cosyntropin and Multiple-Sclerosis

In a 35-year old woman presenting familial multiple lipomatosis, spastic paraparesis developed and became worse under tetracosactide therapy. Signs of spinal cord compression at T3 were present. CT and MRI revealed a fat-containing epidural tumour (angiolipoma). The association of angiolipoma with familial multiple lipomatosis has not yet been reported. This association supports the theory that angiolipomas are hamartomatous lesions. The deterioration observed under tetracosactide suggests that iatrogenic epidural lipomatosis is due to the development of a pre-existing lipoma.

Topics: Adult; Cosyntropin; Diagnosis, Differential; Epidural Neoplasms; Female; Hemangioma; Humans; Lipoma; Lipomatosis, Multiple Symmetrical; Magnetic Resonance Imaging; Multiple Sclerosis; Spinal Cord Compression

The effectiveness of treatment was compared in groups of patients with definite multiple sclerosis (MS) given respectively: methylprednisolone, alpha-24 corticotropine and cyclophosphamide combined with corticotropine. Clinical improvement was assessed by means of the expanded disability status scale (EDSS). The significant results were noted in patients treated with methylprednisolon and corticotropine combined with cyclophosphamide (1.5 in EDSS) for the first time, when compared to subsequent treatment. Within the patients in a more advanced stage of the disease, undergoing subsequent treatment, those given corticotropine displayed the best improvement (1.5 in EDSS), but without statistical significance. The authors suggest methylprednisolone or corticotropine combined with cyclophosphamide are the most effective immunosuppressive treatment in the initial phase of MS.

Topics: Adult; Aged; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Cosyntropin; Cyclophosphamide; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Methylprednisolone; Middle Aged; Multiple Sclerosis; Secondary Prevention; Treatment Outcome

A case of avascular necrosis of whirlbone in a young man affected by multiple sclerosis and treated with high doses of corticosteroids is described. The authors discuss the causes of this collateral effect underlining the risks of underevaluating the symptoms.

Topics: Adult; Betamethasone; Cosyntropin; Femur Head Necrosis; Glucocorticoids; Humans; Male; Methylprednisolone; Multiple Sclerosis

Multiple sclerosis (MS) is infrequent in childhood (0.3-2% of all cases of MS). At the present time more and more paediatric patients are being described. In this paper we describe our experience.. We review seven patients diagnosed as having MS before the age of 16, between 1984 and 1996. We have recorded: age, sex, personal and family history, form of onset and clinical course. CSF, neurophysiological and neuroimaging tests, treatment and diagnostic category according to the criteria of Poser.. Four boys and three girls aged between three and thirteen years at the onset of the disorder. In one case there was a family history of MS. The most frequent form of onset was hemiparesia, followed by oculomotor paralysis and cerebellar disorders. Six cases followed a recurrent-remittent course and one followed a secondarily progressive course. There were oligoclonal bands (OGB) in the CSF in three cases. Visual evoked potentials (VEP) were abnormal in six cases. Magnetic resonance (RM) was a great help in diagnosis and in six cases was very informative. Six patients were treated with corticosteroids during the acute phase and two with long-term azathioprine.. The commonest form of presentation, hemiparesia, makes the differential diagnosis with acute hemiplegia of childhood obligatory. Neurophysiological techniques, especially the VEP are very useful for initial assessment. RM is the most sensitive method, although it is not specific for diagnosis. The average follow-up period (4.5 years) is too short to determine the prognosis.

Topics: Adolescent; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Child; Child, Preschool; Cosyntropin; Diagnosis, Differential; Female; Hemiplegia; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Multiple Sclerosis; Recurrence; Retrospective Studies; Tomography, X-Ray Computed

We investigated the basal and dynamic regulation of the hypothalamo-pituitary-adrenal (HPA), hypothalamo-pituitary-thyroid (HPT) and hypothalamo-pituitary-gonadal axes and prolactin secretion in 52 patients with clinically definite multiple sclerosis. These patients also had gadolinium enhanced brain MRI scans and were divided into relapsing-remitting, secondary progressive and primary progressive subgroups. These subgroups were compared with healthy controls and a group of patients with other neurological diseases. The cortisol diurnal rhythm was preserved in all groups of patients. The time-integrated cortisol response to human corticotropin-releasing hormone (CRH) stimulation was lower in the patients with secondary progressive multiple sclerosis, compared with patients with primary progressive multiple sclerosis and healthy subjects. The time-integrated beta-endorphin response to CRH was greater in the patients with relapsing-remitting multiple sclerosis compared with the others. Feedback regulation assessed by dexamethasone suppression was normal. Serum testosterone was low in 24% of male multiple sclerosis patients and oestradiol was low in 25% of pre-menopausal female multiple sclerosis patients, whereas prolactin and the HPT function were normal. Correlations with C-reactive protein (CRP) and MRI suggest that activation of the HPA axis in multiple sclerosis patients is secondary to an active inflammatory stimulus.

Topics: Adult; Aged; Corticotropin-Releasing Hormone; Cosyntropin; Dexamethasone; Estradiol; Fatigue; Female; Follicle Stimulating Hormone; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Sclerosis; Pituitary-Adrenal System; Prolactin; Testosterone; Thyroid Hormones; Thyrotropin-Releasing Hormone

The routine therapy of multiple sclerosis (MS) in world-wide use today is comprised of four measures: Antiinflammatory and antiedematous treatment with ACTH or Synacthen, respectively, and corticosteroids: only during acute episodes. - High dosage, short duration, no long-term therapy. Immunosuppression with azathioprine (Imurek): Due to the relatively high risk only to use in malignant courses (frequent and severe bouts). Basic therapy with unsaturated fatty acids (sunflower oil, Naudicelle). Influencing circumscribed target symptoms (spasticity, micturition difficulties, constipation, etc.). In addition, physiotherapeutic, psychagogic and, if necessary, nursing and social measures are included. More than a decade's experience with ultrasound therapy of the lymphatic ring as developed by Selzer in over 300 MS-patients gives the impression of a reduction in bout frequency and severity. A statistical evaluation of therapeutic efficiency has so far been impossible for well-known disease-specific reasons, which hold true for all MS-treatment methods. Great practical importance within a foreseeable space of time may be reached by efforts to influence disturbance in nerve conduction and synaptic transmission as specifically caused by the demyelination process. The successful medicinal deceleration of sodium inactivation, inhibition of potassium activation and extension of the action potential, as well as specifically influencing the neurotransmitters responsible for the disturbed synaptic transmission could lead to a total recovery or improvement of dysfunction in a great many cases. Such a "global symptomatic therapy" might indeed not change the course of disease, but bring about great progress to the patient.

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Azathioprine; Baclofen; Combined Modality Therapy; Cosyntropin; Drug Therapy, Combination; Fatty Acids, Unsaturated; Humans; Hydrocortisone; Multiple Sclerosis

Topics: Adrenocorticotropic Hormone; Adult; Chronic Disease; Cosyntropin; Female; Humans; Multiple Sclerosis; Pancreatitis; Radiography

The experience of the authors demonstrated that the best results in sinakten-retard treatment were attained in patients with mild and moderate degrees of severity of the disease. However, even in patients with a protracted development, treatment by sinakten-retard increased the muscular strength in the paralyzed extremities, diminished the increased muscular tone and increased the volume of movements. All these facts permit the authors to recommend sinakten-retard for the treatment of disseminated sclerosis.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adrenal Cortex; Adrenocorticotropic Hormone; Adult; Cosyntropin; Delayed-Action Preparations; Emotions; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Muscle Spasticity; Muscle Tonus; Remission, Spontaneous

Topics: Adrenocorticotropic Hormone; Biomedical Research; Cosyntropin; Drug Therapy; Humans; Multiple Sclerosis; Toxicology

Topics: Adrenocorticotropic Hormone; Cosyntropin; Drug Therapy; Humans; Multiple Sclerosis