Enxaqueca em 746 pacientes com esclerose múltipla

Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS

Consenso brasileiro para o tratamento da esclerose múltipla : Academia Brasileira de Neurologia e Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla

O crescent arsenal terapêutico na esclerose múltipla (EM) tem permitido tratamentos mais efetivos e personalizados, mas a escolha e o manejo das terapias modificadoras da doença (TMDs) tem se tornado cada vez mais complexos. Neste contexto, especialistas do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia reuniram-se para estabelecer este Consenso Brasileiro para o Tratamento da EM, baseados no entendimento de que neurologistas devem ter a possibilidade de prescrever TMDs para EM de acordo com o que é melhor para cada paciente, com base em evidências e práticas atualizadas. Por meio deste documento, propomos recomendações práticas para o tratamento da EM, com foco principal na escolha e no manejo das TMDs, e revisamos os argumentos que embasam as estratégias de tratamento na EM.The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS

Perfil plasmático dos potenciais biomarcadores imunes nos pacientes com esclerose múltipla remitente recorrente em um ensaio clínico controlado

Introdução: Biomarcadores imunes que possam auxiliar no tratamento de pacientes com esclerose múltipla (EM) em uso de fingolimode ainda não estão definidos. Sendo assim, decidiu-se avaliar esses parâmetros em pacientes com esclerose múltipla remitente recorrente (EMRR) virgens de tratamento e que iniciaram fingolimode, comparados a pacientes com EMRR tratados com imunomoduladores e que, posteriormente, migraram para o fingolimode. Objetivo: Identificar possíveis biomarcadores imunes nos pacientes com EMRR em tratamento com fingolimode. Material e Métodos: Ensaio clínico controlado não randomizado. Avaliaram-se as concentrações plasmáticas de onze biomarcadores imunes dos 11 biomarcadores imunes : sCD40L, IL-1β, IL-6, IL- 17A, IL-17F, IL-21, IL-22, IL-31, IL-33, TNF-α e IFN-, em dois grupos de pacientes, quais sejam: o Grupo 1 (n=12), formado por pacientes com EMRR em tratamento com acetato de glatirâmer (AG) ou betainterferona (IFN-β) e que, após 6 meses, modificaram a terapia para fingolimode; e o Grupo 2 (n=12), formado por pacientes com EMRR previamente virgens de tratamento que iniciaram fingolimode na primeira visita. Foi utilizado ANOVA two-way para avaliar os biomarcadores e o coeficiente de Spearman rho para estudo de correlação. Resultados: Dois biomarcadores plasmáticos foram identificados, a IL-31 e o receptor solúvel sCD40L, os quais reduziram de forma correlata seus níveis plasmáticos nos pacientes com EMRR tratados com fingolimode (r=0,834 p<0,001). Foi possível verificar que o Grupo 1 apresentou uma redução significativa da IL-31 e do receptor sCD40L após 12 meses de tratamento (p<0,001), sendo mais acentuada após 6 meses de tratamento com fingolimode apenas para a IL-31 (p<0,05). No Grupo 1, a redução da IL-31 se correlacionou com a redução da IL-33 (r=0,762; p<0,05) e a redução do receptor sCD40L se correlacionou com a redução da IL-1β (r=0,800; p<0,05) e IL-17A (r=0,782 p<0,05). No Grupo 2, houve uma redução no número de surtos por tempo de doença-ano (p<0,001) e no escore do EDSS (p<0,05) após 12 meses de tratamento, acompanhado de uma redução dos níveis da IL-31 (p<0,001) e do receptor sCD40L (p<0,05), que se acentuaram após 6 meses de tratamento (p<0,05). No Grupo 2, o receptor sCD40L se correlacionou com a redução dos níveis do TNF-α (r=0,882; p<0,001), IL-17A (r=0,443; p<0,001), IL17-F (r=881; p<0,05), IL-21 (r=0,688; p<0,05) e IFN-γ (r=0,605; p<0,05) e a IL-31 se correlacionou inversamente com o número de lesões nas sequências ponderadas em T2/FLAIR (r=-0,591; p<0,05). Conclusões: O estudo forneceu dados convincentes sobre a existência de dois promissores biomarcadores imunes, IL-31 e o receptor sCD40L, que reduziram seus níveis plasmáticos nos pacientes com EMRR tratados com fingolimodeEste trabalho foi realizado com a colaboração da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES (Brasil)Introduction: Immune biomarkers that might be used in the treatment of patients with multiple sclerosis (MS) using fingolimod are not yet defined. Therefore, the need to evaluate such parameters in treatment-naïve relapsing remitting multiple sclerosis (RRMS) patients who started fingolimod was set, as well as its comparison to RRMS patients treated with immunomodulators and who subsequently migrated to fingolimod. Objective: To identify possible immune biomarkers in RRMS patients under fingolimod treatment. Material and Methods: Non-randomized controlled clinical trial Eleven plasma immune biomarkers: sCD40L, IL-1β, IL-6, IL-17A, IL-17F, IL-21, IL-22, IL-31, IL-33, TNF-α e IFN- were evaluated in two patient groups. Group 1 (n = 12) was made of RRMS patients on treatment with glatiramer acetate (GA) or interferon-beta (IFN- β) who switched to fingolimod after six months. Group 2 (n = 12), in turn, was made of previously untreated RRMS patients who started fingolimod therapy. ANOVA two-way was used for biomarkers’ analysis and Spearman rho coefficient was used for correlation study. Results: Two plasma biomarkers were identified, IL-31 and sCD40L receptor, which correlated their plasma levels (p <0.001) in patients with RRMS treated with fingolimod (r=0.834; p<0,001). Group 1 showed significant reduction in IL-31 and the sCD40L after 12 months of treatment (p<0,001). However, IL-31 had a sharper reduction after 6 months of fingolimod treatment (p<0,05). In group 1, IL31 reduction correlated to IL33 (r=0.762; p<0,05) and the receptor sCD40L reduction correlated to IL1-β (r=0.800; p<0,05) and IL-17A (r=0.782; p<0,05) decrease. In group 2, there was a reduction in the number of relapses (p<0,001) and in EDSS score (p<0,05) after the 12-month treatment. Moreover, there was a reduction in IL31 (p<0,001) and sCD40L (p<0,05) levels, which became sharper after six months of treatment (p<0,05). In group 2, sCD40L correlated to the reduction of TNF-α (r=0.882; p<0,001), IL-17A (r=0.443; p<0.001), IL-17F (r=881; p<0,05), IL-21 (r=0.688; p<0,05) and IFN-γ (r=0.605; p<0,05) levels and and IL-31 correlated inversely with the number of lesions in the T2 / FLAIR-weighted sequences.Conclusions: This study provided compelling data on the existence of two promising biomarkers, IL-31 and sCD40L receptor, which reduced their plasma levels in RRMS patients under fingolimod treatment116f

Efeitos da hipocloridria induzida por tratamento de curta duração com omeprazol na colonização aeróbia do estômago em pacientes com doenças clóridro-pépticas

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Dapartamento de Clínica Cirúrgica

Acute psychosis in elderly: do not forget the CASPR2 spectrum as a possible cause

Antibodies against contactin-associated protein 2 (CASPR2), a protein associated with the Voltage-Gated Potassium Channel Complex (VGKC) [1], represent an emerging cause of some old neurological manifestations; such as Morvan’s and Isaacs’ syndromes, as well as a variety of phenotypes encompassing limbic encephalitis, neuropathic pain, late onset epilepsy and dysautonomia [2,3].</p

Encephalopathy responsive to thiamine in severe COVID-19 patients

Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19. In this retrospective case series, we report clinical and neurological findings of fifteen patients with COVID-19-associated Wernicke Encephalopathy (WE) and their response to treatment with intravenous thiamine. All patients had encephalopathy, with 67% displaying at least one additional sign of classic WE triad (ophthalmoparesis and ataxia). Two patients (13%) had the classic triad. All COVID-19 patients had significant improvement of the neurological manifestations between two to five days after intravenous thiamine administration. Eleven patients (73%) had good neurological outcome at hospital discharge and only two patients (13%) died. This case series suggests that thiamine deficiency may be an etiology of encephalopathy in severe COVID-19 patients and its treatment may represent a safety and low-cost response to reduce the neurological burden

Evaluation of diagnosis and treatment practices of Brazilian neurologists among patients with multiple sclerosis.

Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management

Definition and diagnosis of small fiber neuropathy: consensus from the Peripheral Neuropathy Scientific Department of the Brazilian Academy of Neurology

ABSTRACT The aim of this study was to describe the results of a Brazilian Consensus on Small Fiber Neuropathy (SFN). Fifteen neurologists (members of the Brazilian Academy of Neurology) reviewed a preliminary draft. Eleven panelists got together in the city of Fortaleza to discuss and finish the text for the manuscript submission. Small fiber neuropathy can be defined as a subtype of neuropathy characterized by selective involvement of unmyelinated or thinly myelinated sensory fibers. Its clinical picture includes both negative and positive manifestations: sensory (pain/dysesthesias/pruritus) or combined sensory and autonomic complaints, associated with an almost entirely normal neurological examination. Standard electromyography is normal. A growing list of medical conditions is associated with SFN. The classification of SFN may also serve as a useful terminology to uncover minor discrepancies in the normal values from different neurophysiology laboratories. Several techniques may disclose sensory and/or autonomic impairment. Further studies are necessary to refine these techniques and develop specific therapies

Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations

Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis