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1.
Article in English | WPRIM | ID: wpr-971322

ABSTRACT

The primary chemical components of Astragalus membranaceus include polysaccharides, saponins, flavonoids, and amino acids. Recent studies have shown that Astragalus membranaceus has multiple functions, including improving immune function and exerting antioxidative, anti-radiation, anti-tumor, antibacterial, antiviral, and hormone-like effects. Astragalus membranaceus and its extracts are widely used in clinical practice because they have obvious therapeutic effects against various autoimmune diseases and relatively less adverse reaction. Multiple sclerosis (MS) is an autoimmune disease of central nervous system (CNS), which mainly caused by immune disorder that leads to inflammatory demyelination, inflammatory cell infiltration, and axonal degeneration in the CNS. In this review, the authors analyzed the clinical manifestations of MS and experimental autoimmune encephalomyelitis (EAE) and focused on the efficacy of Astragalus membranaceus and its chemical components in the treatment of MS/EAE.


Subject(s)
Animals , Humans , Astragalus propinquus/chemistry , Multiple Sclerosis/drug therapy , Encephalomyelitis, Autoimmune, Experimental/metabolism , Drugs, Chinese Herbal/chemistry , Polysaccharides
2.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1425416

ABSTRACT

Tecnologia: Fampridina Indicação: Tratamento de disfunções motoras em pacientes portado-res de esclerose múltipla. Pergunta: A Fampridina é eficaz e segurança para o tratamento de disfunções motoras em adultos portadores de esclerose múltipla comparada ao placebo? Méto-dos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionados três estudos que atenderam aos critérios de inclu-são. Conclusão: A fampridina foi eficaz e segura para tratar disfunções motoras em dosagens específicas. Conforme os resultados dos estudos analisados, a fampridina pode melhora de modo significativo e contínuo a capacidade de deambular dos portadores EM. Além disso, pode ser eficaz para tratar habilidades manuais e cognitiva


Technology: Fampridine. Indication: Treatment of motor disorders in patients with multiple sclerosis. Question: Is Fampridine effective and safe for the treatment of multiple sclerosis in adults with functional limitations compared to placebo? Methods: A bibliographic survey was carried out in the PUBMED database, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the Assessing the Methodological Quality of Systematic Reviews Version 2 tool. Results: Three studies that met the inclusion criteria were selected. Conclusion: Fampridine was effective and safe to treat motor disorders at specific dosages. According to the results of the analyzed studies, fampridine can significantly and continuously improve the ability to walk in MS patients. Also, it can be effective for treating manual and cognitive skills


Subject(s)
Humans , Adult , 4-Aminopyridine/therapeutic use , Multiple Sclerosis/drug therapy , Treatment Outcome
4.
Becker, Jefferson; Ferreira, Lis Campos; Damasceno, Alfredo; Bichuetti, Denis Bernardi; Christo, Paulo Pereira; Callegaro, Dagoberto; Peixoto, Marco Aurélio Lana; Sousa, Nise Alessandra De Carvalho; Almeida, Sérgio Monteiro De; Adoni, Tarso; Santiago-Amaral, Juliana; Junqueira, Thiago; Pereira, Samira Luisa Apóstolos; Gomes, Ana Beatriz Ayroza Galvão Ribeiro; Pitombeira, Milena; Paolilo, Renata Barbosa; Grzesiuk, Anderson Kuntz; Piccolo, Ana Claudia; D´Almeida, José Arthur Costa; Gomes Neto, Antonio Pereira; Oliveira, Augusto Cesar Penalva De; Oliveira, Bianca Santos De; Tauil, Carlos Bernardo; Vasconcelos, Claudia Ferreira; Kaimen-Maciel, Damacio; Varela, Daniel; Diniz, Denise Sisterolli; Oliveira, Enedina Maria Lobato De; Malfetano, Fabiola Rachid; Borges, Fernando Elias; Figueira, Fernando Faria Andrade; Gondim, Francisco De Assis Aquino; Passos, Giordani Rodrigues Dos; Silva, Guilherme Diogo; Olival, Guilherme Sciascia Do; Santos, Gutemberg Augusto Cruz Dos; Ruocco, Heloisa Helena; Sato, Henry Koiti; Soares Neto, Herval Ribeiro; Cortoni Calia, Leandro; Gonçalves, Marcus Vinícius Magno; Vecino, Maria Cecilia Aragón De; Pimentel, Maria Lucia Vellutini; Ribeiro, Marlise De Castro; Boaventura, Mateus; Parolin, Mônica Koncke Fiuza; Melo, Renata Brant De Souza; Lázaro, Robson; Thomaz, Rodrigo Barbosa; Kleinpaul, Rodrigo; Dias, Ronaldo Maciel; Gomes, Sidney; Lucatto, Simone Abrante; Alves-Leon, Soniza Vieira; Fukuda, Thiago; Ribeiro, Taysa Alexandrino Gonsalves Jubé; Winckler, Thereza Cristina Dávila; Fragoso, Yara Dadalti; Nascimento, Osvaldo José Moreira Do; Ferreira, Maria Lucia Brito; Mendes, Maria Fernanda; Brum, Doralina Guimarães; Glehn, Felipe Von.
Arq. neuropsiquiatr ; 79(11): 1049-1061, Nov. 2021. tab
Article in English | LILACS | ID: biblio-1350135

ABSTRACT

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.


RESUMO O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.


Subject(s)
Humans , COVID-19 , Multiple Sclerosis/drug therapy , Neurology , Central Nervous System , Vaccination , SARS-CoV-2
5.
Medicina (B.Aires) ; 81(3): 311-317, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346464

ABSTRACT

Resumen La adherencia al tratamiento prescrito en enfermedades crónicas, como ocurre en la esclerosis múltiple (EM), es un factor crítico para una respuesta terapéutica exitosa. El objetivo de este estudio fue evaluar la asociación entre las variables demográficas y la adherencia al tratamiento en una población de pacientes con EM en Argentina. Se realizó un estudio de cohorte retrospectivo de pacientes con EM que recibieron tratamiento con medicamentos modificadores de la enfermedad, incluidos en la base de datos de dispensación de medicamentos del Programa Nacional de Atención Médica: PAMI (Programa Asistencia Médica Integral). La adherencia óptima se definió como una adquisición del fármaco superior al 80% durante un seguimiento de 9 meses. Se incluyó un total de 648 pacientes, edad media 55 años (RIC 46-64), 59.4% mujeres. La adherencia media al tratamiento fue del 67% (RIC 44-89) y la adherencia óptima se documentó solo en el 35.5% de los casos. La adherencia a los medicamentos inyectables fue 10% menor que la de los medicamentos orales (p = 0.0001) y el uso de marcas originales se asoció con una adherencia 7.4% mayor que los medicamentos genéricos (p = 0.001). En conclusión, la adherencia al tratamiento ha sido subóptima. En la región patagónica, el uso de inyectables y de medicamentos genéricos se asoció con una menor adherencia terapéutica. Estos datos son muy importantes para planificar programas socio-sanitarios que tengan como objetivo aumentar la adherencia terapéutica.


Abstract Adherence to prescribed treatment in chronic diseases, as occurs in multiple sclerosis (MS), is a critical factor for a successful therapeutic response. The objective of this study was to evaluate the association between demographic variables and adherence to treatment of the population of MS patients in Argentina. A retrospective cohort study of MS patients who received treatment with disease-modifying drugs, included in the drug dispensing database of the National Care Medical Program: PAMI (Programa Asistencia Médica Integral), was conducted. Optimal adherence was defined as an acquisition of the drug greater than 80% during a 9-month follow-up. A total of 648 patients were included, mean age 55 years (IQR 46-64), 59.4% women. The mean adherence to treatment was 67% (IQR 44-89) and optimal adherence was documented only in 35.5% of cases. Adherence to injectable medications was 10% lower than that of oral drugs (p = 0.0001) and the use of original brands was associated with 7.4% greater adherence than with generic drugs (p = 0.001). In conclusion, adherence to treatment has been suboptimal. In the Patagonian region, the use of injectables and generic drugs was associated with lower adherence to therapy. These data are very important in order to planning socio-sanitary programs that aim to increase therapeutic adherence.


Subject(s)
Humans , Male , Female , Middle Aged , Multiple Sclerosis/drug therapy , Argentina/epidemiology , Retrospective Studies , Medication Adherence
6.
ABCS health sci ; 46: e021212, 09 fev. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1281233

ABSTRACT

INTRODUCTION: Treatment for multiple sclerosis should focus on relapse prevention and treatment, as well as symptom and disease progression control, which require the use of multiple medications. OBJECTIVE: To evaluate the association of polypharmacy and related clinical, epidemiological factors in multiple sclerosis patient cohorts. METHODS: It was conducted a prospective study of multiple sclerosis patients that held a prescription of disease-modifying drugs between January and December 2017. The medications were analyzed and classified as either long-term or as-needed medications for therapeutic objective and prescription status purposes. RESULTS: During 2017, 124 patients were attended, 106 were eligible for the study, and 81 agreed to participate. The average age was 40.95±11.69 years. The disease duration varied between 6 months and 30 years, with a median of 7 years. More than half of the multiple sclerosis patients suffered from comorbidities (54.32%), and 76.54% were categorized as polypharmacy. The comparison of polypharmacy between the groups yielded significant differences for comorbidities and employment status and regarding age between patients with polypharmacy and patients without polypharmacy of long-term medications. CONCLUSION: The age of the patient and the presence of comorbidities are important factors related to polypharmacy.


INTRODUÇÃO: O tratamento da esclerose múltipla deve ser concentrado na prevenção e tratamento de recaídas, bem como no controle da progressão dos sintomas e doenças, o que requer o uso de vários medicamentos. OBJETIVO: Avaliar a associação de polifarmácia a fatores epidemiológicos clínicos em uma coorte de pacientes com esclerose múltipla. MÉTODOS: Foi realizado um estudo prospectivo de pacientes com esclerose múltipla que possuíam prescrição de medicamentos modificadores da doença entre janeiro e dezembro de 2017. Os medicamentos foram analisados e classificados como medicamentos de longo prazo ou conforme necessário para fins terapêuticos de objetivo e status de prescrição. RESULTADOS: Durante 2017 foram atendidos 124 pacientes, destes 106 pacientes foram elegíveis para o estudo e 81 concordaram em participar. A idade média foi de 40,95±11,69 anos. A duração da doença variou entre 6 meses e 30 anos, com mediana de 7 anos. Mais da metade dos pacientes com esclerose múltipla apresentava comorbidades (54,32%) e 76,54% foram classificados com polifarmácia. A comparação da polifarmácia entre os grupos demonstrou diferenças significativas para comorbidades, e situação de trabalho, e em relação à idade entre pacientes com polifarmácia e pacientes sem polifarmácia com medicamentos de longa duração. CONCLUSÃO: A idade do paciente e a presença de comorbidades são fatores importantes relacionados à polifarmácia.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Polypharmacy , Multiple Sclerosis/drug therapy , Multiple Sclerosis/epidemiology , Comorbidity , Prospective Studies
7.
Rev. méd. Maule ; 36(2): 15-23, dic. 2020. tab
Article in Spanish | LILACS | ID: biblio-1344586

ABSTRACT

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, which occurs in up to 85% of cases as relapsing remitting (RR), with episodes of neurological dysfunction partially forwarded. Its treatment in Chile is financially protected by the Explicit Health Guarantees (GES) and Law 20,850 on high-cost diseases. The Regional Hospital of Talca (HRT) has 25 patients benefiting from Law 20,850 in treatment with second-line biologic therapy. Adverse reactions (RAM) to the use of these drugs have been described and to date there are no case reports or studies of significant adverse events in Chile. Objectives: To present the experience of the use of biologic therapy in EMRR in HRT, in relation to adverse events. METHODS: A review of the current guidelines in Chile for the treatment of relapsing-remitting multiple sclerosis and the protocol of law 20,850 was carried out, the clinical records of 25 patients benefiting from the law in the HRT were reviewed, with emphasis on the adverse events presented before First and second line therapies and the con sequences of these events on the continuity of therapy. RESULTS: Half of the patients who started their treatment with first-line drugs had adverse effects, of which 28% involved a change in therapy, the remaining changed from therapy due to failure to treatment. Of the 26 patients included in the sample, 24 are currently using second-line drugs. The profile of adverse effects should be a variable to consider when indicating a therapy for MS.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Chile , Interferon-beta/administration & dosage , Interferon-beta/adverse effects , Practice Guidelines as Topic , Glatiramer Acetate/adverse effects , Immunosuppressive Agents , Multiple Sclerosis/complications
8.
Rev. chil. neuropsicol. (En línea) ; 15(1): 32-37, oct. 2020. tab
Article in Spanish | LILACS | ID: biblio-1353737

ABSTRACT

La esclerosis múltiple (EM) es una enfermedad crónica, autoinmune y neurodegenerativa; que tiene como principal característica la desmielinización de los axones en el sistema nervioso. Los medicamentos modificadores de la enfermedad (MME) logran retrasar la aparición de los síntomas y modificar parcialmente el progreso de la desmielinización y daño neuronal, resultando cada vez más complejo determinar un esquema terapéutico estandarizado según la condición particular de cada paciente. En este artículo se presenta una revisión actualizada de la evidencia clínica que ha llevado al uso de los esquemas terapéuticos en EM. La mayoría de los medicamentos aprobados actualmente son utilizados para la EM remitente-recurrente y se pueden dividir de acuerdo a la eficacia y seguridad. Los medicamentos de primera línea han mostrado una baja o moderada eficacia y alta seguridad; después de usar estos fármacos sin lograr una buena respuesta o ante una enfermedad avanzada se usan medicamentos de segunda y tercera línea que tienen una alta eficacia, pero son menos seguros, presentando mayores efectos secundarios y riesgos asociados para los pacientes. El ocrelizumab es el único fármaco aceptado para la EM primaria progresiva y el siponimod fue aprobado como una alternativa para la EM secundaria progresiva. El desarrollo de nuevos medicamentos y el seguimiento clínico de los ya aprobados permitirá establecer un mejor abordaje terapéutico logrando así mejorar la calidad de vida de cada paciente.


Multiple sclerosis (MS) is a chronic, autoimmune and neurodegenerative disease; whose main characteristic is the demyelination of axons in the nervous system. Disease-modifying drugs (DMD) can delay the onset of symptoms and partially modify the progression of demyelination and neuronal damage, making it increasingly complex to determine a standardized therapeutic scheme that is individualized to each patient. This article presents an updated review on the clinical evidence that has led to the use of current therapeutic schemes in MS with focus on DMD. Current medications in treating relapsing-remitting MS can be divided according to efficacy and safety. First-line drugs have shown low or moderate efficacy and high safety. Second- and third-line drugs are used after a poor response or in cases of advanced disease. These drugs are highly effective, but less safe, presenting greater side effects and associated risks for patients. Ocrelizumab is the only accepted drug for primary progressive MS and siponimod is accepted as an alternative for secondary progressive MS. The development of new medications and the clinical follow-up of those already approved will allow establishing a better therapeutic approach, thus improving the quality of life of each patient.


Subject(s)
Humans , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Demyelinating Diseases/drug therapy
9.
Arq. neuropsiquiatr ; 78(7): 430-439, July 2020. tab
Article in English | LILACS | ID: biblio-1131732

ABSTRACT

ABSTRACT Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism's normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.


RESUMO Introdução: A mais recente pandemia causada pelo coronavírus SARS-CoV-2 (COVID-19, do inglês coronavirus disease 2019) representa uma ameaça potencial para pacientes com doenças autoimunes, incluindo esclerose múltipla (EM) e transtorno do espectro de neuromielite óptica (NMOSD, do inglês neuromyelitis optica spectrum disorders). Esses pacientes são geralmente tratados com medicamentos imunomoduladores ou imunossupressores que podem alterar a resposta normal do organismo a infecções. Até o momento, não há consenso sobre como o manejo dos pacientes com EM e NMOSD deve ser realizado durante a pandemia. Objetivo: Discutir estratégias para manejar esses pacientes. Métodos: Focamos em como 1) reduzir o risco de infecção por COVID-19, como distanciamento social, telemedicina e exames laboratoriais e de imagem em intervalos mais amplos; 2) manejo de surtos, incluindo evitar tratamento de surto leve e uso de corticoide oral; 3) gerenciar terapias modificadoras de doença, como a preferência por medicamentos associados a menor risco de infecção (interferons, glatirâmer, teriflunomida e natalizumabe) e infusão em intervalo estendido de natalizumabe, quando seguro; 4) individualizar a escolha da terapia de indução para EM (anticorpos monoclonais anti-CD20, alentuzumabe e cladribina); 5) manejar terapias preventivas de NMOSD, incluindo seleção inicial de terapia e manutenção do tratamento atual; 6) manejar pacientes com EM/NMOSD que foram infectados por COVID-19. Conclusão: No futuro, séries de casos de pacientes com MS/NMOSD infectados com COVID-19 nos ajudará a definir as melhores estratégias de manejo. Por enquanto, contamos com a experiência e orientação especializadas.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Neuromyelitis Optica/drug therapy , Coronavirus Infections/prevention & control , Coronavirus , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Pneumonia, Viral/epidemiology , China/epidemiology , Risk , Neuromyelitis Optica/diagnosis , Telemedicine , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections , Coronavirus Infections/epidemiology , Disease Susceptibility , Pandemics , Betacoronavirus , Immunologic Factors/therapeutic use , Multiple Sclerosis/diagnosis
10.
Medicina (B.Aires) ; 79(supl.3): 66-70, set. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1040553

ABSTRACT

Se revisan dos de las principales enfermedades desmielinizantes en niños, la encefalomielitis aguda diseminada (EAD) y la esclerosis múltiple (EM). Por sus características fisiopatológicas, etiologías probables, manifestaciones clínicas, diagnóstico, tratamiento, pronóstico, evolución, así como alteraciones atípicas que complican su diagnóstico; cuanto más pequeño es el paciente se necesita estudiar más, antes de llegar al diagnóstico. El Grupo Internacional de Estudio de Esclerosis Múltiple Pediátrica publicó las definiciones operativas para enfermedades desmielinizantes adquiridas del sistema nervioso central: la EAD es monofásica, polisintomática y con encefalopatía. Su duración es de hasta 3 meses, con síntomas fluctuantes y hallazgos en resonancia magnética. La EM se define como síndrome aislado monofocal o polifocal, sin encefalopatía. Actualmente se consideran dos enfermedades diferentes y distinguibles desde el inicio de los síntomas.


The two main demyelinating diseases in children are reviewed. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). For its physiopathological characteristics, probable etiologies, clinical manifestations, diagnosis, treatment, prognosis, evolution, as well as atypical alterations that complicate its diagnosis, the smaller the child is, more study is needed before reaching the diagnosis. The International Study Group of Multiple Pediatric Sclerosis, published the operating definitions for demyelinating diseases acquired from the central nervous system in children: the ADEM is monophasic, polysymptomatic and with encephalopathy. Its duration is up to 3 months, with fluctuating symptoms and magnetic resonance findings. MS is an isolated monofocal or polyfocal syndrome, without encephalopathy. Currently, two different and distinguishable diseases are considered from the onset of symptoms.


Subject(s)
Humans , Child , Encephalomyelitis, Acute Disseminated/diagnostic imaging , Multiple Sclerosis/diagnostic imaging , Steroids/therapeutic use , Syndrome , Brain/physiopathology , Brain/diagnostic imaging , Magnetic Resonance Imaging , Drug Therapy, Combination , Encephalomyelitis, Acute Disseminated/drug therapy , Immunotherapy , Multiple Sclerosis/drug therapy
11.
Rev. Soc. Bras. Clín. Méd ; 17(1): 35-37, jan.-mar. 2019. graf., tab.
Article in Portuguese | LILACS | ID: biblio-1026181

ABSTRACT

A doença de Addison é uma endocrinopatia rara, de etiologia autoimune. É caracterizada por défice na secreção de glicocorticoides e mineralocorticoides. A esclerose múltipla consiste em patologia neurológica, de origem autoimune, que resulta na desmielinização da bainha de mielina. O objetivo deste relato foi demonstrar a associação rara entre essas duas patologias e suas possíveis relações imunológicas. A paciente analisada é do sexo feminino, 41 anos, portadora de esclerose múltipla, que posteriormente foi diagnosticada com insuficiência adrenal primária. (AU)


Addison's disease is a rare endocrinopathy of autoimmune etiology. It is characterized by a secretion's deficit of glucocorticoids and mineralocorticoids. Multiple sclerosis is a neurological pathology of autoimmune origin, which results in demyelination of the myelin sheath. The purpose of this report is to demonstrate the uncommon association between these two pathologies and their possible immunological relationships. The analyzed patient is a woman, 41 years old, with multiple sclerosis, who was later diagnosed with primary adrenal insufficiency. (AU)


Subject(s)
Humans , Female , Adult , Addison Disease/diagnosis , Multiple Sclerosis/diagnosis , Potassium/blood , Asthenia , Autoimmune Diseases/diagnosis , Sodium/blood , Vomiting , Immunoglobulins/therapeutic use , Hydrocortisone/blood , Prednisone/therapeutic use , Addison Disease/complications , Addison Disease/genetics , Addison Disease/drug therapy , Magnetic Resonance Spectroscopy , Tomography , Weight Loss , Abdominal Pain , Hyperpigmentation , Adrenal Cortex Hormones/therapeutic use , Adrenal Insufficiency/diagnostic imaging , Adrenocorticotropic Hormone/blood , Diagnosis, Differential , Glucocorticoids/therapeutic use , Glucose Tolerance Test , Hypoglycemia/etiology , Hyponatremia/etiology , Hypotension/etiology , Immunologic Factors/therapeutic use , Multiple Sclerosis/genetics , Multiple Sclerosis/drug therapy , Nausea
12.
Arq. neuropsiquiatr ; 77(3): 166-173, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001345

ABSTRACT

ABSTRACT It is currently unknown how genetic factors may influence the clinical course of multiple sclerosis (MS). Objective: We examined the impact of CIITA polymorphisms −168A/G (rs3087456) and +1614G/C (rs4774) on the risk of disability progression, severity and on responses to first-line immunomodulator treatments. Methods: Genomic DNA was extracted from blood samples. We used ABI3730xl and GeneMapper v.4.0 software to identify genotype variations. All patients were followed up and clinically reassessed at three-month intervals. Disability progression was measured by the Expanded Disability Status Scale and disease severity by the Multiple Sclerosis Spasticity Scale (MSSS). Results: We included 37 men and 80 women. We found no evidence regarding the influence of the single nucleotide polymorphisms studied in the Expanded Disability Status Scale or therapeutic response of the evaluated drugs. We performed a logistic regression analysis with the MSSS and found that a less severe MS course was associated with wild type CIITA −168AA and CIITA +1614GG, as the chance of the patient progressing to MSSS2 and MSSS3 decreased in 61% and 75% with CIITA −168AA and 66% and 75% with CIITA +1614GG, respectively (p < 0.0001). Although less significant, the CIITA +1614 GC also pointed to a less severe MS course and the chance of the patient progressing to MSSS3 decreased 79% (p = 0.015). We also observed that the CIITA −168GG genotype was more frequent in MSSS2 and MSSS3 and had 40% lower odds ratio to becoming more severe MS. Conclusion: These data suggest that CIITA −168AA, CIITA +1614GG and CIITA +1614 GC polymorphisms may be associated with a better MS clinical course. This knowledge may be useful for a better understanding of MS and its therapeutic management.


RESUMO Atualmente não se sabe como os fatores genéticos podem influenciar o curso clínico da esclerose múltipla (EM). Objetivo: Examinamos o impacto dos polimorfismos CIITA −168A/G (rs3087456) e CIITA +1614G/C (rs4774) no risco de progressão da incapacidade, gravidade e resposta aos tratamentos imunomoduladores de primeira linha. Métodos: O DNA genômico foi extraído de amostras de sangue. Utilizamos o software ABI3730xl e GeneMapper v.4.0 (Applied Biosystems) para identificar variações genotípicas. Todos os pacientes foram acompanhados e reavaliados clinicamente em intervalos de três meses. A progressão da incapacidade foi medida pela EDSS e a gravidade da doença pelo MSSS. Resultados: Incluímos 37 homens e 80 mulheres. Não encontramos evidências sobre a influência dos SNPs estudados no EDSS e na resposta terapêutica aos fármacos avaliados. Realizamos uma análise de regressão logística com o MSSS e observamos uma evolução menos grave da EM associada aos tipos selvagens CIITA −168AA e CIITA +1614GG, pois a chance do paciente atingir MSSS2 e MSSS3 diminuiu em 61%/75%, e 66/75% respectivamente (p < 0,0001). Embora menos significativo, o CIITA +1614GC também foi relacionado com evolução menos grave da EM e a chance do paciente atingir o MSSS3 diminuiu 79% (p = 0,015). Nós também observamos que o genótipo CIITA −168GG foi mais frequente no MSSS2 e MSSS3 e teve uma razão de chance 40% menor para atingir forma mais grave da EM. Conclusão: Estes dados sugerem que os polimorfismos CIITA −168AA, CIITA +1614GG e CIITA +1614GC podem estar associados a um melhor curso clínico da EM. Este conhecimento pode ser útil para uma melhor compreensão da EM e o seu manejo terapêutico.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Nuclear Proteins/genetics , Trans-Activators/genetics , Disease Progression , Polymorphism, Single Nucleotide/genetics , Multiple Sclerosis/genetics , Time Factors , Severity of Illness Index , Logistic Models , Retrospective Studies , Interferon-beta/therapeutic use , Disability Evaluation , Kaplan-Meier Estimate , Genetic Association Studies , Glatiramer Acetate/therapeutic use , Gene Frequency , Genotype , Immunologic Factors/therapeutic use , Multiple Sclerosis/mortality , Multiple Sclerosis/drug therapy
13.
Medicina (B.Aires) ; 78(supl.2): 75-81, set. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-955019

ABSTRACT

Las enfermedades desmielinizantes constituyen un grupo de afecciones de etiología autoinmune dirigida contra la mielina del sistema nervioso central. En muchos casos, el inicio del cuadro es precedido por una infección viral inespecífica. La esclerosis múltiple evoluciona con recaídas y remisiones con déficit neurológicos polifocales, siendo los más frecuentes la neuritis óptica, la mielitis transversa y el compromiso de tronco encefálico. Se caracteriza por lesiones hiperintensas que se observan en una resonancia magnética nuclear (RMN) en T2 y FLAIR peri-ventriculares y peri-callosas, cerebelo, tronco y médula espinal. La neuromielitis óptica se caracteriza por la presencia de neuritis óptica y mielitis transversa asociada a síndrome de área postrema y diencefálico. Las lesiones en RMN se distribuyen en los sectores ricos en acuaporina-4 (AQP-4): hipotálamo, peri tercer y cuarto ventrículo, nervios ópticos y médula espinal. Los anticuerpos anti AQP4 ayudan al diagnóstico aunque no son esenciales para el mismo. La encefalomielitis diseminada aguda es un cuadro clásicamente monofásico caracterizado por una encefalopatía aguda asociada a lesiones en RMN hiperintensas en T2 y FLAIR bilaterales, asimétricas, de gran tamaño y de bordes irregulares. En los tres casos, el líquido cefalorraquídeo (LCR) puede mostrar pleocitosis e hiperproteinorraquia. La presencia de bandas oligoclonales en LCR es característica de la esclerosis múltiple. En todos los casos, el tratamiento agudo incluye corticoides a altas dosis por vía endovenoso y en caso de no respuesta, plasmaféresis. Tanto la esclerosis múltiple como la neuromielitis óptica requieren tratamiento a largo plazo para evitar nuevas recaídas ya que se trata de enfermedades recurrentes.


Demyelinating diseases are a group of conditions of autoimmune etiology directed against the myelin of the central nervous system. In many cases, the onset of the illness is preceded by a nonspecific viral infection. Multiple sclerosis is a disease that evolves with relapses and remissions with polyfocal neurological deficits, being the most frequent optic neuritis, transverse myelitis and encephalic trunk involvement. Typically, magnetic resonance image (MRI) shows peri-ventricular, peri-callosal, cerebellum, brain stem and spinal cord hyperintensive lesions in T2 and FLAIR weighted images. Optic neuromyelitis is characterized by the presence of optic neuritis and transverse myelitis associated with the postrema and diencephalic area syndrome. MRI lesions are distributed in sectors rich with aquaporine-4 channels (AQP-4): hypothalamus, third and fourth ventricle, optic nerves and spinal cord. Finding anti AQP4 antibodies is useful for the diagnosis although they are not essential for it. Acute disseminated encephalomyelitis is typically a monophasic condition characterized by acute encephalopathy associated with hyperintense MRI large, bilateral and irregular asymmetric lesion in T2 and FLAIR weighted images. In all three cases, cerebral spine fluid (CSF) can show pleocytosis and hyperproteinorrachia. The presence of oligoclonal bands in CSF is characteristic of multiple sclerosis. In all cases, acute treatment includes high dose intravenous corticosteroids and plasmapheresis in non-responsive cases. Both multiple sclerosis and optic neuromyelitis require long-term treatment to prevent relapse and recurrent diseases.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Neuromyelitis Optica/diagnosis , Encephalomyelitis, Acute Disseminated/diagnosis , Multiple Sclerosis/diagnosis , Magnetic Resonance Imaging , Neuromyelitis Optica/cerebrospinal fluid , Neuromyelitis Optica/drug therapy , Contrast Media , Encephalomyelitis, Acute Disseminated/cerebrospinal fluid , Encephalomyelitis, Acute Disseminated/drug therapy , Aquaporin 4 , Multiple Sclerosis/cerebrospinal fluid , Multiple Sclerosis/drug therapy
14.
Arq. neuropsiquiatr ; 76(9): 588-591, Sept. 2018.
Article in English | LILACS | ID: biblio-973952

ABSTRACT

ABSTRACT Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV). Objective: To identify the serologic profile of JCV in patients with MS. Methods: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program. Results: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months. Conclusion: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.


RESUMO As opções terapêuticas para esclerose múltipla (EM) modificaram-se ao longo dos últimos anos, trazendo uma nova categoria de drogas com melhor perfil de eficácia. No entanto, estas drogas vieram com um novo perfil de potenciais eventos adversos que exigem que o neurologista os reconheça bem e rapidamente. Uma das complicações mais temidas destes tratamentos para a EM é a leucoencefalopatia multifocal progressiva (LEMP), causada pela reativação do vírus John Cunningham (JCV). Objetivo: Identificar o perfil sorológico de JCV em pacientes com EM. Métodos: Dados sorológicos de JCV foram obtidos através do ensaio por enzimas imuno-adsorvidas (ELISA) fornecido pelo programa STRATIFY-JCV. Resultados: Um total de 1.501 testes sanguíneos foram obtidos de 1.102 pacientes com EM. O grupo teve 633 pacientes (57,1%) soropositivos para anticorpos anti-JCV e 469 pacientes negativos (42,9%). Vinte e três pacientes se tornaram posivitos após resultados iniciais negativos para anticorpos anti-JCV. A taxa de soroconversão foi 18,5% em 22 meses. Conclusão: O perfil sorológico do JCV e a soroconversão nos pacientes brasileiros foi semelhante àquela descrita em outros países.


Subject(s)
Humans , Male , Female , Adult , Leukoencephalopathy, Progressive Multifocal/immunology , JC Virus/immunology , Polyomavirus Infections/immunology , Antibodies, Viral/blood , Multiple Sclerosis/virology , Brazil/epidemiology , Enzyme-Linked Immunosorbent Assay , Sex Factors , Prevalence , Leukoencephalopathy, Progressive Multifocal/blood , Polyomavirus Infections/epidemiology , Natalizumab/adverse effects , Seroconversion , Multiple Sclerosis/drug therapy , Multiple Sclerosis/blood
15.
Arq. neuropsiquiatr ; 76(8): 539-554, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950578

ABSTRACT

ABSTRACT The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.


RESUMO O crescent arsenal terapêutico na esclerose múltipla (EM) tem permitido tratamentos mais efetivos e personalizados, mas a escolha e o manejo das terapias modificadoras da doença (TMDs) tem se tornado cada vez mais complexos. Neste contexto, especialistas do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia reuniram-se para estabelecer este Consenso Brasileiro para o Tratamento da EM, baseados no entendimento de que neurologistas devem ter a possibilidade de prescrever TMDs para EM de acordo com o que é melhor para cada paciente, com base em evidências e práticas atualizadas. Por meio deste documento, propomos recomendações práticas para o tratamento da EM, com foco principal na escolha e no manejo das TMDs, e revisamos os argumentos que embasam as estratégias de tratamento na EM.


Subject(s)
Humans , Vitamin D/therapeutic use , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Recurrence , Brazil , Academies and Institutes , Neurology
16.
Rev. bras. neurol ; 54(2): 34-39, abr.-jun. 2018. ilus, tab
Article in Portuguese | LILACS | ID: biblio-907028

ABSTRACT

A paraparesia espástica é caracterizada pela perda de função total ou parcial dos membros inferiores associado ao aumento do tônus muscular velocidade-dependente. A toxina botulínica é utilizada no tratamento de diversos padrões de espasticidade, sejam em flexão, extensão ou adução. Objetivo: determinar a eficácia e segurança do bloqueio químico com toxina botulínica em pacientes com paraparesia espástica. Método: foi realizada uma revisão sistemática com busca nas bases de dados do PUBMED, MEDLINE, LILACS e SCIELO. Os critérios de inclusão foram: ensaios clínicos que utilizaram a toxina botulínica para o tratamento de pacientes com paraparesia espástica e publicados em inglês a partir da década de 1980. Os desfechos considerados foram: a pontuação na Escala de Ashworth Modificada, a amplitude de movimento passiva e ativa e os efeitos adversos da toxina botulínica. Resultados: foram incluídos cinco artigos. Todos mostraram melhora da espasticidade nos pacientes estudados. Quatro artigos mostraram aumento da amplitude de movimento passivo e três relataram aumento da amplitude de movimento ativo. Três artigos trouxeram relatos de efeitos adversos após o uso da toxina botulínica, mas a maioria deles não eram graves e cessaram espontaneamente. Conclusão: os estudos analisados mostraram que a toxina botulínica é eficaz e segura em pacientes com paraparesia espástica.(AU)


Spastic paraparesis is the loss of total or partial lower limb function associated with increased speed-dependent muscle tone. Botulinum toxin is used in the treatment of several spasticity presentations that include flexion, extension and adduction. Objective: To determine both safety and efficacy of botulinum toxin as a blocking agent in the treatment of spastic paraparesis. Method:A systematic review was carried out with a search on PUBMED, MEDLINE, LILACS and SCIELO databases. The inclusion criteria were: clinical trials that used botulinum toxin for the treatment of patients with spastic paraparesis and published in English from the 1980s. The following outcomes were assessed by the studies: the Ashworth Modified scale score, the range of passive and active motion and botulinum toxin adverse effects. Results:Five articles were included. All of them showed spasticity improvements in the patients. Four studies showed increases in passive range of motion and three articles showed increase in active range of motion. Three papers reported adverse effects after botulinum toxin use but they were mostly mild and ceased spontaneously. Conclusion: Most analyzed studies indicated that botulinum toxin is safe and efficient inthe treatment of spastic paraparesis. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Botulinum Toxins, Type A/therapeutic use , Paraparesis, Spastic/diagnosis , Paraparesis, Spastic/drug therapy , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Review Literature as Topic , Randomized Controlled Trials as Topic , Treatment Outcome
17.
Acta méd. (Porto Alegre) ; 39(1): 409-418, 2018.
Article in Portuguese | LILACS | ID: biblio-911633

ABSTRACT

Introdução: Esclerose Múltipla (EM) é uma doença imunomediada do Sistema Nervoso Central (SNC) que atinge um grande número de pacientes no mundo. Estão disponíveis diversas medicações com mecanismos, vias de administração e eficácia diferentes que serão abordadas nesta revisão. Métodos: Realizamos uma busca por artigos de revisão dos últimos 5 anos na base de dados PubMed. Resultados: Nove drogas foram descritas com base nos seus mecanismos de ação, via de administração e eficácia. Conclusão: Há uma variedade de possibilidades para tratar pacientes com EM. Devem-se observar os perfis específicos de cada droga, a fim de equilibrar os riscos e benefícios junto com a preferência do paciente pela via de administração.


Introduction: Multiple Sclerosis (MS) is an immune mediated disease of the Central Nervous System (CNS) that affects a large number of patients globally. There is a variety of medications with different mechanisms, administration routes and efficacy that will be reviewed in this paper. Methods: We searched for review articles of the last 5 years at the PubMed database. Results: Nine drugs were described regarding their mechanism of action, administration routes and efficacy. Conclusion: There are several possibilities when treating a patient with MS. Patient's preference for the administration route and the specific profile of each drug should be considered to balance the risks and benefits of the treatment.


Subject(s)
Multiple Sclerosis/drug therapy , Pharmaceutical Preparations
19.
MedicalExpress (São Paulo, Online) ; 4(2): M170201, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-841479

ABSTRACT

PURPOSE: To systematically evaluate whether oral steroids can be used with the same efficacy and safety in comparison with the intravenous regimen for treatment of multiple sclerosis relapses. METHOD: We searched Medline, Embase and Cochrane Library and systematically reviewed articles comparing outcomes of oral versus intravenous steroids for acute relapses in patients with a clinically definite diagnosis of multiple sclerosis. RESULTS: Six articles with 414 participants in total were analyzed. Five of the included trials reported the proportion of patients experiencing improvement in Expanded Disability Status Scale after receiving either oral or intravenous methylprednisolone treatment at four weeks; the pooled results showed that there was no statistically significant difference (OR 0.96; 95% CI 0.60, 1.54; p=0.86) between treatments. Three trials reported the detailed results of adverse events, indicating the two treatments appear to be equally safe. Two trials revealed that there was no significant difference in gadolinium enhancement activity on magnetic resonance imaging. One trial showed that the mean area under the concentration-time curve (AUC) at 24 and 48 hours did not differ between groups. CONCLUSION: No significant differences were found in terms of clinical (benefits and adverse events), radiological and pharmacological outcomes in multiple sclerosis relapses in patients after oral or intravenous steroids treatment. Our meta-analysis provides evidence that oral steroid therapy is not inferior to intravenous steroid therapy. Thus oral administration may be a favorable substitute for intravenous medication of multiple sclerosis relapses.


PROPÓSITO: Avaliar de forma sistemática se esteroides orais podem ser utilizados com a mesma eficácia e segurança em comparação com o regime intravenoso para o tratamento de recaídas da esclerose múltipla (MS). MÉTODO: Foram pesquisados Medline, Embase e Cochrane Library e sistematicamente revistos artigos comparando resultados de esteroides orais versus intravenosos para recaídas agudas em pacientes com diagnóstico de esclerose múltipla clinicamente definida. RESULTADOS: Seis artigos com 414 participantes no total foram analisados. Cinco dos estudos incluídos relataram a proporção de doentes com melhoria através de "Expanded Disability Status Scale" depois de receber um ou outro tratamento: metilprednisolona oral ou intravenosa por quatro semanas. Os resultados combinados mostraram que não houve diferença estatisticamente significativa (OR 0,96; 95% 101 0,60, 1,54 ; p = 0,86). Três estudos mostraram os resultados detalhados de eventos adversos, indicando que os dois tratamentos parecem ser igualmente seguros. Dois ensaios revelaram que não havia nenhuma diferença significativa no aumento de atividade de gadolínio via imagens por ressonância magnética. Um estudo mostrou que a área média sob as curvas de concentração-tempo (AUC) às 24 horas e 48 horas não diferiram entre os grupos. CONCLUSÃO: Não foram encontradas diferenças significativas em termos de clínicos (benefícios e eventos adversos) ou nos resultados radiológicos e farmacológicos em pacientes pós-esteroides por via oral ou intravenosa no tratamento de várias recaídas de esclerose. Nossa metanálise fornece evidências de que a terapia com esteroides por via oral não é inferior à terapia com esteroides por via intravenosa. Assim, a administração oral pode ser um substituto favorável para medicação intravenosa de recidivas da esclerose múltipla.


Subject(s)
Humans , Steroids/administration & dosage , Multiple Sclerosis/drug therapy , Recurrence , Methylprednisolone/administration & dosage , Administration, Oral , Administration, Intravenous
20.
Arq. neuropsiquiatr ; 75(1): 57-65, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-838850

ABSTRACT

ABSTRACT Multiple sclerosis has become an ever-increasing challenge to neurologists. With the release of the latest medications on the market, Brazilian neurologists feel divided between following their patients’ evolution in accordance with the strict rules established by the Brazilian Ministry of Health regarding drug distribution, or following disease progression and worsening in accordance with the evidence in the literature. Therefore, a systematic review of the main published treatment guidelines was conducted and an escalating therapy proposed for guiding multiple sclerosis patient treatment in Brazil.


RESUMO A esclerose múltipla vem se tornando um desafio crescente para os neurologistas. Com o lançamento de novos medicamentos no mercado, os neurologistas brasileiros se encontram divididos entre, apesar da evolução dos seus pacientes, seguir as regras restritas estabelecidas pelo Ministério da Saúde para distribuição de medicamentos, ou ao contrário, considerar a progressão e piora da doença, em concordância com as evidências da literatura. Devido a este impasse foi realizada uma revisão sistemática sobre as principais orientações de tratamento publicadas e foi proposto um escalonamento terapêutico para orientar o tratamento dos pacientes com esclerose múltipla no Brasil.


Subject(s)
Humans , Multiple Sclerosis/drug therapy , Guidelines as Topic , Evidence-Based Medicine , Consensus , Academies and Institutes
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