Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist.

BACKGROUND: Sexual dysfunction (SD) is a common comorbidity in people with multiple sclerosis (pwMS). It affects the quality of life and remains an overlooked condition. The objective of this study was to describe how Colombian neurologists assess and treat SD and explore the barriers during sexual function evaluation. METHODS: In this observational cross-sectional study we developed a questionnaire for neurologists with 4 sections (demographic data, evaluation and treatment of SD, and possible reasons for not discussing sexual dysfunction.) It was sent via email to 326 Colombian neurologists. We grouped the answers according to the type of consultation (neurologists from a MS program or no MS program). We described through absolute frequencies and proportions. RESULTS: Fifty neurologists answered the survey. 64% stated that they usually study sexual dysfunction in neurological disorders. The main methods employed were private reading (86%) and attending conferences (14%). 5/50 participants have never attend pwMS; the Sect. 2-4 was not answered by them. 29% work in a MS program, all of them asked their patients about sexual function, but 18.75% of physicians working outside an MS program have never asked about it. Main reasons for not talking about sexual dysfunction were lack of knowledge (65.1%), presence of a companion (65.1%) and lack of time (55.8%). 91% of the neurologists reported that their patients usually and frequently ask about sexual function. Neurologists use informal questions to assess sexual function (80%), although 64.4% said that they are aware of SD questionnaires. When sexual dysfunction is detected, 91% of neurologists refer patients to another specialist and 87% do not start any treatment. CONCLUSIONS: Colombian neurologists are concerned with sexual function in pwMS, however it remains an underdiagnosed an undertreated condition. It is necessary to strengthen knowledge about the diagnosis and treatment of sexual dysfunction in pwMS, for neurologists and patients. It is also imperative to eliminate barriers around the topic and include sexual function evaluation and treatment as the routine care of pwMS.

Polycystic ovary syndrome and the new antiepileptic drugs: A systematic review.

OBJECTIVE: To evaluate the presence of polycystic ovary syndrome (PCOS) in women of reproductive age with the use of antiepileptic drugs. METHODS: A systematic literature review of observational analytical studies (cohort, cross-sectional and case-control), from January 1966 to January 2021 on PCOS in women of reproductive age with the use of the antiepileptics. The search covered the Cochrane, MEDLINE, Embase and LILACS databases. INCLUSION CRITERIA: Studies reporting the frequency of PCOS with the antiepileptic drugs in women of reproductive age. EXCLUSION CRITERIA: studies that did not have categorically relevant measurements, those published as abstracts only, and studies of investigational treatment. Data extraction was performed based on the PECOT strategy, considering the method of intervention, methodological quality, and presence of PCOS with the antiepileptic drugs. RESULTS: A total of 2043 references were obtained from which 22 articles were selected by title and abstract. Four articles met the inclusion criteria. No articles were found describing the risk of PCOS upon exposure to levetiracetam, felbamate, gabapentin, lacosamide, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or zonisamide. Only articles related to oxcarbazepine and lamotrigine were found, in which the frequency of PCOS was like that found in women without epilepsy. CONCLUSIONS: The anticonvulsants are probably safer, but the risk of developing PCOS associated with the antiepileptics cannot be established, since there are insufficient studies.

Human Immunoglobulin Versus Plasmapheresis in Guillain-Barre Syndrome and Myasthenia Gravis: A Meta-Analysis.

OBJECTIVES: To evaluate the efficacy and safety over a short time period of human intravenous immunoglobulin versus plasma exchange (PE) in the management of some autoimmune neurologic diseases. In addition, length of hospital stay and duration of ventilator support were compared. METHODS: Randomized controlled trials and analytical observational studies of more than 10 cases were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI, and Ovid, were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio. RESULTS: A total of 552 articles were found and 24 met the criteria for a studied population of 4657 cases: 14 articles were about Guillain-Barré syndrome and 10 of myasthenia gravis. No evidence was found to suggest that PE or intravenous immunoglobulin differed in terms of efficacy or safety to treat any of the 2 diseases. Hospital stay length and ventilatory support time are different in each illness; however, we found no statistical difference in either of the 2 treatments. CONCLUSIONS: There is no evidence for superiority in the efficacy or safety of immunoglobulin or plasmapheresis in the management of Guillain-Barré syndrome and myasthenia gravis. However, caution should be exercised in the interpretation of these results given the limitations in the quality of the evidence and the heterogeneity of the studies.

Síndrome de alertamiento capsular asociado con el síndrome antifosfolípidos: reporte de un caso / Capsular Warning Syndrome Associated with Antiphospholipid Syndrome: Case Report / Síndrome de advertência capsular associado à síndrome antifosfolípide: reporte de um caso

El síndrome de alertamiento es definido como ataques isquémicos transitorios esterotipados y recurrentes, los cuales se manifiestan con síntomas motores y/o sensitivos de un hemicuerpo. Las lesiones, generalmente, son de pequeño vaso de la cápsula interna. Entre un 40% y 60% de los casos terminan con infarto del territorio sintomático. El proceso fisiopatológico exacto aún se desconoce y, a pesar de algunos casos exitosos, no existe consenso sobre el manejo óptimo de este síndrome. Se presenta un caso de síndrome de alertamiento capsular de un en paciente con historia de síndrome antifosfolípidos, a la fecha no hay casos publicados que describan la correlación de estas dos condiciones clínicas.

The capsular warning syndrome is defined as recurrent and stereotyped transient ischemic attacks that manifest themselves with motor and/or sensory symptoms. Generally, injuries take place in the small vessel of the internal capsule. Between 40 and 60% of cases will have a stroke.The pathophysiological process is still unknown, and despite some success cases, there is no consensus for the optimal management of the condition.This case of the capsular warning syndrome is presented in a patient with a history of antiphospholipid syndrome. To date, there are no published cases describing the correlation between these two conditions.

A síndrome de advertência é definida como ataques isquêmicos transitórios estereotipados e recorrentes, os quais manifestam-se com sintomas motores e/ou sensitivos de um hemicorpo. As lesões são geralmente de pequeno vaso da capsula interna.Entre um 40% e 60% dos casos terminam com infarto do território sintomático. O processo fisiopatológico exato ainda desconhece-se e apesar de alguns casos de sucesso não existe consenso sobre o manejo óptimo desta síndrome.Apresenta-se um caso de síndrome de advertência capsular de um paciente com história de síndrome antifosfolípide; até esta data não há casos publicados que descrevam a correlação destas duas condições clínicas.

Meningoencefalitis por Nocardia spp: Reporte de un caso y revisión de la literatura / Nocardia spp meningoencephalitis: A case report and literature review

Resumen La nocardiosis es una rara infección oportunista que afecta principalmente a pacientes con alteración de la inmunidad celular, como pacientes con síndrome de inmunodeficiencia adquirida o postrasplantes. El compromiso del sistema nervioso central es generalmente como absceso y menos frecuentemente como meningitis primaria. El presente artículo hace el reporte de un caso de meningitis primaria por Nocardia en paciente inmunocompetente y revisión de la literatura.

Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. The central nervous system presentation is as cerebral abscesses and less frequently, as primary meningitis. Here, a case of primary nocardia meningitis is described in a patient without a predisposing condition, along with a literature review.

Caracterización de pacientes adultos mayores con epilepsia en dos hospitales de Bogotá (Colombia) / Characterizing older adult patients suffering from epilepsy in two hospitals in Bogotá (Colombia) / Caracterização de pacientes adultos mais velhos com epilepsia em dois hospitais de Bogotá (Colômbia)

La prevalencia global de la epilepsia en Colombia es del 1,13% y en pacientes mayores de 65 años puede estar cercana al 1,5%. El objetivo de este trabajo ha sido el de describir las características demográficas y clínicas de la población mayor de 65 años que presenta epilepsia. Materiales y métodos: estudio descriptivo, de corte transversal en dos hospitales en Bogotá (Colombia), durante los años 2005-2008. Se revisaron las bases de datos y se seleccionaron las historias clínicas de los pacientes mayores de 65 años con epilepsia. Resultados: se revisaron 211 historias clínicas y se seleccionaron 179. La edad media fue de 75 años (65-98) y el inicio de la epilepsia fue a los 67,5 (7-93); el 64,4% inició la enfermedad después de los 65 años. El 84% de las crisis fueron clasificadas como focales. El diagnóstico más frecuente fue epilepsia focal sintomática (94,4%). 61 pacientes tuvieron como etiología una enfermedad cerebro-vascular. Los antiepilépticos de primera generación, especialmente fenitoína, fueron los más utilizados (99%), aunque 81 de 104 pacientes tratados no estaban libres de crisis. Conclusiones: la mayoría de las crisis son resultado de una epilepsia focal sintomática como consecuencia de una lesión vascular, por lo que se debe considerar el tratamiento farmacológico desde la primera crisis. Es recomendable iniciar el tratamiento con antiepilépticos de segunda generación como lamotrigina, gabapentin, levetiracetam, para minimizar efectos secundarios, y mantener el principio de inicio con dosis bajas y mantenimiento con dosis bajas. Si las condiciones económicas no lo permiten, se puede usar fenitoína o carbamacepina con precaución.

Epilepsy's overall prevalence in Colombia is 1.13%. Its prevalence in patients aged over 65 could be around 1.5%. Objective: describe demographic and clinical characteristics of patients older than 65 years of age with epilepsy. Materials and methods: A cross-sectional descriptive study was carried out in two high complexity hospitals in Bogotá, Colombia during 2005-2008. Demographic data were compiled and patients characterized regarding the type, frequency and diagnosis of seizures (based on ILAE classification), probable etiology, having a family background of epilepsy, and current pharmacological management. Results: 211 clinical histories were reviewed and 179 of them selected. Mean patient age was 75 (65-98) and average age at onset of epilepsy was 67.5 (7-93). 84% of the seizures were classified as being focal. The most frequently occurring diagnosis was symptomatic focal epilepsy (94.4%). 74 cases (41.3%) had an etiological diagnosis. The most important cause was cerebrovascular disease (61 patients). First generation anti-epileptic drugs were the most used ones (99%). 81/104 patients were found not to be free from epileptic episodes. Conclusions: Most seizures have a partial beginning, resulting from symptomatic partial epilepsy as a consequence of a vascular lesion. Pharmacological treatment must be considered following the first seizure. Treatment with second generation anti-epileptic drugs such as Lamotrigine, Gabapentin, Levetiracetam and Topiramate must be begun for minimizing secondary effects and low doses must be maintained from the start of treatment. Costs may limit the use of the above antiepileptic drugs, in such cases Phenytoin and Carbamazepine may be used with extreme caution.

A prevalência global da epilepsia na Colômbia é 1,13% e em pacientes maiores de 65 anos pode estar próxima a 1,5%. O objetivo deste trabalho tem sido descrever as características demográficas e clínicas da população maior de 65 anos que apresenta epilepsia. Materiais e métodos: estudo descritivo, de corte transversal em dois hospitais em Bogotá, Colômbia, durante os anos 2005-2008. Revisaram-se as bases de dados e se selecionaram as histórias clínicas dos pacientes maiores de 65 anos com epilepsia. Resultados: Se revisaram 211 histórias clínicas e se selecionaram 179. A idade média foi de 75 anos (65-98) e o inicio da epilepsia foi aos 67,5 (7-93); 64,4% iniciaram a doença depois dos 65 anos. 84% das crises foram classificadas como focais. O diagnóstico mais freqüente foi epilepsia focal sintomática (94.4%). 61 pacientes tiveram como etiologia uma doença cardiovascular. Os antiepilépticos de primeira geração, especialmente Fenitoína, foram os mais utilizados (99%) ainda que 81 de 104 pacientes tratados não estivessem livres de crises. Conclusões: a maioria das crises é resultado de uma epilepsia focal sintomática como conseqüência de uma lesão vascular pelo que se deve considerar o tratamento farmacológico desde a primeira crise. É recomndável iniciar o tratamento com antiepilépticos de segunda geração como Lamotrigina, Gabapentin, Levetiracetam para minimizar os efeitos secundários e, manter no princípio o início com doses baixas e conservação com doses baixas. Se as condições econômicas não o permitem, pode-se usar Fenitoína ou Carbamacepina com precaução.