Demographic and clinical characterization of multiple sclerosis in Mexico: The REMEMBer study.

BACKGROUND: Multiple sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system with high prevalence in young adults around the world. The vast majority of epidemiological studies and statistics are based on European and American data, so most clinical guidelines and medical consensus are based on this information. There is very limited evidence in Mexico regarding demographic and clinical aspects of MS. Therefore, this study comprehensively described the epidemiological and clinical features of MS in a large cohort of patients from eight tertiary-level centers in Mexico. METHODS: A cross-sectional multicenter study was conducted. A group of neurologists, the "Registro Mexicano de Esclerosis Multiple" (REMEMBer) group, compiled the information of MS patients (January to December 2019) from eight tertiary-level centers. Clinical and demographic data were extracted. RESULTS: A total of 1,185 patients were included. The mean age was 40.65 ± 11.43 years old. Women represented more than half of the whole cohort (64.9% vs. 35.1%). Of the whole cohort, forty-three percent of MS patients had a relative with at least one autoimmune disease (MS: 24%, other autoimmune disorders: 74.9%) or thyroid disease (28%). Furthermore, the mean age of clinical onset was 31.23 ± 9.71 (range: 16-68) years old, and the disease duration was 9.33 ± 7.25 (0.46-40.19) years. The most prevalent phenotype of MS was relapsing-remitting (87.76%). Primary (1.18%) and secondary (9.11%) progressive, as well as clinically isolated syndrome (CIS, 1.43%), were also found. Clinical phenotypes (facial, hearing, and speech disorders, and movement impairment and ataxia) and the frequency of thyroid disorders were different between genders. CONCLUSION: In Mexico, the frequency of MS seems to be higher in the female gender (2:1 women/men ratio) compared to other series. In addition, there was a predominance of facial, hearing and speech disorders, as well as movement impairment and ataxia. Thyroid diseases were more common in women with multiple sclerosis than men.

Clinical features of Guillain-Barré Syndrome in a tertiary-level hospital in Mexico / Síndrome de Guillain-Barré en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI

Background: Guillain-Barré Syndrome (GBS) is an acute polyneuropathy characterized by symmetrical weakness of the limbs with hyporeflexia or areflexia with a maximum progression within four weeks and can impair respiratory function and implies disability at a long. The aim of this paper was to describe the clinical, epidemiological and neurophysiological features of patients with GBS at the Hospital de Especialidades del Centro Medico Nacional Siglo XXI (HECMNSXXI) Methods: An observational, retrospective cross-sectional study, data were collected form clinical records of adults with GBS hospitalized in HECMNSXXI from March 2012 to March 2016. The recorded variables were demographics, previous infection, clinical presentation, disability scores, prognosis scores and neurophysiological subtypes. Results: Clinical records of 94 patients were analysed with a mean age of 53 years, 61% male, with previous infection in 80%. Albumin cytologic dissociation was present in 50%. Medical Research Council (MRC) sum scores mean was 32, the SGB disability score at admittance with a mean of 3.63. The axonal subtype was in 68%, and demyelinating in 29%, not conclusive in 3%. Conclusions: In this study the demographic and clinical features are similar to other previous reports, we documented a greater proportion of axonal subtype, which are related with important disability and worse prognosis.

Introducción: El síndrome de Guillain-Barré (SGB) es una polirradiculoneuropatía aguda caracterizada por debilidad simétrica progresiva de las extremidades con hipo o arreflexia, que progresa en un máximo de 4 semanas y que puede llevar a la falla respiratoria y a discapacidad a largo plazo. El objetivo de este trabajo fue describir las características clínicas, epidemiológicas y neurofisiológicas de pacientes con SGB del Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HECMNSXXI). Métodos: Se realizó un estudio observacional de tipo transversal retrolectivo. Se obtuvieron datos de expedientes clínicos de adultos con diagnóstico de SGB hospitalizados en el HECMNSXXI en el periodo de marzo de 2012 a marzo de 2016. Se registraron variables demográficas, clínicas y neurofisiológicas. Resultados: Se incluyeron 94 pacientes con un promedio de edad de 53 años, en su mayoría hombres, con infección previa en 80%. La fuerza muscular medida con la escala del Medical Research Council (MRC) fue en promedio de 32, la escala de discapacidad del SGB (Hughes) al ingreso tuvo un promedio de 3.63. La variedad axonal se encontró en 68%, la desmielinizante en 29% y en 3% no concluyente. Conclusiones: Se documentan en esta muestra características demográficas y clínicas similares a lo reportado en la literatura, así como la mayor proporción de variedades axonales, las cuales tienen mayor severidad en la presentación clínica así como mal pronóstico.

[Clinical and demographic characteristics of patients with multiple sclerosis]. / Características clínicas y demográficas de los pacientes con esclerosis múltiple.

BACKGROUND: Multiple sclerosis (MS) is a disease whose physiopathogenesis shows a complex interaction of genetic and environmental factors. Given that those factors have not been documented in our country, we describe the clinical and demographic characteristics from a sample of patients with MS. METHODS: We carried out an observational, descriptive, cross-sectional, and retrolective study in a Center for Demyelinating Diseases. We took the information from the clinical records of a sample of patients with multiple sclerosis, who arrived to the center from April 2014 to July 2015. RESULTS: We obtained data from 313 patients, out of which 65.5 % were women. Mean age was 41 years (SD 11.22). Minimum age of diagnosis was 12 years and maximum, 66 years; mean age of diagnosis was 32 years (SD 9.72). With regards to clinical variables, 3.4 % presented radiologically isolated syndrome (RIS), 82 % relapsing-remitting MS (RRMS), 13.9 % secondary-progressive MS (SPMS), and 0.8 % primary-progressive MS (PPMS). Of all the patients, 10 % had first or second degree relatives with diagnosis of this disease; 16 % had foreign ancestors; 27 % were smokers. Treatment consisted of glatiramer acetate, 28 %; intramuscular interferon beta 1a, 18 %; subcutaneous interferon beta 1a, 16 %; subcutaneous interferon beta 1b, 30 %; fingolimod, 3 %; and others, 5 %. CONCLUSIONS: Clinical and demographic characteristics are similar to those reported in international literature. More studies would be needed to typify Mexican population with MS.

Introducción: la esclerosis múltiple (EM) es una enfermedad que presenta una compleja interacción de factores genéticos y ambientales en su fisiopatogenia. Dado que esos factores han sido poco abordados en México, describimos las características clínicas y demográficas de una muestra de pacientes con EM. Métodos: estudio observacional, descriptivo, transversal y retrolectivo, realizado en un hospital de tercer nivel. Se obtuvo información de expedientes clínicos de una muestra de pacientes con el diagnóstico de EM, captados de abril de 2014 a julio de 2015. Resultados: se obtuvieron datos de 313 pacientes, 65.5 % mujeres, con edad promedio de 41 años (DE 11.22). La edad mínima del diagnóstico fue de 12 años y la máxima de 66; el promedio de edad del diagnóstico fue 32 años (DE 9.72). De la variante clínica 3.4 % tuvo síndrome neurológico aislado (CIS), EM remitente-recurrente 82 %, EM secundaria progresiva 13.9 % y EM primaria progresiva 0.8 %. El 10 % de los pacientes tenía parentesco de primer o segundo grado con diagnóstico de EM. El 16 % tuvo ascendencia extranjera. El 27 % tenía hábito tabáquico. Los tratamientos utilizados fueron el acetato de glatiramero 28 %, interferon beta 1a IM 18 %, interferon beta 1a SC 16 %, interferon beta 1b SC 30 %, fingolimod 3 % y otros 5 %. Conclusiones: las características clínicas y demográficas son similares a lo reportado en la literatura internacional. Se requieren más estudios para caracterizar mejor a la población mexicana con EM.