1/29. Exercise in 94 degrees F water for a patient with multiple sclerosis.BACKGROUND AND PURPOSE: The purpose of this case report is to describe the examination, intervention, and outcome of a patient with multiple sclerosis (MS) who participated in a comprehensive rehabilitation program that included aquatic therapy with a pool temperature of 94 degrees F. There are few descriptions of aquatic exercise programs on muscle force, exercise tolerance, and functional outcomes in individuals with MS, and most authors recommend a water temperature of less than 85 degrees F to prevent an exacerbation of symptoms. DESCRIPTION: The patient was a 33-year-old woman. Before, during, and after the aquatic program, she was monitored for body temperature, heart rate, blood pressure, and perceived exertion. She was also assessed for muscle force and functional abilities. OUTCOMES: The patient did not experience heat sensitivity or fatigue throughout the program, and her manual muscle test grades and mobility improved. DISCUSSION: This patient's participation in aquatic therapy, in conjunction with land-based interventions, may have been associated with the improvement in functional abilities.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
2/29. Engraftment syndrome: a common cause for rash and fever following autologous hematopoietic stem cell transplantation for multiple sclerosis.Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a therapy for patients with progressive multiple sclerosis (MS) at risk of debilitating neurological impairment. While preliminary results from a few studies have been reported, little is known about toxicities or outcome of HSCT for MS. We report a relatively frequent triad of non-infectious fever, rash and fatigue or lassitude that may also be associated with pruritis, pulmonary symptoms, and eosinophilia and frequently occurs around engraftment. This syndrome occurred in 26% of our series of patients (5/19) undergoing HSCT for multiple sclerosis. The engraftment syndrome is usually self-limited but may require intervention with systemic corticosteroids.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
3/29. multiple sclerosis and oral care.multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
4/29. Concurrent administration of interferon alfa-2b and beta-1a.OBJECTIVE: To describe the concurrent use of interferon (IFN) alfa and beta in a patient with multiple sclerosis (MS) and chronic myeloid leukemia (CML). CASE SUMMARY: A 60-year-old white man developed CML while receiving IFN beta-1a treatment for MS. The patient was started on IFN alfa-2b 1 million units 3 times weekly with IFN beta-1a 30 micro g weekly. The dosage of IFN alfa was increased to 3 million units/d 1 month later. He achieved complete hematologic remission in 3 months. The observed adverse effects were mild and included fatigue, somnolence, weight loss, and difficulty with memory. At 19 months after treatment, the patient remained in hematologic remission and his expanded disability status scale score remained unchanged. DISCUSSION: Concomitant treatment with interferon alfa and beta by a gradual increase in the dosage of IFN alfa was well tolerated. Although imatinib mesylate may be a preferred treatment for patients with CML and MS at this time, our experience with safe concurrent use of IFN alfa and beta may benefit other patients who require this combined treatment. CONCLUSIONS: Concurrent administration of interferon alfa-2b and beta-1a was well tolerated by our patient with CML and MS.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
5/29. multiple sclerosis and Hashimoto thyroiditis: two cases.multiple sclerosis (MS) occurs with immune-mediated mechanisms, but its pathogenesis is not accurately known. The coexistence of MS with other autoimmune diseases has been reported. The hypothesis that MS coexists with other autoimmune diseases has been supported by the reported association of MS with type I diabetes mellitus and inflammatory disorders. Even though there have been only rare reports of associations between Hashimoto thyroiditis and MS, this association is important for its clinical and therapeutic aspects. Proximal muscle weakness, myalgia, and fatigue are symptoms that are common in both MS and hypothyroidism. When MS patients demonstrate these symptoms, thyroid function tests should be performed. The thyroid hormone levels of MS patients being treated with interferon-beta and Campath-1H also should be monitored. The authors report the clinical data of 2 definite MS patients who also fulfilled criteria for Hashimoto thyroiditis.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
6/29. Locomotor training and virtual reality-based balance training for an individual with multiple sclerosis: a case report.BACKGROUND AND PURPOSE: Impaired walking ability, balance, and fatigue are common problems for people with multiple sclerosis (MS). The purpose of this case report is to describe the use of plan of care that included locomotor training using both a body weight support (BWS) with a treadmill (TM) and overground walking as well as a virtual reality (VR)-based balance intervention to improve walking ability, balance, and endurance for an individual with MS. CASE DESCRIPTION: The client was a 48-year-old female with a 10-year history of MS. Her main goals were to improve walking ability, balance, and endurance. She presented with impaired gait, balance, motor function, and increased fatigue. Locomotor training using a BWS/TM system and overground and VR-based balance interventions were implemented 2 days a week for 12 weeks. OUTCOMES: The client demonstrated improvements in gait speed, gait endurance, and balance postintervention and maintained the improvements at a 2-month follow up. DISCUSSION: This case report is the first to report on the use of locomotor training with BWS/TM system and overground and VR-based balance interventions for a client with MS. The plan of care was formulated based on the patient's goals and the available literature on the use of the interventions with other patients with neurologic conditions to provide an intervention that was task-oriented, skilled, and intensive.- - - - - - - - - - ranking = 2keywords = fatigue (Clic here for more details about this article) |
7/29. amantadine-induced livedo reticularis: a report of two cases.In the last several years, amantadine has been increasingly prescribed for akinesia in Parkinson's disease and to combat fatigue associated with multiple sclerosis. amantadine is a well-known medication involved in drug-induced livedo reticularis (LR), yet remains under-reported in the English literature. We describe 2 patients with amantadine livedo reticularis: one patient with multiple sclerosis had, previous to this eruption, tolerated 4 years of amantadine therapy without adverse reactions and another patient with Parkinson's disease who developed LR 1 month after starting amantadine.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
8/29. Outcomes of an aquatic exercise program including aerobic capacity, lactate threshold, and fatigue in two individuals with multiple sclerosis.BACKGROUND AND PURPOSE: fatigue in individuals with multiple sclerosis (MS) may be exacerbated by poor cardiovascular fitness. Although aqua aerobic exercise is often recommended, little research has been conducted on the efficacy of aqua aerobic exercise in improving cardiovascular fitness in patients with MS. The purpose of this case report is to describe changes in cardiovascular fitness and fatigue for 2 people with MS following an aqua aerobics class. CASE DESCRIPTIONS: The participants were 2 females, both with MS for over 10 years and mild disability. Participant A (40 years old and EDSS = 2.5/10) reported fatigue, numbness in her hands and feet, and occasional blurred vision. Participant B (51 years old and EDSS = 3.0/10) reported the same problems as Participant A plus stiffness in her right lower extremity. The participants performed aqua aerobics at an intensity equivalent to their lactate threshold twice a week for 8 weeks. Lactate threshold is the exercise intensity just prior to the accumulation of blood lactate during graded exercise. OUTCOMES: A graded exercise test (with measurements of gas exchange) and a test of fatigue were administered before and after the intervention. Initially, both participants had poor cardiovascular fitness as demonstrated by their low peak oxygen consumption (VO2peak) and low lactate threshold (LT). After the intervention, both participants achieved a higher peak workload (their VO2peak increased) and they could sustain a higher submaximal workload without accumulation of acid substances causing fatigue (their LT increased). Changes in fatigue following the intervention were equivocal with Participant A reporting decreased fatigue and Participant B reporting no change. SUMMARY: This report describes the use of exercise testing to guide clinical decision making for dosing of an aqua aerobic fitness intervention and illustrates positive effects of the intervention on cardiovascular fitness in 2 people with MS.- - - - - - - - - - ranking = 10keywords = fatigue (Clic here for more details about this article) |
9/29. Acute zonal occult outer retinopathy and multiple sclerosis.The case of a 30-year-old woman who had two episodes of photopsia along with sudden-onset monocular visual field defects, developing into bilateral tunnel vision within 4 years, is reported. She also had episodes of a right hemiparesis and right-sided hypoaesthesia, accompanied by severe fatigue. This patient fulfilled the criteria for both clinically definite multiple sclerosis and acute zonal occult outer retinopathy (AZOOR). AZOOR can have an onset with monocular visual field loss, and can be distinguished from optic neuritis. In addition, some observations suggest common neuropathological and inflammatory mechanisms between multiple sclerosis and AZOOR.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
10/29. The social environment and neurological disease.This chapter has reviewed some of the methodological and theoretical issues in research linking the social environment to medical illnesses. The second part of the chapter has focused on three specific neurological entities to examine evidence for a possible association between neurological illness and life stress. There is some suggestion that certain vulnerable epileptic patients can experience convulsions in response to acute emotional upheaval or certain types of cognitive challenges. More commonly, it is probable that social stress and emotional tension can produce lowering of seizure threshold by increasing levels of fatigue and disrupting sleep. The latter factor, in particular, is known to lower seizure threshold. In the case of stroke, several dramatic cases of intracranial hemorrhage have been related to disastrous life circumstances. A general association between life stress and stroke has yet to be established. The case for a link between life events and onset of exacerbation of multiple sclerosis seems stronger. Events which produce emotional upset seem capable of worsening symptoms in patients with existing disease, and several studies have reported unusual life stresses in the period preceding onset of symptoms in this disorder.- - - - - - - - - - ranking = 1keywords = fatigue (Clic here for more details about this article) |
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