapses and some retardation of the clinical course of the disease (p < 0.06). The beneficial effect was seen only in females.
1980LancetControlled trial quality: predicted high
Long-term transfer-factor treatment for multiplesclerosis. In groups of 16 patients with multiplesclerosis, 13 months' double-blind treatment with transfer factor from random normal donors differed from placebo treatment only in producing a temporary restoration of lymphocyte reactivity to measles virus antigen, and did not arrest the degeneration of nerve tissue.