Multiple Sclerosis: Hietaharju A

Elovaara I, Apostolski S, van Doorn P, Gilhus NE, Hietaharju A, Honkaniemi J, van Schaik IN, Scolding N, Soelberg Sørensen P, Udd B, Anonymous00010. · Department of Neurology and Rehabilitation, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland. · Eur J Neurol. · Pubmed #18796075 No free full text.

Abstract: Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven in Guillain-Barré syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis (MG) and short-term treatment of severe MG (level A recommendation), and some paraneoplastic neuropathies (level B). IVIG is recommended as a second-line treatment in combination with prednisone in dermatomyositis (level B) and treatment option in polymyositis (level C). IVIG should be considered as a second or third-line therapy in relapsing-remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (level B), and in relapses during pregnancy or post-partum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases (good practice point) [corrected],stiff-person syndrome (level A), some acute-demyelinating diseases and childhood refractory epilepsy (good practice point).

Hietaharju A, Pettersson T, Nordström DC, Kähärä V, Leivo I, Hernesniemi J, Konttinen YT. · TAYS, neuroalat ja kuntoutus, PL 2000, 33521 Tampere. · Duodecim. · Pubmed #19341024 No free full text.

Abstract: Central nervous system vasculitides are rare and life-threatening diseases with challenging diagnostics. Their neurological symptom spectrum is multifaceted: the patient may have intense headache, confusion, decreased cognitive function, changes in consciousness, epileptic attacks and symptoms resembling multiple sclerosis. Angiographic investigations, magnetic resonance imaging of the brain and examination of cerebrospinal fluid will clarify the diagnosis, but brain biopsy may be required to confirm the diagnosis. In differential diagnostics, special attention should be paid to cerebrovascular vasoconstriction syndromes. Standard therapy of cerebral vasculitis includes corticosteroids often combined with immunosuppressants.

Hietaharju A, Peltola J, Seppä J, Luukkainen R, Dastidar P. · Department of Neurology and Rehabilitation, Tampere University Hospital, Finland. · Scand J Rheumatol. · Pubmed #11324790 No free full text.

Abstract: The occurrence of both multiple sclerosis (MS) and systemic lupus erythematosus (SLE) has previously been described in several members within the same family and in twins of successive generations, but the finding of both diseases in one patient is a great rarity. We here report on a rare coexistence of MS and SLE both in mother and daughter. Both patients fulfill the diagnostic criteria of primary-progressive subtype of MS as well as SLE. The finding constitutes supporting evidence of a common genetic background for these two autoimmune disorders.