Education And Debate

Recent Advances: Neurology

BMJ 1994; 309 doi: (Published 06 August 1994) Cite this as: BMJ 1994;309:392
  1. R S Howard
  1. St Thomas's Hospital, Guy's and St Thomas's Hospital Trust, London SE1 7EH.

    The pace of research and development in the neurosciences remains breathtaking. This brief review attempts to highlight some of the areas in which very recent scientific and clinical advances have led to a greater understanding of the pathophysiology and management of neurological disease. The constraints of this paper prevent coverage of many important fields of neurological research, including infectious diseases, headache, muscle disease, interventional radiology, neuroepidemiology, and neuropsychiatry.

    Multiple sclerosis

    Evidence for a strong genetic influence in multiple sclerosis continues to accumulate from twin studies, which show consistently high monozygotic concordance and also increased dizygotic concordance in twins compared with non-twin siblings.1 Susceptibility to multiple sclerosis seems unlikely to be determined by a single dominant or even recessive gene but is more likely to be polygenic. A study of pregnancy and multiple sclerosis showed a threefold increase in the relapse rate during the first three postpartum months, and these relapses were more severe than those during pregnancy. There was no changes in the relapse rate during pregnancy.2

    The diagnostic role of magnetic resonance imaging is well established and the technique is increasingly used to monitor disease activity and treatments. The use of gadolinium enhancement has been shown greatly to increase the sensitivity of successive monthly brain scans in monitoring the treatment of relapsing and remitting or secondary progressive multiple sclerosis. Powerful prognostic information is provided by brain scans in patients who present with an acute clinically isolated syndrome suggestive of multiple sclerosis.3 After five years 65% of patients who had asymptomatic white matter lesions at presentation had developed clinically definite multiple sclerosis, compared with 3% of patients with normal scan results at presentation. The disease progressed rapidly if the scan showed four or more lesions at presentation, and a greater number of lesions also correlated with development of moderate …

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