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      Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis : Six new cases and a literature review

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          Multiple Sclerosis: Current Knowledge and Future Outlook

          Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by demyelination and axonal loss. The etiology of MS is unknown; however, environmental and genetic factors play a key role in the development of MS. Diagnostic criteria have been adapted to facilitate earlier diagnosis with increased sensitivity and specificity. Our understanding of the pathophysiology of MS has deepened considerably in recent years, resulting in different therapies to modify the disease course. Furthermore, several drugs have lately shown efficacy in phase III studies and their approval is expected in the near future. As treatment options expand, a future challenge will be to find the optimal treatment for the individual patient. Summary: This mini-review gives an overview of the current knowledge of MS with emphasis on the latest diagnostic criteria and both current and upcoming treatment options. Key Messages: Treatment of MS changes rapidly as the knowledge and therapeutic options in MS expand. Clinical Impact: Diagnosis of MS is based on McDonald criteria. MS therapy can be divided into relapse, disease-modifying and symptomatic treatment. Relapses are commonly treated with intravenous methylprednisolone. First-line therapy consists of either interferon-β, glatiramer acetate or teriflunomide. In general, agents used as escalation therapies (natalizumab, fingolimod and mitoxantrone) are more potent than the agents used for first-line therapy; however, these have potentially serious side effects and should be used with care.
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            The epidemiology of narcolepsy in Olmsted County, Minnesota: a population-based study.

            To determine the age- and sex-specific incidence rates and prevalence of narcolepsy in a United States community. The records-linkage system of the Rochester Epidemiology Project was utilized to ascertain all patients with narcolepsy seen in Olmsted County, Minnesota between 1960 and 1989. Age- and sex-specific incidence rates were calculated, using census data. Prevalence of narcolepsy on January 1,1985 was calculated. N/A. Community patients diagnosed with narcolepsy by a validated set of diagnostic criteria. N/A. The incidence rate per 100,000 persons per year was 1.37 (1.72 for men and 1.05 for women). The incidence rate was highest in the 2nd decade, followed in descending order by the 3rd, 4th and 1st decades. The prevalence on January 1, 1985 was 56.3 per 100,000 persons. Approximately 36% of prevalence cases did not have cataplexy. Narcolepsy is not a rare disorder. It appears to be commoner in men. It originates most commonly in the 2nd decade. Narcolepsy without cataplexy is an important subgroup, warranting further study.
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              DQB1 locus alone explains most of the risk and protection in narcolepsy with cataplexy in Europe.

              Prior research has identified five common genetic variants associated with narcolepsy with cataplexy in Caucasian patients. To replicate and/or extend these findings, we have tested HLA-DQB1, the previously identified 5 variants, and 10 other potential variants in a large European sample of narcolepsy with cataplexy subjects.
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                Author and article information

                Journal
                Journal of Neurology
                J Neurol
                Springer Science and Business Media LLC
                0340-5354
                1432-1459
                September 2018
                July 4 2018
                September 2018
                : 265
                : 9
                : 2071-2078
                Article
                10.1007/s00415-018-8949-x
                29974206
                31ea72e5-41d5-44d8-a9a1-061e5f963489
                © 2018

                http://www.springer.com/tdm

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