الفهرس 
Multiple SclerosisOnly 14 pages are availabe for public view
 |  | from | 256 |  |  |
| | | from | 256 | | |
Abstract
The present study aimed at assessing diagnostic and prognostic value of some CSF cytokines (IL1b, TNF alpha) in relapsing-remitting multiple sclerosis patients and their relation to disease activity, severity and progression. A second aim of this study was evaluation of the The present study aimed at assessing diagnostic and prognostic value of some CSF cytokines (IL1b, TNF alpha) in relapsing-remitting multiple sclerosis patients and their relation to disease activity, severity and progression. A second aim of this study was evaluation of the relationship between these CSF cytokines and MRI lesions (brain and spinal). This study was carried out on forty Egyptian patients with definite relapsing-remitting multiple sclerosis according to revised Mc Donald diagnostic criteria 2005 and on forty healthy controls matching for age and sex with the patients. Patients were selected from the neurology outpatient clinic and from inpatients of neurology department, Minoufiya University hospital. Patients ages ranged from (21-55 years), with mean age (34.35±10.42 years), they were 22 males (55%) and 18 females (45%). The control group age ranged from (21-55 years) with mean age (36.80±9.34 years). They were 20 females (50%) and 20 males (50%). Patients were assessed two times: one at time of relapse, and the other at time of remission. The assessment included clinical (history, examination, expanded disability status scale), radiological (enhanced and non enhanced brain and spinal MRI), neuro physiological (visual evoked potential) and immunological assessment: CSF cytokines (cerebrospinal fluid tumour necrosis factor alpha and interleukin 1b). The control group was assessed regarding to CSF cytokines only. In the present study, Duration of the illness among multiple sclerosis patients ranged from (1 to 23) years with a mean of (4.30± 5.21 years), number of relapses ranged from (2 to 7) times with a mean of (3.15±1.35). At onset of the disease (MS), twelve patients (30%) showed polysymptomatic presentation and twenty eight patients (70%) showed monosymptomatic presentation. Patients at relapse had stastistically significant higher scores on Expanded Disability Status Scale in comparison to Patients at remission. All patients in this study show positive MRI lesions corresponding with Multiple Sclerosis. MRI results were in the form of hyper intense lesions in T2-weighted images MRI. Ten patients (25%) had enhanced brain lesions during time of relapse. Patients at time of relapse had statistically significant higher number of brain and spinal MRI lesions than MS patients at time of remission. Out of the 40 patients who underwent VEP, 30 patients (75%) had abnormal VEP recording, either in the form of unilateral delay in the P100 absolute latency or bilateral delay in P100 absolute latency or bilateral normal latency but significant inter ocular difference. CSF analysis of TNFα1 was done for all patients (40). At relapse, it ranged from (2.5 to 15.2) pg/ml with a mean of (8.72 ± 3.84) pg/ml. Thirty-two patients (80%) showed increased level of CSF TNF alpha above the normal range. At remission, it ranged from (2 to 8) pg/ml with a mean of (4.60 ± 1.73) pg/ml. Twenty two patients (55%) that showed increased level above the normal range. Conclusion CSF analysis of IL1b was done for all patients (40). At relapse, it ranged from (4 to 20.8) pg/ml with a mean of (9.68 ± 4.81) pg/ml. Thirtyeight patients (95%) showed increased level above the normal range. At remission, it ranged from (3.3 to 12.2) pg/ml with a mean of (5.87 ± 2.19) pg/ml. Twenty-six patients (65%) showed increased level above the normal range. Multiple Sclerosis (MS) patients had statistically significant higher level of CSF TNF alpha and CSF IL1b than healthy controls at time of relapse and remission. Studied Multiple Sclerosis patients at time of relapse had statistically significant higher level of CSF TNF alpha and CSF IL1b than studied Multiple Sclerosis patients at time of remission. Multiple Sclerosis patients showed stastistically significant positive correlation between Expanded Disability Status Scale score and both age of the patient and duration of the disease at relapse and at remission. Also, stastistically significant positive correlations were found between Expanded Disability Status Scale score, at time of remission, and both number of relapses and MRI lesions number at remission. Among Multiple Sclerosis (MS) patients, there were stastistically significant positive correlations between CSF TNF alpha level and total brain and spinal MRI lesions number at time of relapse. Also, stastistically significant negative correlations were found between CSF TNF alpha level at remission and both age of the patient and age at onset of the illness. Summary and Conclusion Among Multiple Sclerosis (MS) patients, there were stastistically significant positive correlations between CSF IL1b level, at relapse, and each of duration of the illness, number of relapses and EDSS score (at remission). Also, stastistically significant positive correlations were found between CSF IL1b level at remission and number of relapses. In patients at relapse: -Presence of one or more of the following parameters can be a risk factor of (increasing number of MRI lesions among MS patients): increased age of the patients, increased duration of the disease, increased number of relapses, poly symptomatic first presentation, prolonged visual evoked potential distal latency, increased CSF TNF alpha level at relapse and decreased age at onset of the illness. -Increased total number of brain and spinal MRI lesions, followed by increased gadolinium enhanced MRI lesions number can be a risk factor of ( increased the level of CSF TNF alpha) among MS patients . - Increased number of relapses, followed by prlonged left visual evoked potential, followed by increased duration of the disease can be a risk factor of (increased the level of CSF IL1b) among MS patients In patients at remission: -Presence of one or more of the following parameters can be a risk factor of (increasing number of MRI lesions among MS patients): increased age of the patient, increased duration of the illness, increased number of relapses, polysymptomatic first presentation, prolonged left visual evoked potential distal latency and decreased age at onset of the illness. Increased duration of the illness, followed by increased CSF IL1b level at relapse, followed by prolonged interocular distance difference can be a risk factor of (increased Expanded Disability Status Scale score).relationship between these CSF cytokines and MRI lesions (brain and spinal). This study was carried out on forty Egyptian patients with definite relapsing-remitting multiple sclerosis according to revised Mc Donald diagnostic criteria 2005 and on forty healthy controls matching for age and sex with the patients. Patients were selected from the neurology outpatient clinic and from inpatients of neurology department, Minoufiya University hospital. Patients ages ranged from (21-55 years), with mean age (34.35±10.42 years), they were 22 males (55%) and 18 females (45%). The control group age ranged from (21-55 years) with mean age (36.80±9.34 years). They were 20 females (50%) and 20 males (50%). Patients were assessed two times: one at time of relapse, and the other at time of remission. The assessment included clinical (history, examination, expanded disability status scale), radiological (enhanced and non enhanced brain and spinal MRI), neuro physiological (visual evoked potential) and immunological assessment: CSF cytokines (cerebrospinal fluid tumour necrosis factor alpha and interleukin 1b). The control group was assessed regarding to CSF cytokines only.In the present study, Duration of the illness among multiple sclerosis patients ranged from (1 to 23) years with a mean of (4.30± 5.21 years), number of relapses ranged from (2 to 7) times with a mean of (3.15±1.35). At onset of the disease (MS), twelve patients (30%) showed polysymptomatic presentation and twenty eight patients (70%) showed monosymptomatic presentation. Patients at relapse had stastistically significant higher scores on Expanded Disability Status Scale in comparison to Patients at remission. All patients in this study show positive MRI lesions corresponding with Multiple Sclerosis. MRI results were in the form of hyper intense lesions in T2-weighted images MRI. Ten patients (25%) had enhanced brain lesions during time of relapse. Patients at time of relapse had statistically significant higher number of brain and spinal MRI lesions than MS patients at time of remission. Out of the 40 patients who underwent VEP, 30 patients (75%) had abnormal VEP recording, either in the form of unilateral delay in the P100 absolute latency or bilateral delay in P100 absolute latency or bilateral normal latency but significant inter ocular difference. CSF analysis of TNFα1 was done for all patients (40). At relapse, it ranged from (2.5 to 15.2) pg/ml with a mean of (8.72 ± 3.84) pg/ml. Thirty-two patients (80%) showed increased level of CSF TNF alpha above the normal range. At remission, it ranged from (2 to 8) pg/ml with a mean of (4.60 ± 1.73) pg/ml. Twenty two patients (55%) that showed increased level above the normal range.CSF analysis of IL1b was done for all patients (40). At relapse, it ranged from (4 to 20.8) pg/ml with a mean of (9.68 ± 4.81) pg/ml. Thirtyeight patients (95%) showed increased level above the normal range. At remission, it ranged from (3.3 to 12.2) pg/ml with a mean of (5.87 ± 2.19) pg/ml. Twenty-six patients (65%) showed increased level above the normal range. Multiple Sclerosis (MS) patients had statistically significant higher level of CSF TNF alpha and CSF IL1b than healthy controls at time of relapse and remission. Studied Multiple Sclerosis patients at time of relapse had statistically significant higher level of CSF TNF alpha and CSF IL1b than studied Multiple Sclerosis patients at time of remission. Multiple Sclerosis patients showed stastistically significant positive correlation between Expanded Disability Status Scale score and both age of the patient and duration of the disease at relapse and at remission. Also, stastistically significant positive correlations were found between Expanded Disability Status Scale score, at time of remission, and both number of relapses and MRI lesions number at remission. Among Multiple Sclerosis (MS) patients, there were stastistically significant positive correlations between CSF TNF alpha level and total brain and spinal MRI lesions number at time of relapse. Also, stastistically significant negative correlations were found between CSF TNF alpha level at remission and both age of the patient and age at onset of the illness. Among Multiple Sclerosis (MS) patients, there were stastistically significant positive correlations between CSF IL1b level, at relapse, and each of duration of the illness, number of relapses and EDSS score (at remission). Also, stastistically significant positive correlations were found between CSF IL1b level at remission and number of relapses. In patients at relapse: -Presence of one or more of the following parameters can be a risk factor of (increasing number of MRI lesions among MS patients): increased age of the patients, increased duration of the disease, increased number of relapses, poly symptomatic first presentation, prolonged visual evoked potential distal latency, increased CSF TNF alpha level at relapse and decreased age at onset of the illness. -Increased total number of brain and spinal MRI lesions, followed by increased gadolinium enhanced MRI lesions number can be a risk factor of ( increased the level of CSF TNF alpha) among MS patients . - Increased number of relapses, followed by prlonged left visual evoked potential, followed by increased duration of the disease can be a risk factor of (increased the level of CSF IL1b) among MS patients In patients at remission: -Presence of one or more of the following parameters can be a risk factor of (increasing number of MRI lesions among MS patients): increased age of the patient, increased duration of the illness, increased number of relapses, polysymptomatic first presentation, prolonged left visual evoked potential distal latency and decreased age at onset of the illness. Increased duration of the illness, followed by increased CSF IL1b level at relapse, followed by prolonged interocular distance difference can be a risk factor of (increased Expanded Disability Status Scale score).