Comment on Neuromyelitis Optica: Potential Roles for Intravenous Immunoglobulin

Universidade Federal de São Paulo, Neuroimmunol Clin, São Paulo, BrazilUniversidade Federal de São Paulo, Neuroimmunol Clin, São Paulo, BrazilWeb of Scienc

Seasonality of 278 neuromyelitis optica relapses in a Brazilian cohort

Universidade Federal de São Paulo, Dept Neurol, BR-04023900 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Neurol, BR-04023900 São Paulo, SP, BrazilWeb of Scienc

Síndrome SUNCT de ocorrência bilateral associada a sinusopatia maxilar crônica

SUNCT syndrome (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) is defined as short attacks of periorbital unilateral pain and accompanied by ipsilateral lacrimation and redness of the same eye. We present an unusual SUNCT case with bilateral pain that started five years ago after an acute maxillary sinus infection that evolved to chronic sinusitis. This association has been described in few SUNCT cases, but its causal role remains uncertain. The patient was a 58 years old man that fulfilled a headache diary that showed the usual circadian pattern, worsening in the morning and afternoon, and responded to treatment with gabapentina. He was submitted to a functional endoscopic sinus surgery and evolved with milder pain. In a review of 21 patients, 5 had a past medical history of sinusitis, but the causal role of this association remained uncertain.A síndrome SUNCT (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) é definida como curtos ataques de dor periorbital unilateral, acompanhada de lacrimejamento e hiperemia conjuntival ipsilateral. Apresentamos um raro caso de SUNCT com dor bilateral com evolução de cinco anos e iniciado após uma infecção de seio maxilar que evoluiu para sinusite crônica. Esta associação foi descrita em poucos casos de SUNCT, porém pouco esclarecida. O paciente era um homem de 58 anos que preencheu um diário de dor que demonstrou o típico padrão circadiano da síndrome, com pioras matinais e vespertinas, e apresentou melhora com uso de gabapentina. Submetido a cirurgia endoscópica funcional em seio maxilar e evoluiu com modulação da dor, sugerindo um potencial efeito benéfico após tratamento da sinusopatia.Na revisão de literatura encontramos 21 casos de SUNCT bilateral, cinco dos quais apresentavam história de sinusite; no entanto, a relação entre as duas entidades permanece ainda incerta.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Neurology and NeurosurgeryUNIFESP, EPM, Department of Neurology and NeurosurgerySciEL

Risk Acceptance in Multiple Sclerosis Patients on Natalizumab Treatment

Objective: We aimed to investigate the ability of natalizumab (NTZ)-treated patients to assume treatment-associated risks and the factors involved in such risk acceptance.Methods: From a total of 185 patients, 114 patients on NTZ as of July 2011 carried out a comprehensive survey. We obtained disease severity perception scores, personality traits' scores, and risk-acceptance scores (RAS) so that higher RAS indicated higher risk acceptance. We recorded JC virus status (JCV+/-), prior immunosuppression, NTZ treatment duration, and clinical characteristics. NTZ patients were split into subgroups (A-E), depending on their individual PML risk. Some 22 MS patients on first-line drugs (DMD) acted as controls.Results: No differences between treatment groups were observed in disease severity perception and personality traits. RAS were higher in NTZ than in DMD patients (p<0.01). Perception of the own disease as a more severe condition tended to predict higher RAS (p=0.07). Higher neuroticism scores predicted higher RAS in the NTZ group as a whole (p=0.04), and in high PML-risk subgroups (A-B) (p=0.02). in low PML-risk subgroups (C-E), higher RAS were associated with a JCV+ status (p=0.01). Neither disability scores nor pre-treatment relapse rate predicted RAS in either group.Conclusions: Risk acceptance is a multifactorial phenomenon, which might be partly explained by an adaptive process, in light of the higher risk acceptance amongst NTZ-treated patients and, especially, amongst those who are JCV seropositive but still have low PML risk, but which seems also intimately related to personality traits.Bayer Health CareMerck SeronoTEVAVall dHebron Univ Hosp, Dept Neurol Neuroimmunol, Multiple Sclerosis Ctr Catalonia Cemcat, Barcelona, SpainUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilUniv Hosp Principe de Asturias, Dept Neurol, Madrid, SpainUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilWeb of Scienc