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The detection of cognitive dysfunction in multiple sclerosis
Blahová-Dušánková, Jana ; Kubala Havrdová, Eva (advisor) ; Papežová, Hana (referee) ; Rektorová, Irena (referee)
Evaluation of cognitive impairment is often omitted in multiple sclerosis (MS), as the available instruments usually require considerable time and resources, and are not readily available in all countries. The aims of this study were to examine validity of the Czech translation of the MACFIMS (Minimal Assessment of Cognitive Function in MS), to validate the BICAMS (Brief International Cognitive Assessment for MS) and to compare outcomes of the MACFIMS and the BICAMS. We evaluated 367 MS patients and 134 healthy controls with the MACFIMS battery, which also comprises the 3 tests of the BICAMS (Symbol Digit Modalities Test, Brief Visuospatial Memory Test- Revised, California Verbal Learning Test, second edition). The most accurate BICAMS criterion of cognitive deficit was that of at least 1 of the overall 3 tests outside the normal range (sensitivity = 94%, specificity = 86%, p=10-28). Outcomes of the Czech translation of the MACFIMS were comparable to its original. The MACFIMS and the BICAMS identified cognitive deficit in 55% and 58% of the MS patients, respectively. Both the BICAMS and MACFIMS predicted patient vocational status. The BICAMS is highly sensitive and specific to cognitive impairment in MS as defined by the MACFIMS. This impairment is significantly associated with vocational status. Our work...
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Characteristics of gait impairment and possible therapeutic interventions in people with multiple sclerosis.
Novotná, Klára ; Kubala Havrdová, Eva (advisor) ; Čakrt, Ondřej (referee) ; Taláb, Radomír (referee)
Walking disorders are one of the most visible symptoms of multiple sclerosis (MS). Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease of the central nervous system that is the most common cause of disability of young adults. Walking disorders are one of the most common motor problems that accompany this disease, which patients themselves perceive as the most limiting. Walking disorders can be caused by many symptoms of MS such as: muscle weakness, spasticity, sensory disturbances, visual disturbances, sphincter problems, cognitive dysfunction, fatigue and thermosensitivity. Measuring of various gait parameters (most often speed and endurance) also helps to monitor the effects of treatment and to evaluate the progression of the disease. Even in patients with minimal neurological symptoms it is possible to detect deterioration of gait parameters. Realized studies have shown that subjectively perceived improvement in gait after treatment with natalizumab can be objectified with the aid of assessment of walking parameteres. Similarly, a functional gait test can be used to assess the therapeutic response (and thus evaluate the cost effectiveness of treatment) to symptomatic treatment with fampridine. As a physiotherapist, I was also interested in the possibility of influencing...
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Optical coherence tomography in multiple sclerosis.
Lízrová-Preiningerová, Jana ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Taláb, Radomír (referee)
Spectral domain optical coherence tomography (SD-OCT), a non-invasive imaging method, is based on an analysis of a near-infrared light deflected from tisssue layers, that provides detailed images of retinal structures. Nerve cells of the retina, that originate from neuroectoderm, reflect neurodegeneration of the central nervous system (CNS), as well as acute damage of nerve structures caused by optic neuritis. The dissertation first presents established imaging protocol and quality standards for SD-OCT imaging in multiple sclerosis (MS). In the following section we introduce SD-OCT as a biomarker in MS. In a multicentric cross-sectional study, we had shown, that a single time measurement of peripapillary retinal nerve fiber layer thickness (RNFL) has a predictive value for a risk of disease progression in the next five years. Patients with a thickness of RNFL in the lowest tercile of the studied population had a relative risk of disease progression 2x higher than patients in the highest tercile. The second presented study tests whether the history of optic neuritis (ON) in MS is a risk factor for neurodegeneration of RNFL in later years. The study confirmed that long term changes of RNFL thickness in eyes post-ON and in eyes with no history of ON are not different. Therefore, we conclude that both,...
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Immunosuppression in active multiple sclerosis: combination treatment with interferon beta and azathioprine and fingolimod monotherapy
Tichá, Veronika ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Laczó, Jan (referee)
Introduction: Addition of a second drug used to be a strategy to achieve clinical stabilization of multiple sclerosis in many patients with on-going activity despite monotherapy. Modern immunosuppressive drugs used in monotherapy exert more specific mode of action. Methods: This retrospective observational study evaluated 5-year data from 85 patients with active multiple sclerosis despite monotherapy with either interferon beta or azathioprine, who received add-on azathioprine or interferon beta, respectively. In a subgroup of 23 patients 10- year data were analysed. In a second part of the study, a group of 126 patients switched either from interferon beta or glatiramer acetate to fingolimod was followed-up for one after the change of their treatment and a in a subgroup of 53 patients the 2-year data were assessed. Clinical (relapse frequency, disability) parameters were compared preceding and following the addition of second drug or the switch of treatment. Laboratory results and potential serious adverse events were evaluated in a group of patients with combination therapy. Results: The add-on treatment triggered a drop in annualised relapse rate by approximately 1.5 points sustained over 5 and 10 years. No effect on disability was observed. Simultaneously, white blood cell and lymphocyte counts...
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Influence of corticosteroids and movement disorder on development of osteoporosis in patients with multiple sclerosis (MS)
Týblová, Michaela ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Taláb, Radomír (referee)
Introduction: Multiple sclerosis (MS) is associated with impaired bone health in comparison to an equally healthy population, even already in patients at the onset of this disease. The main risk factors for development of osteoporosis in MS patients are known. The aim of the study was to find the relationship of the decrease in bone mineral density (BMD) to the administered cumulative dose of steroids and to other risk factors in MS, mainly to the degree of motor deficit. Further goal was to evaluate the occurence of the risk of low-trauma fractures in multiple sclerosis patients.. The BMD and muscle mass was compared in MS patients (women and men) and control subjects, to examine the effect of main ones - physical disability and long-term glucocorticoid (GC) therapy on BMD. Clinical values of bone remodeling markers were evaluated in assessment of rate of bone loss in patients with multiple sclerosis long term treated with low dose of GC. Patients and methods: We used dual -energy X-ray absorptiometry for a measurement of BMD in 591 MS patients (455 females and 136 males) in 2004 and in cross-sectional longitudinal study published in 2014 with 474 patients (353 women and 121 men). Out of the whole study group body composition was evaluated in 250 MS females, 104 males and 247 healthy controls (193...
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The detection of cognitive dysfunction in multiple sclerosis
Blahová-Dušánková, Jana ; Kubala Havrdová, Eva (advisor) ; Papežová, Hana (referee) ; Rektorová, Irena (referee)
Evaluation of cognitive impairment is often omitted in multiple sclerosis (MS), as the available instruments usually require considerable time and resources, and are not readily available in all countries. The aims of this study were to examine validity of the Czech translation of the MACFIMS (Minimal Assessment of Cognitive Function in MS), to validate the BICAMS (Brief International Cognitive Assessment for MS) and to compare outcomes of the MACFIMS and the BICAMS. We evaluated 367 MS patients and 134 healthy controls with the MACFIMS battery, which also comprises the 3 tests of the BICAMS (Symbol Digit Modalities Test, Brief Visuospatial Memory Test- Revised, California Verbal Learning Test, second edition). The most accurate BICAMS criterion of cognitive deficit was that of at least 1 of the overall 3 tests outside the normal range (sensitivity = 94%, specificity = 86%, p=10-28). Outcomes of the Czech translation of the MACFIMS were comparable to its original. The MACFIMS and the BICAMS identified cognitive deficit in 55% and 58% of the MS patients, respectively. Both the BICAMS and MACFIMS predicted patient vocational status. The BICAMS is highly sensitive and specific to cognitive impairment in MS as defined by the MACFIMS. This impairment is significantly associated with vocational status. Our work...
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Lymphocyte subpopulations, cytokine production and stem cells transplantation in multiple sclerosis patients
Krasulová, Eva ; Kubala Havrdová, Eva (advisor) ; Ehler, Edvard (referee) ; Syková, Eva (referee)
Multiple sclerosis (MS) represents a demyelinating disease of the central nervous system with known autoimmune etiology. Currently new diagnostic criteria are used allowing us to diagnose MS early after first relapse of clinical symptoms. Several drugs are available to reduce disease activity and postpone later MS stages with irreversible disability. Prognosis of an individual patient and accurate treatment is however defined only imperfectly based on our clinical experience and brain magnetic resonance imaging. Specific prognostic markers are missing. Aims: 1. To identify suitable prognostic immunological marker from peripheral blood of MS patients in different disease stages and under different treatment regimens; 2. To describe group of MS patients treated with autologous stem cells transplantation (ASCT) or allogeneic stem cells transplantation (alloSCT) with respect to efficacy, adverse events and accurate patient selection. Patients and methods: In the first part of the study we involved 33 patients with clinically isolated syndrome, 17 MS patients treated with natalizumab and 14 patients with aggressive MS treated with ASCT. Disability measured by Expanded Disability Status Scale (EDSS) as well as relapse rate were evaluated before treatment (baseline) and after 3, 6, 12 and 24 months after...
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