Natural Cure for Multiple Sclerosis
About half of people with multiple sclerosis have cognitive difficulties. As with physical symptoms, individual experiences with these symptoms differ considerably. The most common cognitive problems occur in the realms of attention, concentration, and executive functions, which refer to high-level cognitive functions, such as planning and reasoning. Deficits in these areas can have secondary impact on memory. In some people, these problems worsen over time, whereas in others, they remain stable or might even improve. There's no cure for multiple sclerosis, but research indicates that certain medications can slow the progression of the disease. I69_
16 Clinical Neuropsychological Assessment of Callosal Dysfunction Multiple Sclerosis and Dyslexia Warren S. Brown 391 commentary 16.1 Interhemispheric Conduction Delay in Multiple Sclerosis Francesco Tomaiuolo, Marco Iacoboni, M. Altieri, Vittorio Di Piero, Carlo Pozzilli, Gian L. Lenzi, and Carlo A. Marzi 407 17 Alexithymia as a Consequence of Impaired Callosal Function Evidence from Multiple Sclerosis Patients and Normal Individuals Michel Habib, GEraldine Daquin, Jean Pelletier, Michele Montreuil, and Fabrice Robichon 415
Many of the biopharmaceuticals have been developed under the 1983 Orphan Drug Act, which provides a 7-year market exclusivity for drugs targeting diseases that affect fewer than 200,000 individuals in the United States. For these drugs, it becomes important to be the first to reach the market. For example, Amgen's Neupogen Granulocyte Colony-Stimulating Factor (G-CSF) was approved 2 weeks earlier than Leukine (Immunex Gran-ulocyte Macrophase Colony-Stimulating Factor GM-CSF ) and was thus awarded market exclusivity for several conditions characterized by neutro-penia and became a billion-dollar product. Companies have been able to successfully argue that their product is different from the one previously approved under the Orphan Drug Act. For example, Biogen successfully argued that their interferon product Avonex was not the same drug as Betaseron because it has a better safety profile regarding skin necrosis at injection sites. Currently, these two as well as another interferon...
Smoking it to alleviate the symptoms of multiple sclerosis might not be. At least the different circumstances merit a discussion. The law of gravity cannot be contested in the same way, and neither can the doctor's duty to act in her patient's best interests. This is because the title 'doctor' defines the function which the person who takes that title has to perform. If she did not want to act in her patients' best interests, she would not call herself a doctor. Now, if she also wishes to conduct research upon her patients, and hence add the title 'researcher' to the title doctor, a question arises as to whether it can still be taken as read that she must act in her patients' best interests. I would argue that such a function remains so long as the title doctor remains, which it will do if there is someone present calling himself a patient. It is even questionable whether doctors can shed their role at any time (Walsh, 1998). The role of researcher has its...
Beta interferon Interferon beta-1b Recombinant version of the endogenous biological compound, produced in E. coli with an inserted human fibroblast-derived gene. The recombinant form has 165 aa and is not glycosylated. Used to treat relapsing multiple sclerosis, although not all patients respond proprietary name Betaseron.
Medical disorders associated with an elevated risk of suicide are AIDS, cancer (especially head and neck), Huntington disease, multiple sclerosis, peptic ulcer disease, end-stage renal disease, spinal cord injury, and systemic lupus erythematosus. Any serious medical illness can raise the risk of suicide in elderly Caucasian men. In most cases, suicide in the context of a medical disorder occurs in conjunction with a depressive disorder or a history of alcohol abuse, or both.
Similar to most subspecialties of internal medicine, neurology is particularly rewarding for aspiring doctors who prefer using their minds more often than their hands. Regardless, there are several important procedures that all neurologists perform on a daily basis. The most common is the famous spinal tap (lumbar puncture). During this procedure, the physician carefully inserts a needle into the thecal sac below the termination of the spinal cord to withdraw cerebrospinal fluid. Unchanged for the past hundred years, this technique can diagnose patients with certain acute infections, particularly meningitis, as well as multiple sclerosis, intracranial bleeding, and neuropathies. Furthermore, the spinal tap can also serve as a therapeutic measure by removing fluid to relieve conditions such as hydrocephalus (water on the brain) or increased intracranial pressure. It also provides a means by which the physician directly injects chemotherapeutic agents or antibiotics to treat infections...
Neurologists often consult with neurosurgeons and vascular surgeons to discuss treatment alternatives related to excision and repair of neurologic deficits. However, they also have an extensive array of neuropharmacologic choices in their therapeutic regimen. Whether the presenting disease is a complex pain syndrome, debilitating multiple sclerosis, or Parkinson disease, neurologists use powerful new medications to alleviate symptoms. In addition, they can also counter these diseases with more aggressive therapies, like high-dose steroids, strong acute blood thinners, intravenous immune therapies, plasmapharesis (for cleaning out the blood), vagal nerve stimulators, and many others.
Neurologists practice by virtue of not giving up on their patients, no matter how little improvement has been achieved. Health professionals with little background in neurology often dash the hopes of patients and their families in cases of acute confusion, disability following a stroke, or progressive multiple sclerosis. Instead, the neurologist knows that even the most severely disabled patient may eventually recover substantially. But these physicians do not necessarily practice on the basis of common sense alone. Rather, all neurologists strive for a combination of calmness and initiative, compassion and objectivity, the ability to communicate clearly, and the skill to listen quietly.
Confabulation also has been reported in association with other etiologies, such as traumatic brain injury (Baddeley& Wilson, 1988 Berlyne, 1972 Box etal., 1999 Moscovitch & Melo, 1997), multiple sclerosis (Feinstein et al., 2000), rupture of a PCoA aneurysm (Dalla Barba et al., 1997a Mercer et al., 1977), fronto-temporal dementia (Nedjam et al., 2000 Moscovitch & Melo, 1997), herpes simplex encephalitis (Moscovitch & Melo, 1997) and other disorders. Some have reported confabulation in dementia of the Alzheimer type (Nedjam et al., 2000 Kern et al., 1992 Kopelman, 1987 Tallberg & Almkvist, 2001 Dalla-Barba et al., 1999). However, at least in the early stages of the disease, these reports seem to stretch the definition of confabulation to include various types of intrusions, and only rarely is a full-blown confabulatory syndrome seen in these patients (DeLuca, 2000a).
In an attempt to clarify the relationship between lesion location and confabulation we reviewed 33 studies in which significant imaging or post mortem findings were reported (see Table 15.1). These studies describe 79 confabulating patients whose confabulations may be regarded as spontaneous according to Kopelman's (1987) definition and who were past the confusional state. The majority of patients (47) had ruptures of aneurysms in the ACoA 14 patients had traumatic brain injury (TBI) and the rest had dementias, other cerebrovascular abnormalities (infarcts, arteriovascular malformations, occlusions, PCoA), multiple sclerosis, encephalitis, meningitis, Korsakoff's syndrome, etc. Multiple sclerosis
Demyelinating diseases Diseases in which the myelin sheath of nerves is destroyed and that often have an autoimmune component. Examples are multiple sclerosis, acute disseminated encephalomyelitis (a complication of acute viral infection), experimental allergic encephalomyelitis, Guillain-Barr syndrome.
Mononeuropathies can also occur on the face. Repeated bouts of recurrent lancinating pain involving a single dermatome on the face are the hallmark of trigeminal neuralgia, which can be either an isolated disorder or a manifestation of multiple sclerosis or a compressive lesion.
Natalizumab is a compound which is able to block both a4p7-MadCAM-1 and a4p7-VCAM-1 interactions in humans (the latter one is a crucial step for lymphocyte migration in multiple sclerosis see Sect. 188.8.131.52). It has shown promise in phase II trials of patients with Crohn's disease (Sandborn and Yednock 2003).
Spasticity A condition in which certain muscles are continuously contracted, causing stiffness or tightness of the muscles that may interfere with movement and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. It may occur together with spinal cord injury, multiple sclerosis, cerebral palsy, brain damage, severe head injury, and some metabolic diseases.
In a portion of patients with DO, neurogenic dysfunction can be identified as the underlying pathology and is therefore classified as neurogenic DO (NDO). Examples of neurological impairment include spinal cord lesions, stroke, multiple sclerosis, Parkinson's disease, and dementia. In other cases, no demonstrable neurological impairment can be identified. Accordingly, the disorder is classified as non-neurogenic or idiopathic DO (IDO). Other defects, such as detrusor myocyte hyperactivity, have been suggested as possible etiologies in these patients who have no underlying neurological dysfunction (25). However, the exact etiology of IDO is currently unknown. The first urological application of BTX-B was reported by Dykstra et al. in 2003. In this case report, the authors treated one patient with DO resulting from multiple sclerosis (60). Treatment consisted of two separate intradetrusor injections of 5000 and 7500 U BTX-B. An immediate treatment response was demonstrated and the...
There are many other places that you can turn to for information. An Internet search finds organizations such as the Alliance of Genetic Support Groups, the March of Dimes, and the National Organization for Rare Disorders. Some individuals who are trying to take an active role in communication about disorders in their families have established Web pages that present information or reach out to others with similar problems. There are several ways to locate an organization that provides information or support relative to a particular disease. For many different diseases, organizations raise funds for research, provide support groups, and provide information about the disease. One example is The Foundation Fighting Blindness, which supports research, carries on educational programs, has local chapters throughout the country, and holds national meetings attended by patients, family members, caregivers, and educators who want to understand more about forms of retinal degeneration, such as...
A role for the macrophage in both the induction and effector phases of multiple sclerosis (MS) (see Chapter 8) has been suggested. Inappropriate induction of antigen-specific helper T cells resulting in altered regulation of the immune response is postulated to be one of the factors in the mechanism of autoimmune disease. In MS (Bar-Or et al., 1999), once autoreactive T cells have been presented with the relevant antigen and received the appropriate cytokine stimuli, they become activated and cross into the CNS across the blood-brain barrier. Subsequent proliferation of these autoreactive T cells may occur following presentation by indigenous macrophages, microglia or possibly astrocytes. CNS damage and edema following the release of cytokines and macrophages, which are known to strip myelin from nerve sheaths, play a role in the subsequent demyelination. See also Chapter 13 for a more detailed examination of the role of macrophages in the CNS.
Orally administered antigens stimulate a strong secretory immune response with immunoglobulin A (IgA) and IgM antibodies, while the systemic immune response is inhibited. Thus the live polio vaccine and vaccines against salmonellae and Vibrio cholera are administered orally. Orally administered autoantigens may induce selective immunological tolerance and could be used to treat autoimmune diseases, such as multiple sclerosis, although results of clinical trials have so far been discouraging.
Ataxia Shaky movements and unsteady gait caused by the brain's failure to regulate the body's posture and the strength and direction of limb movements. Ataxia is usually the result of brain damage in the cerebellum or spinal cord, resulting from infection, head injury, brain tumor, toxins, multiple sclerosis, and so on. In cerebellar ataxia, there is a clumsiness in intentional movements, including walking, speaking, and eye movements. Sensory ataxia (unsteady movements that are exaggerated when the patient closes the eyes) occurs from a lack of sensory feedback. Friedreich's ataxia is a fatal genetic disease characterized by the degeneration of the motor nerves of the spinal cord that the cerebellum, causing a loss of coordination and a disturbance in gait. it may be inherited as a recessive or dominant trait and may strike persons from a very early age up to and beyond age 50. While it is similar to multiple sclerosis, MS is not inherited and is believed to have a different origin....
Creatic cells for diabetes, hematopoietic cells for leukemia, neuroglia cells for multiple sclerosis, and so on. When returned to the patient's body, the cloned cells in such tissues or organs ideally would repair or replace the damaged body part, without evoking immunological rejections.
National Multiple Sclerosis Society A national support group for patients with multiple sclerosis (ms) and their families that supports and coordinates research into the cause, treatment, and cure of MS. The group provides services for patients, helps establish Ms clinics and therapy centers, and sponsors public education. The society sponsors Project Rembrandt, a biennial competition for artists with MS. The society provides information and referrals and offers community services, counseling, training programs for caregivers, swimming programs, vocational rehabilitation, and loans medical equipment. The group maintain an information resource center and library, maintains a speakers' bureau, and compiles statistics.
Joseph disease Also called Machado-Joseph disease, this is a genetic disorder of the central nervous system that cripples and paralyzes. it affects all races and many ethnic groups, and is often mis-diagnosed as multiple sclerosis, Parkinson's disease, or spino-cerebellar degeneration. Joseph disease is also known as spino-cerebellar ataxia, type 3, or SCA 3, a common hereditary ataxia.
More persistent tremors are caused by trauma, tumors, stroke, or degenerative disease. Coarse tremors (four to five movements per second) that occur during rest, diminishing during movement, are a common sign of Parkinson's disease. Intention tremors (tremors that worsen on movement) are a sign of cerebellum disease. Tremors often accompany such diseases as multiple sclerosis, Wilson's disease, mercury poisoning, thyrotoxico-sis, and liver encephalopathy. younger people with multiple sclerosis. Attacks recur in clusters of brief episodes that may last for weeks the recurrences tend to occur closer and closer together with time.
Mixed dysarthrias reflect combinations of two or more of the single dysarthria types. They occur more frequently than any single dysarthria type in many clinical settings. Some diseases are associated only with a specific mix for example, flaccid-spastic dysarthria is the only mix expected in ALS. Other diseases, because the locus of lesions they cause is less predictable (e.g., multiple sclerosis, traumatic brain injury), may be associated with virtually any mix. The presence of mixed dysarthria is very uncommon or incompatible with some diseases (e.g., myasthenia gravis is associated only with flaccid dysarthria), so sometimes the presence of a mixed dys-arthria can make a particular disease an unlikely cause or raise the possibility that more than a single disease is present.
Table 1 summarizes the evidence for and against an autoimmune basis for narcolepsy. The tight association between narcolepsy and HLA-DQB1*0602 is generally greater than HLA associations observed with known autoimmune disorders such as multiple sclerosis or type I diabetes mellitus (a notable exception may be ankylosing spondylitis and HLA-B27) Furthermore, like most autoimmune diseases, narcolepsy tends to affect younger individuals (peripubertal onset). Unlike most autoimmune diseases, which tend to affect females more, however, narcolepsy is seen equally in both sexes (1). Also, there is no known clustering of narcolepsy with known autoimmune diseases. Levels of inflammatory markers such as C-reactive protein and erythrocyte sedimentation rates, as well as CD4 CD8 lymphocyte subsets, have all been reported to be within the normal range. (1,16-19). This could be because by the time narcolepsy is clinically apparent, the initial inflammatory response may have disappeared or the immune...
Disseminated encephalomyelitis (51,52), hypothalamic sarcoidosis (53,54) or histiocytosis X, multiple sclerosis (MS) (44,48,55,56), and Parkinson's disease (42,48,57,58). In some cases, lesions of the hypothalamic hypocretin centers have been clearly identified using magnetic resonance imaging, as in bilateral MS plaques in the hypothalamus and tumors of the third ventricle (59-62). Cataplexy may not be present in these cases, and the CSF hypocretin-1 levels may be either in the narcolepsy range (
AAC is used to assist adults with a wide range of disabilities, including congenital disabilities (e.g., cerebral palsy, mental retardation), acquired disabilities (e.g., traumatic head injury, stroke), and degenerative conditions (e.g., multiple sclerosis, amyotrophic lateral sclerosis) (American Speech-Language-Hearing Association ASHA , 1989). Individuals at any point across the life span and in any stage of communication ability may use AAC (see the companion entry, augmentative and The patterns of communication disorders in adults vary from condition to condition. Persons with aphasia, traumatic brain injury, Parkinson's disease, Guillain-Barre syndrome, multiple sclerosis, and numerous motor speech impairments benefit from using AAC (Beukelman and Mirenda, 1998). ACC approaches for a few adult severe communication disorders are described here.
Demyelinating disorders A group of diseases characterized by the breakdown of myelin, the fatty sheath surrounding and insulating nerve fibers that interferes with nerve function. The best-known of these is multiple sclerosis others include schilder's disease and dysmyelination In multiple sclerosis, lesions appear in the brain and spinal cord, causing a variety of intermittent neurological symptoms. While the cause of this demyelinating disease is unknown, some researchers believe it may involve a disruption in the body's immune system or by infection from a slow-acting virus. It generally strikes adults in their 30s and 40s, and its symptoms vary some patients live many years with few symptoms, while others experience frequent attacks. In general, however, each new attack is followed by more severe episodes. The disease is not often immediately fatal the average duration of life after onset is about 25 years. In the terminal stage, almost every portion of the nervous system is...
Human narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS), cataplexy, and other abnormal manifestations of REM sleep, such as hypnagogic hallucinations and sleep paralysis (11). Narcolepsy is not a rare disease, affecting approximately 1 in 2000 in the general population, which is equivalent to Parkinson's disease (12) or multiple sclerosis (13). EDS in narcolepsy is overwhelming and is characterized by recurring episodes of sleep during the daytime (11). Patients also experience disturbed nocturnal sleep, although less frequently emphasized (11). The total amount of sleep that narcoleptic subjects have over 24 h does not exceed that of normal subjects (14). Therefore, narcolepsy is not an intrinsic hypersomnia but rather a pathological condition involving instability of the vigilance state (sleep wake fragmentation or problems maintaining wake sleep for longer period).
Human herpesvirus 6 Herpesvirus that infects lymphocytes, including CD4 cells. HHV-6 infection generally occurs early in life and may cause fever and exanthem (roseola, a red skin rash) in infants. HHV-6 is associated with neuropathology, chronic fatigue syndrome, multiple sclerosis, and certain autoimmune diseases.
Abstract In this chapter we review current neuroimaging research on the structure of the corpus callosum. The corpus callosum is the main fiber tract connecting the two brain hemispheres, consisting of approximately 200-350 million fibers in humans. Given the corpus callosum's importance in communicating perceptual, cognitive, mnemonic, learned, and volitional information between the hemispheres, it has not surprisingly been a focus of many studies examining structural and functional neuropathology. We and other groups have investigated callosal abnormalities in Alzheimer's disease, multi-infarct dementia, schizophrenia, attention deficit hyperactivity disorder, and multiple sclerosis and during normal and aberrant development. Nonetheless, extreme variations in brain structure make it difficult to design computerized strategies that detect and classify abnormal structural patterns. Intense controversy exists on the question of whether different callosal regions undergo selective...
Gastroparesis is the term used to describe delayed stomach emptying. The pathogenesis of this disorder depends on the underlying etiology, but can be broadly categorized as neuropathic or myopathic. Neuropathic processes involving the stomach are characterized by poorly coordinated contractile activity of the stomach (i.e., non-peristaltic), reduced frequency of gastric contractions, but preserved contractile amplitude. On full thickness biopsy, there is a degeneration of axons, dendrites, and or neurons with preserved circular and longitudinal smooth muscle layers (3). Some neuropathic causes of gastroparesis include endocrine disorders (diabetes mellitus, hypo hyperthyroidism), post-surgical (e.g., resulting from vagotomy), drug-induced (e.g., anticholinergics and narcotics), post-infectious (e.g., Chagas disease), and complications of systemic neurological disorders (e.g., Parkinson's disease and multiple sclerosis).
Cerebral edema is commonly associated with acute episodes of neurological disease (e.g., head injury), but it is also recognized that less-dramatic increases in CNS water content may chronically and regionally accompany persistent conditions, such as multiple sclerosis, Alzheimer's dementia, and perhaps some forms of epilepsy. Here are reviewed only a few examples of experimental evidence linking changes in potassium homeostasis to acute or chronic neurological disease. Table 1 summarizes other homeostatic mechanisms that may impact transmitters, or other molecules and ions.
It is also possible that chronic hypocretin deficiency may cause a secondary deficit that is important for mediating hypocretin neurotransmission such deficits may also be responsible for some of the narcolepsy phenotype. A series of recent human studies demonstrated that undetectable CSF hypocretin levels are likely to be measured at very early stages of the disease even before the onset of cataplexy and REM sleep abnormalities (60). Various neurological conditions associated with significant hypocretin ligand deficiency, such as acute disseminated encephalomyelitis, Guillain-Barre syndrome, and multiple sclerosis have been reported (5,60-65). In some of these cases, hypocretin deficiency occurred acutely, and the degree of hypocretin deficiency was as significant (undetectable levels in the CSF) as in most sporadic cases of narcolepsy-cataplexy (3-5). Hypocretin deficiency is often associated with the occurrence of EDS, but the occurrence of cataplexy is rare, suggesting that a...
Cervical spine disease in elderly patients is most commonly caused by progressive arthritic narrowing of the spinal column. This is worsened by falls that cause hyperextension injuries, further compressing the cervical cord. Cervical myelopathies cause exclusively upper motor neuron weakness (brisk reflexes, upgoing toes) but also cause bladder difficulties (by interrupting descending tracts) and sensory loss (by affecting the posterior columns). Cervical spine disease can also result from tumor or injury. In younger patients, spinal cord disease can be caused by multiple sclerosis or isolated transverse myelitis, an acute immune-mediated process associated with cells in the cerebrospinal fluid. Transverse myelitis differs from spondylytic cervical myelopathy in its acute onset, younger age, and cellular cerebrospinal fluid. Usually, it occurs in the thoracic, rather than the cervical, spine.
Chronic granulomatous disease, and, most recently, multiple sclerosis. Most interferons belong to one of three classes a, p, or g. The a family is largest with more than 20 members. Interferons-a and -p are often classified as type I interferons, and these can be produced by essentially all cells in the body in response to a viral infection. Interferon-g is a type II molecule produced only by the T lymphocytes and natural killer cells of the immune system.
CAT shows internal brain structures much better than conventional X rays. It is particularly useful for diagnosing brain disorders such as stroke, hemorrhage, tumor, injury, abscesses, cysts, swelling, fluid accumulation, and dead tissue. MRI scans are good at imaging areas affected by stroke that cannot be seen well on a CAT scan, and to diagnose nerve fiber disorders such as multiple sclerosis.
Case Example A single young man was hospitalized with a one-month history of weakness of his legs and difficulty walking. Neurologic evaluation was unremarkable, yet the patient persisted in a fearful worry that he had multiple sclerosis. His present illness had started acutely, after he had begun a new job where he felt fearful of his boss, who was critical and demanding. The final straw came after he had begun dating a woman from his office. Although he saw their relationship as casual and platonic, she had begun pressing him for more of a commitment. After a distressing discussion with her one night, he awoke the next morning feeling weak in his legs and unable to walk. By temperament he was a dramatic, perfectionistic, and self-centered person. Examination of the patients mental state did not reveal evidence of major depression, an anxiety disorder, or schizophrenia. His behavior was understood as motivated by both fears of dealing with situations he wished to avoid and a desire...
Ms does not shorten life span, and most people with the disease can lead fairly normal lives. Recent studies have found that, contrary to earlier beliefs, pregnancy does not worsen symptoms and does not affect the long-term course of the disease. However, some experts caution that a parent with Ms may not have the physical stamina to care for a baby or an active child and may need some child care help. For more information, contact the national multiple sclerosis society for address, see Appendix I. Multiple Sclerosis Foundation A national support group that provides funding for research into the cause, prevention, treatment, and cure of multiple sclerosis. The foundation provides information, referral and support services, and health care options. Founded in 1986, the foundation publishes a quarterly newsletter and brochures. For address, see Appendix I. See also multiple sclerosis society. The abnormal breakdown of myelin, such as in multiple sclerosis, is called demyelination, and...
Specialists in neuroimmunology concentrate on patients with autoimmune neurologic disease, particularly multiple sclerosis. According to the AAN, roughly 350,000 to 500,000 people suffer from multiple sclerosis in the United States. The neuroimmunologist also evaluates and treats patient with other autoimmune neurologic problems, such as myasthenia gravis, lupus, and Sjogren disease. Due to the complexity of these diseases, neuroimmunologists are also knowledgeable in their complications, including depression, psychosis, spasticity, incontinence, sexual dysfunction, and pain.
Trauma can occur after injuries in the home, at the workplace, during sports activities, or on the road. Any of these injuries can result in severe disability and pain. Some patients who have had an injury to the spinal cord experience intense pain ranging from tingling to burning and, commonly, both. Such patients are sensitive to hot and cold temperatures and touch. For these individuals, a touch can be perceived as intense burning, indicating abnormal signals relayed to and from the brain. This condition is called central pain syndrome or, if the damage is in the thalamus (the brain's center for processing bodily sensations), thalamic pain syndrome. It affects as many as 100,000 Americans with multiple sclerosis, Parkinson's disease, amputated limbs, spinal cord injuries, and stroke. Their pain is severe and is extremely difficult to treat effectively. A variety of medications, including analgesics, antidepressants, anticonvulsants, and electrical stimulation, are options available...
Multiple sclerosis A neurological disease causing unpredictable bouts of paralysis, numbness, and vision loss, once thought to strike only adults but now acknowledged to occur in children. Multiple sclerosis (MS) affects about 350,000 American adults, but experts estimate that as many as 20,000 children in the united States also have the disease yet remain undiagnosed. New medical evidence suggests that the number of pediatric patients is rising, probably because more doctors are considering the diagnosis when they see a child suffering from telltale symptoms such as a sudden visual problem. Multiple sclerosis occurs when the body's immune cells turn and mistakenly attack the thick sheath (myelin) covering the nerve fibers of the brain and spinal cord. When the myelin is destroyed, the underlying nerve can be damaged, triggering a range of symptoms such as tremors or slurred speech.
Although a-MSH has potential use in multiple sclerosis, an analogue of a-MSH, (NLe4, D-Phe7)-a-MSH, has potential applications for hypopigmen-tary disorders and for the stimulation of skin tanning without ultraviolet light. This melanotropic peptide can be delivered transdermally through human skin, as suggested by some in vitro studies.58
The multitude of diseases and conditions affecting the cerebellum can be broadly divided into acquired and degenerative. Patients with the latter typically present with a gait disorder and incoordination, and tremor is rarely a prominent part of the picture. The most severe cerebellar tremors are encountered in acquired diseases. In these situations, the diagnosis is often obvious head trauma, multiple sclerosis, or a posterior circulation stroke. Accurate diagnosis, which may require referral to a neurologist, is essential.
Diabetes), other medical conditions (such as urinary tract infection, enlarged prostate, liver failure, multiple sclerosis, and sleep apnea), and medication (especially diuretics). Some cases are caused or exacerbated by excessive fluid intake after dinner, especially drinks containing alcohol or caffeine.
After birth, angiogenesis still contributes to organ growth, but during adulthood most blood vessels remain quiescent angiogenesis only occurs in the cycling ovary and placenta during pregnancy. However, endothelial cells (ECs) retain the remarkable ability of dividing rapidly in response to a physiological stimulus, such as hypoxia and inflammation. Angiogenesis is also reactivated during wound healing and repair. In many disorders, however, this stimulus becomes excessive, and the balance between stimulators and inhibitors is disturbed, resulting in an angiogenic switch. The best-known conditions in which angiogenesis is switched on are malignant, ocular and inflammatory disorders, but many additional processes are affected-such as atherosclerosis, asthma, diabetes, cirrhosis, multiple sclerosis, endometriosis, acquired immunodeficiency syndrome (AIDS), bacterial infections and autoimmune diseases (Table 1). In obesity, adipose tissue may also show excessive growth. A high-fat diet...
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