Segurança na mudança direta de natalizumabe para fingolimode em um grupo de pacientes com esclerose múltipla e positivos para JCV

To assess safety of the switch between natalizumab and fingolimod without a washout period. Methods Prospective data on 25 JCV positive patients who underwent this medication switch were collected and analyzed. Results After a median period of nine months from the medication switch, there were no safety issues to report. The patients had good disease control and no adverse events were reported. Conclusion Washout may not be necessary in daily practice when switching from natalizumab to fingolimod. Expertise on multiple sclerosis management, however, is essential for drug switching748650652Avaliar a segurança na mudança entre natalizumabe e fingolimode sem período de washout. Métodos Dados prospectivos de 25 pacientes positivos para vírus JC que tiveram sua medicação modificada foram coletados e analisados. Resultados Após uma mediana de nove meses da troca de medicação, não havia aspectos de segurança a relatar. Os pacientes estavam com bom controle da doença e não foram relatados eventos adversos. Conclusão Washout pode não ser necessário na prática diária para a mudança entre natalizumabe e fingolimode. No entanto, expertise no manejo de esclerose múltipla é essencial para esta troca entre medicaçõe

Temporal dispersion in the electrophysiological analysis of patients with X-linked Charcot-Marie-Tooth disease

Introdução: Os estudos de condução nervosa (ECN) são ferramentas úteis na caracterização diagnóstica dos pacientes com Doença de Charcot-Marie-Tooth. Classicamente, se atribui aos exames eletroneuromiográficos dos pacientes com neuropatias desmielinizantes hereditárias reduções homogêneas das velocidades de condução, em contraposto às neuropatias desmielinizantes adquiridas em que há um envolvimento multifocal com assincronia da condução pelas fibras nervosas e presença de dispersão temporal. Atualmente, entretanto, com a realização dos testes genéticos nota-se que cada neuropatia hereditária pode ter sua particularidade na apresentação neurofisiológica. A dispersão temporal na CMTX1 seria uma possível característica eletrofisiológica deste grupo. Objetivos: Identificar e analisar a presença de dispersão temporal nos estudos eletrofisiológicos de pacientes com CMTX1 e comparar com os ECN dos pacientes com CMT1A, PIDC e controles normais, afim de avaliar a importância da dispersão temporal dentro do diagnóstico da CMTX1, e na possível diferenciação com outras neuropatias hereditárias ou adquiridas. Métodos: Estudos de condução motora de pacientes com diagnóstico genético da CMTX1 foram estudados e analisados dentro do próprio grupo, e comparados com os de paciente com PIDC, CMT1A e controles saudáveis. A dispersão temporal anormal foi identificada quando na análise do PAMC: 1. a relação entre a duração do potencial proximal e distal era de 30% a 59% (dispersão leve) ou acima de 60% (dispersão acentuada), 2. havia uma morfologia multifásica, ou 3. a duração do potencial distal era maior que 9 ms. Resultados: 99 nervos de 21 pacientes com CMTX1 foram avaliados. Dos 99 nervos, 28 (28,28%) tinham dispersão temporal anormal; 16 tinham dispersão leve (16,16%), 11 nervos com dispersão acentuada (11,11%), morfologia multifásica em 12 (12,12%) e com duração do potencial distal maior que 9 ms em 1 nervo (1,01%). Dos 21 pacientes, 14 (66,66%) tinham pelo menos 1 nervo disperso, 8 (38,09%) tinham pelo menos 2 nervos dispersos e 4 tinham pelo menos 2 nervos com dispersão acentuada e/ou multifásicos (19,04%). A média da porcentagem de nervos dispersos por paciente com CMTX1 foi de 30,91%. A quantidade de nervos multifásicos e com dispersão acentuada; e de pacientes com pelo menos 1 nervo com multifásico, 1 nervo com dispersão acentuada ou 2 nervos com dispersão acentuada e/ou multifásico foi significativamente menor nos pacientes com CMTX que nos pacientes com PIDC. Não houve diferença significativa na análise de todos os parâmetros da dispersão temporal entre homens e mulheres com CMTX1. 7 das 8 familias com diferentes mutações para o gene da Cx32 apresentavam dispersão temporal nos ECN, e 6 delas tinham pelo menos 1 nervo com dispersão acentuada. Não houve presença de dispersão temporal anormal nos grupos CMT1A e controles. Conclusões: 1. Pacientes com CMTX1 apresentam frequentemente dispersão temporal anormal nos estudos de condução nervosa; 2. Pacientes com CMTX1 apresentam menos frequentemente nervos mostrando PAMCs com dispersão temporal acentuada e morfologia multifásica que pacientes com PIDC, não sendo possível utilizar estes parâmetros para diferenciar as duas condições; 3. O sexo na CMTX1 não influencia a presença ou a forma de apresentação da dispersão temporal; 4. Diferentemente da CMTX1, pacientes com CMT1A não costumam apresentar dispersão temporal; 5. Há presença de dispersão temporal em pacientes com diferentes mutações para o gene da Cx32.Introduction: Nerve conduction studies (NCS) are useful tools in Charcot-Marie-Tooth disease diagnosis. Homogeneous reductions in conduction velocities are attributed to hereditary demyelinating neuropathies; in contrast, in acquired demyelinating neuropathies there is a multifocal involvement with asynchronous conduction by nerve fibers and presence of temporal dispersion. Currently, however, with the performance of genetic tests, it becomes evident that each hereditary neuropathy may have its own particularity in neurophysiological presentation and temporal dispersion could be a possible electrophysiological feature of CMTX1. Objectives: To identify and analyze the presence of temporal dispersion in the electrophysiological studies of patients with CMTX1 and compare with NCS of patients with CMT1A, CIDP and normal controls, in order to evaluate the importance of temporal dispersion within the diagnosis of CMTX1, and possible differentiation with other hereditary or acquired neuropathies. Methods: Motor conduction studies of patients with genetic diagnosis of CMTX1 were studied and analyzed within the group itself, and compared with those of patients with PIDC, CMT1A and healthy controls. Abnormal temporal dispersion was identified when the CMAP analysis showed that: 1. the relationship between proximal and distal potential duration was 30% to 59% (mild dispersion) or above 60% (marked dispersion), 2. there was a multiphasic morphology, or 3. the distal potential duration was greater than 9 ms. Results: 99 nerves from 21 patients with CMTX1 were evaluated. Of the 99 nerves, 28 (28.28%) had abnormal temporal dispersion; 16 had mild dispersion (16.16%), 11 had marked dispersion (11.11%), 12 had multiphasic morphology (12.12%) and duration of the distal potential was greater than 9 ms in 1 nerve (1.01%). Of the 21 patients, 14 (66.66%) had at least 1 dispersed nerve, 8 (38.09%) had at least 2 dispersed nerves and 4 had at least 2 marked dispersed and/or multiphasic nerves (19.04%). The average percentage of dispersed nerves per patient with CMTX1 was 30.91%. The number of multiphasic and marked dispersed nerves; and the number of patients with at least 1 multiphasic nerve, 1 marked dispersed nerve, or 2 marked dispersed and/or multiphasic nerves were significantly smaller in CMTX patients than in CIDP patients. There was no significant difference in the analysis of all temporal dispersion parameters between men and women with CMTX1. 7 of the 8 families with different mutational variants for the Cx32 gene had temporal dispersion in the NCS, and 6 of them had at least 1 nerve with marked dispersion. There was no abnormal temporal dispersion in the CMT1A and control groups. Conclusions: 1. CMTX1 patients often have abnormal temporal dispersion in nerve conduction studies; 2. CMTX1 patients less frequently have nerves showing marked temporal dispersion and multiphasic morphology CMAPs than patients with CIDP, and it is not possible to use these parameters to differentiate the two conditions; 3. Gender in CMTX1 does not influence the presence of temporal dispersion; 4. Unlike CMTX1, patients with CMT1A do not have temporal dispersion in NCS; 5. There is temporal dispersion in NCS of patients with different mutations for the Cx32 gene

Pseudoaneurisma de artéria poplítea após correção de lesão do ligamento cruzado anterior

Pseudoaneurismas traumáticos de artéria poplítea são raros e resultam da ruptura da parede arterial com extravasamento de sangue que é contido pelos tecidos vizinhos. Apresentamos um caso de um paciente que apresentou pseudoaneurisma de artéria poplítea após correção de lesão do ligamento cruzado anterior. O paciente foi submetido a tratamento cirúrgico convencional com melhora do quadro clínico no pós-operatório imediato

Oligoclonal Bands in Cerebrospinal Fluid of Black Patients with Multiple Sclerosis

Genetic susceptibility is a well-recognized factor in the onset of multiple sclerosis (MS). The objective of this study was to determine the frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid, in an ethnically mixed group of MS patients in the city of São Paulo, Brazil. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. OCB were found in 49 (54.4%) out of 90 patients with clinically definite MS; out of the 23 brown/black patients, 17 (73.9%) were OCB+; out of the 66 white patients, 32 (48.5%) were OCB+; and the only patient yellow was OCB+ ( = 0.05). Analysis of the IgG index was also consistent with the findings, but with lower statistical significance. The data presented in our study show that the ethnic differences in MS extend to the immune response

Oligoclonal Bands in Cerebrospinal Fluid of Black Patients with Multiple Sclerosis

Genetic susceptibility is a well-recognized factor in the onset of multiple sclerosis (MS). The objective of this study was to determine the frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid, in an ethnically mixed group of MS patients in the city of São Paulo, Brazil. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. OCB were found in 49 (54.4%) out of 90 patients with clinically definite MS; out of the 23 brown/black patients, 17 (73.9%) were OCB+; out of the 66 white patients, 32 (48.5%) were OCB+; and the only patient yellow was OCB+ (p=0.05). Analysis of the IgG index was also consistent with the findings, but with lower statistical significance. The data presented in our study show that the ethnic differences in MS extend to the immune response

Tratamento de aneurisma da artéria renal por embolização e técnica de remodelamento de colo: relato de caso

O tratamento endovascular dos aneurismas de artéria renal tem sido descrito como alternativa à cirurgia convencional. Relatamos o caso de uma paciente com um aneurisma de artéria renal complexo à direita que apresentava hipertensão arterial de difícil controle. O tratamento endovascular foi realizado com a técnica de remodelagem de colo (técnica de Moret), ou técnica de embolização assistida por balão. A paciente obteve normalização da pressão arterial após o procedimento sem recidiva dos sintomas ou necessidade do uso de drogas anti-hipertensivas

Safety of switching from natalizumab straight into fingolimod in a group of JCV-positive patients with multiple sclerosis

ABSTRACT Objective To assess safety of the switch between natalizumab and fingolimod without a washout period. Methods Prospective data on 25 JCV positive patients who underwent this medication switch were collected and analyzed. Results After a median period of nine months from the medication switch, there were no safety issues to report. The patients had good disease control and no adverse events were reported. Conclusion Washout may not be necessary in daily practice when switching from natalizumab to fingolimod. Expertise on multiple sclerosis management, however, is essential for drug switching

Alternatives For Reducing Relapse Rate When Switching From Natalizumab To Fingolimod In Multiple Sclerosis.

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.