Restless legs syndrome and multiple sclerosis: a Brazilian multicenter study and meta-analysis of the literature

OBJECTIVE: The increased prevalence of restless legs syndrome (RLS) in multiple sclerosis (MS) has recently been the subject of a few papers. The present study investigated the prevalence of RLS symptoms in MS patients and in controls in four Brazilian cities. Additionally, a systematic review and meta-analysis of the literature was carried out on the subject of RLS-MS. METHOD: MS patients and controls were investigated regarding the presence of the four typical symptoms of RLS. A questionnaire assessing RLS severity was also used for patients and controls presenting the four RLS symptoms criteria. The systematic review and meta-analysis on the subject were carried out according to the strict international criteria. RESULTS: In the present report, the RLS-MS association was confirmed as being more than fortuitous in Brazilian MS patients, in a multicenter case-control study. MS patients also presented RLS symptoms of greater severity than did the control population. A systematic review and meta-analysis of the literature showed that MS patients had a fourfold higher chance of presenting RLS than did the controls. CONCLUSION: Although underlying mechanisms to explain the association RLS-MS are still a matter of discussion, there is a clear association of these two neurological conditions

Frequency of reported European ancestry among multiple sclerosis patients from four cities in the southern and southeastern regions of Brazil

Recent reports on the prevalence of multiple sclerosis (MS) have described discrepancies between the rates in cities in the northeastern and southeastern regions of Brazil, representing a north-south gradient. European immigrants settled in southeastern and southern Brazil at the beginning of the twentieth century. In this study, we report the frequency of European ancestors among Brazilian MS patients in four cities in the southern and southeastern regions of Brazil. Methods: A total of 652 consecutive patients with confirmed MS diagnoses seen at four centers in Belo Horizonte, Ribeirão Preto, Londrina and Santos were asked about the origin of their ancestors, going back three generations. Results: 287 (44%) reported Italian ancestry, 211 (32%) reported that all ancestors were born in Brazil, 49 (7.5%) had Portuguese ancestry and 70 (10%) had Spanish ancestry. The patients in Belo Horizonte and Londrina reported higher proportions of Italian ancestry than the proportions estimated for the populations of their respective States. Conclusion: Brazil has a north-south gradient of 0.91/100,000 per degree of latitude, which is higher than the gradient for Latin America. Since the largest immigrant group that settled in southern and southeastern Brazil was from Italy, it is possible that Italian immigration was one of the factors that have contributed toward increasing the prevalence of MS in these regions. © 2013 Elsevier B.V. All rights reserved

Cadasil: case report / Cadasil: relato de caso

A 48-year-old patient, male, previously healthy, started migraine with aura at 46 years old of age. After two years, he evolved with the first episode of Ischemic Stroke, with motor and sensory deficit of the left hemibody with partial recovery of symptoms. Stroke protocol and etiological investigation were performed without alterations. Two months later, he presented convulsive crisis requiring the use of medication still for control. It evolved with mild cognitive impairment and depression. Three years later, he had a new episode of stroke, performed Magnetic Resonance Imaging of the Skull, evidencing areas of hypersignal in T2/ FLAIR in the poles of the temporal lobes, also diffusely affecting the supratentorial white substance, with small focal alterations of a means suggestive of small ischemic sequelae, also present in the callous body, deep gray substantial and brainstem, of probable vascular nature. Thus, CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) was suspected, requested genetic testing showing alteration in the DNA sequence of the NOTCH-3 gene, Allelo1: t > C transition, nucleotide 514; códon 146; exchange of the amino acid cysteine > Arginine. Allelo 2: Transition C > G, nucleotide 1272; códon 398; no amino acid exchange, confirming diagnostic suspicion. The patient is monitored in the neurology outpatient clinic with multidisciplinary rehabilitation therapy, secondary prevention treatment for stroke, antidepressant medication and topiramate for migraine treatment

Guillain-Barre syndrome following the first dose of SARS-CoV-2 vaccine, Oxford/AstraZeneca (ChAdOx1) / Síndrome de Guillain-Barre após a primeira dose da vacina contra a SRA-CoV-2, Oxford/AstraZeneca (ChAdOx1)

In the United Kingdom, until 04/21, 6 patients with SGB after the ChAdOx1 were notified out of a total of 42.917 vaccinated, with an 80% reduction in hospitalization in the elderly after vaccination. Facts added to the global pandemic scenario, the vaccine remains necessary

Case report: Syndrome of the disconnection of the callus body in a patient with extensive injury - Mellitus Diabetes and malnutrition - Marchiafava-Bignami disease / Relato de caso: Síndrome da desconexão do corpo calo num doente com lesões extensas - Diabetes Mellitus e má nutrição - doença Marchiafava-Bignami

MFL, 51 years old, female, right-handed, diabetic and previous stroke. Non alcoholic, and report of malnutrition. On neurological examination, he presented tactile anomy, visual agnosia, bucovisual apraxia, left hand agraphia, normal graphia right hand with Alexia, and bilateral crossed optical ataxia. Magnetic resonance imaging (MRI) showed extensive lesion with a swollen aspect in commissural fibers of the corpus callosum, notably in the right body and splenium, and corona radiata with hypersignal in T2 / FLAIR, suggesting demyelinating noninflammatory lesion or subacute vascular lesion

HLA-DRB1*allele-associated genetic susceptibility and protection against multiple sclerosis in Brazilian patients

Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system that causes neurological disorders in young adults. Previous studies in various populations highlighted an association between the HLA-DRB1*1.5 allele and MS. This study investigated the association between HLA-DRB1*15 and other HLA-DRB1 alleles and MS in a Brazilian Caucasian population sample from Londrina, Southern Brazil. HLA-DRB1 alleles were analyzed by polymerase chain reaction with specific sequence oligonucleotide primers in 119 MS patients and in 305 healthy blood donors as a control. Among the MS patients, 89 (75.0%) presented with relapsing remitting MS, 24 (20.0%) with secondary progressive MS and 6 (5.0%) with primary progressive MS. The frequency of the HLA-DRB1*15 allele observed in the MS Brazilian patients was similar to findings reported in previous studies carried out in populations worldwide. However, the results showed a higher frequency of the HLA-DRB1*15 allele in the MS patients compared to the controls, with a relative frequency of 0.1050 (10.50%) and 0.0443 (4.4%), respectively (OR=2.53; 95% CI 1.43-4.46; p=0.0009). A protector allele was also detected. The frequency of the HLA-DRB1*11 allele was reduced in the MS patients compared to the controls, with a relative frequency of 0.1345 (13.4%) and 0.1869 (18.7%), respectively (OR=0.67; 95% CI 0.44-1.03; p=0.0692). The results demonstrated that the HLA-DRB1*15 allele in heterozygosity is positively associated with MS (p=0.0079), and may be considered a genetic marker of susceptibility to the disease. A negative association between the HLA-DRB1*11 allele in homozygosity and MS was also verified (p=0.0418); this allele may be considered a genetic marker of resistance to MS in the Brazilian population

Granuloma esquistossomotico medular: registro de um caso

Os autores relatam um caso de granuloma esquistossomótico de localização medular cujo diagnóstico inicial, foi de tumor intramedular sem caracterização nosológica. O resultado e diagnóstico, após exame histológico da peça cirúrgica, bem como aspectos diagnósticos através de exames complementares e características endêmicas do processo são discutidos