Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas / Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas / Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

Multiple cranial neuropathy: Clinical findings in a case series of 142 patients.

INTRODUCTION: Multiple cranial neuropathies (MCN) is an entity frequently seen in clinical practice but there is a lack of studies published about this entity, with most of them based on case reports and small case series. OBJECTIVE: The aim of this study is to describe the clinical involvement of different cranial nerves, the location within the central or peripheral nervous system and the diagnosis in a group of patients with MCN managed in one hospital in Bogotá-Colombia. METHODOLOGY: A case series study was conducted using the electronic clinical records of a teaching hospital in Bogota-Colombia. Clinical data were collected from patients aged ≥18 with a clinical diagnosis of MCN between 2015 and July 2021. RESULTS: The cranial nerves most commonly affected were III and VII, with the most prevalent combinations being III-IV, III-VI, and V-VII. Among etiologies, the most frequently found were autoimmune, vascular and neoplastic and most common locations included peripheral nerves, neuromuscular junction, cavernous sinus and lateral medulla. CONCLUSIONS: The differential diagnosis of MCN is broad, but clinical clues may aid in identifying the underlying etiology. According to our results, MG was the most frequent etiology, so it should be considered in any patient with a clinical diagnosis of MCN associated with fatigability.

Acute HSV and anti-NMDA encephalitis occurring as a neurosurgical complication.

We present a 24-year-old man with a 2-year history of progressive right-sided monocular vision loss with no other symptoms. An MRI showed a meningioma compressing the right optic nerve and the cavernous sinus. The tumour was partially resected. Eight days after discharge the patient was admitted with fever, a severe stabbing headache, insomnia, nausea and vomiting. A FilmArray panel and a cerebral biopsy were performed which were positive for herpes simplex virus 1 (HSV-1). An MRI of the brain showed asymmetric bilateral lesions in the frontobasal region with predominance of the right side. Acyclovir was started and continued until completing 21 days. A month after discharge, he started experiencing insomnia, trichotillomania, limb tremor, persistence of abulia, apathy and emotional lability. An HSV-1 encephalitis relapse was suspected, acyclovir and foscarnet were started. Due to the poor response to antiviral therapy CSF was tested, which was positive for anti-NMDA receptor encephalitis. A treatment course of intravenous immunoglobulin was started with a favourable outcome.

Manifestaciones neurológicas de infección por virus Epstein-Barr y citomegalovirus / Neurological manifestations of Epstein-Barr virus and cytomegalovirus infection

RESUMEN La familia de los herpesvirus es una gran familia compuesta por varios integrantes, entre ellos el herpes simple tipo 1 y 2, varicela zóster, citomegalovirus, Epstein-Barr y herpesvirus humano 6, los cuales en los últimos años se ha puesto en evidencia que infectan todo el neuroaxis, por lo que es de vital importancia reconocer los síntomas iniciales y hacer exámenes apropiados para identificar y manejar de manera efectiva estas infecciones, evitando así secuelas neurológicas devastadoras e incapacitantes para los pacientes. En este apartado se revisará el virus de Epstein-Barr, para lo cual se abordará su fisiopatología, diagnóstico y tratamiento.

SUMMARY The herpesvirus family is a large family composed of several members including Herpes simplex type 1 and 2, Varicella Zoster, Cytomegalovirus, Epstein barr and Herpesvirus 6, which in recent years have been shown to infect the entire neuraxis, therefore It is vitally important to recognize the initial symptoms and perform appropriate tests to identify and effectively manage these infections to avoid neurological sequelae devastating and disabling for patients. In this section the Epstein virus will be reviewed by Barr where he will address the pathophysiology, diagnosis and treatment.

The multiple faces of encephalitis: Antibody profile in a case series of autoimmune encephalitis in Bogotá, Colombia.

There is a lack of population based studies of autoimmune encephalitis (AE) in Latin American countries, especially in Colombia. The aim of this study is to characterize patients with AE managed in three centers in Bogotá-Colombia, emphasizing on antibody profile. We conducted a retrospective case-series study, including 9 patients. The most prevalent antibody found was NMDAR, followed by LGI1. Some distinguishing features included: faciobrachial dystonia and hyponatremia in LGI1, a younger age and good outcome in NMDAR, a notable response to steroids in anti TPO-Thyroglobulin, a cerebellar syndrome associated with Anti-Yo, and epilepsy with insomnia in CASPR2.

Epistemología, salud y género: diálogos entre la cardiología y las ciencias sociales / Epistemology, health, and gender: dialogues between cardiology and social sciences / Epistemologia, saúde e gênero: diálogos entre a cardiologia e as ciências sociais

Propósito/Contexto. Este artículo tiene como propósito enfatizar la importancia que tienen las epistemologías y éticas feministas en el conocimiento médico, especialmente en la cardiología. La discusión está motivada por los importantes sesgos que hay en la distinción entre las categorías de sexo y género en la medicina. Metodología/Enfoque. El enfoque que guía la elaboración de este artículo es el feminismo del punto de vista, formulado por Sandra Harding y complementado con la visión de diferentes médicas y filósofas que trabajan la intersección entre la filosofía de las ciencias y la cardiología. Resultados/Hallazgos. Los resultados que se obtienen a partir de esta revisión permiten contribuir al debate sobre los beneficios de un enfoque médico fundamentado por las teorías feministas, así como proponer una atención médica más holística en los diferentes escenarios de salud. Discusión/Conclusiones/Contribuciones. Analizar estas categorías, a partir de la salud pública y la epistemología, permitirá crear espacios para ofrecer una mejor atención a las mujeres, especialmente en condiciones como la enfermedad coronaria, que es una de las principales causas de mortalidad y morbilidad a nivel mundial. Además, se enfatizan los compromisos sociales, políticos, históricos, culturales y éticos que debe tener toda práctica médica en la estructuración del conocimiento.

Purpose/Context. This article aims to emphasize the importance of feminist epistemologies and ethics to medical knowledge, especially cardiology. Significant biases in the distinction between sex and gender categories in medicine motivate the discussion. Method/Approach. The approach guiding this article is Sandra Harding's standpoint feminism, supplemented by the views of female doctors and philosophers who work on the philosophy of science-cardiology intersection. Results/Findings. The results obtained from this review contribute to the debate on the benefits of a medical approach based on feminist theories and propose more holistic medical care in different health settings. Discussion/Conclusions/Contributions. Analyzing these categories based on public health and epistemology will create opportunities to offer better care to women, especially in conditions such as coronary heart disease, which is one of the main causes of mortality and morbidity worldwide. Besides, the social, political, historical, cultural, and ethical commitments that all medical practice must make in structuring knowledge are emphasized.

Objetivo/Contexto. Este artigo tem como objetivo enfatizar a importância que têm as epistemologias e éticas feministas no conhecimento médico, principalmente na cardiologia. A discussão é motivada pelos importantes vieses existentes na distinção entre as categorias de sexo e gênero na medicina. Metodologia/Abordagem. A abordagem que orienta a elaboração deste artigo é o feminismo do ponto de vista, formulado por Sandra Harding e complementado com a visão de diferentes médicas e filósofas que trabalham a interseção entre a filosofia das ciências e a cardiologia. Resultados/Descobertas. Os resultados obtidos nesta revisão possibilitam contribuir para o debate sobre os benefícios de uma abordagem médica fundamentada pelas teorias feministas, assim como propor um atendimento médico mais holístico nos diferentes cenários de saúde. Discussão/Conclusões/Contribuições. A análise dessas categorias, baseada na saúde pública e a epistemologia, permitirá a criação de espaços que ofereçam melhor atendimento às mulheres, principalmente em condições como a doença coronária, que é uma das principais causas de mortalidade e morbidade no mundo. Além disso, são enfatizados os compromissos sociais, políticos, históricos, culturais e éticos que deve ter toda prática médica na estruturação do conhecimento.