Publications by authors named "Elliott Frohman"

3 Publications

  • Page 1 of 1

Dynamic pupillometry as an autonomic testing tool.

Clin Auton Res 2013 Dec 24;23(6):297-303. Epub 2013 Jul 24.

Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hives Blvd, Dallas, TX, 75390-9129, USA,

Objective: To determine normal values for pupillometry indices in healthy control subjects and to examine these indices in patients with autonomic dysfunction and healthy controls.

Methods: Infrared video pupillometry was used to investigate the pupil response to a brief light flash in 79 healthy controls, 28 patients with normal autonomic function (composite autonomic severity score, CASS < 2), and 26 patients with moderate to severe autonomic failure (CASS > 4) seen in our autonomic laboratory from January 2008 to June 2011. In six subjects, we examined the effects of varying light stimulus intensity and light stimulus duration. Descriptive analysis, correlation, and ANCOVA adjusted for age were performed.

Results: We determined eight indices corresponding to parasympathetic and sympathetic pupil function. Baseline pupil diameter (BPD), maximum constriction velocity (MCV), absolute constriction amplitude (ACA), and maximum dilation velocity (MDV) negatively correlated with age (p < 0.01) among controls. MCV and ACA increased with increasing intensity of light stimulus from 3.5 to 112 μW. Indices of parasympathetic pupil innervation (MCV and ACA) were lower in the high CASS group compared to others (p < 0.0001). Indices of sympathetic pupil function, time to reach 75 % of initial resting diameter during pupillary dilation (T¾), and dilation velocity at T¾ (DV¾) did not differ significantly in the three study groups. However, T¾ corrected for the magnitude of pupillary constriction (T¾:ACA) was higher in the high CASS group suggesting sympathetic dysfunction in that group (p = 0.0003).

Conclusions: Indices of pupillomotor function significantly differ between patients with moderate to severe autonomic failure and healthy controls.
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http://dx.doi.org/10.1007/s10286-013-0209-7DOI Listing
December 2013

The thalamus and multiple sclerosis: modern views on pathologic, imaging, and clinical aspects.

Neurology 2013 Jan;80(2):210-9

Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

The paired thalamic nuclei are gray matter (GM) structures on both sides of the third ventricle that play major roles in cortical activation, relaying sensory information to the higher cortical centers that influence cognition. Multiple sclerosis (MS) is an immune-mediated disease of the human CNS that affects both the white matter (WM) and GM. A number of clinical observations as well as recent neuropathologic and neuroimaging studies have clearly demonstrated extensive involvement of the thalamus, basal ganglia, and neocortex in patients with MS. Modern MRI techniques permit visualization of GM lesions and measurement of atrophy. These contemporary methods have fundamentally altered our understanding of the pathophysiologic nature of MS. Evidence confirms the contention that GM injury can be detected in the earliest phases of MS, and that iron deposition and atrophy of deep gray nuclei are closely related to the magnitude of inflammation. Extensive involvement of GM, and particularly of the thalamus, is associated with a wide range of clinical manifestations including cognitive decline, motor deficits, fatigue, painful syndromes, and ocular motility disturbances in patients with MS. In this review, we characterize the neuropathologic, neuroimaging, and clinical features of thalamic involvement in MS. Further, we underscore the contention that neuropathologic and neuroimaging correlative investigations of thalamic derangements in MS may elucidate not heretofore considered pathobiological underpinnings germane to understanding the ontogeny, magnitude, and progression of the disease process.
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http://dx.doi.org/10.1212/WNL.0b013e31827b910bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589190PMC
January 2013

Intense immunosuppression in patients with rapidly worsening multiple sclerosis: treatment guidelines for the clinician.

Lancet Neurol 2008 Feb;7(2):173-83

The Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School of Medicine, and The Detroit Medical Center, Detroit, MI 48201, USA.

Several lines of evidence link immunosuppression to inflammation in patients with multiple sclerosis (MS) and provide a rationale for the increasing use of immunosuppressive drugs in the treatment of MS. Treatment-refractory, clinically active MS can quickly lead to devastating and irreversible neurological disability and treating these patients can be a formidable challenge to the clinician. Patients with refractory MS have been treated with intense immunosuppression, such as cyclophosphamide or mitoxantrone, or with autologous haematopoeitic stem cell transplants. Evidence shows that intense immunosuppression might be effective in patients who are unresponsive to immunomodulating therapy, such as interferon beta and glatiramer acetate. Natalizumab, a new addition to the armamentarium for treating MS, might also have a role in the treatment of this MS phenotype. This Review describes the use of intense immunosuppressant drugs and natalizumab in patients with rapidly worsening MS and provides clinicians with guidelines for the use of these drugs in this patient group.
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http://dx.doi.org/10.1016/S1474-4422(08)70020-6DOI Listing
February 2008