"Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. " Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin ical trials have excluded PPMS patients on two counts. Clinical worsening devel ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi ence suggests that the results may not be dramatic.

The book represents an updated report of the most recent advances in primary progressive multiple sclerosis

Klappentext

This monograph is an up-to-date report of the most recent advances in the research on primary progressive multiple sclerosis (PPMS) - a variant of MS - and of the considerable progress made in understanding it. The reviews, written by leading scientists in this field, clearly demonstrate that the advances in understanding the natural history, pathophysiology, pathogenesis and pathology of PPMS are being extended by ongoing studies of the MS plaque and normal appearing white matter using magnetic resonance imaging and spectroscopic techniques. This confluence of thought provides insight into possible disease mechanisms.

Inhalt
1 Observations from the Natural History Cohort of London, Ontario.- 2 Pathology.- 3 Immunology.- 4 Neurophysiology.- 5 Neuropsychology.- 6 Overview of Treatment Trials: Early Baseline Clinical and MRI Data of the PROMiSe Trial.- 7 Conventional MRI.- 8 Magnetization Transfer and Diffusion Tensor Magnetic Resonance Imaging.- 9 Proton Magnetic Resonance Spectroscopy.- 10 Functional Magnetic Resonance Imaging.- Subjectlndex.