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

Resposta imune em ratos com encefalomielite alergica experimental aguda tratados com a substancia P

Orientador : Giberto da Assunção FernandesTese (doutorado) - Universidade Estadual de Campinas, Faculdade Ciencias MedicasResumo: Centralmente aplicada, a Substância P (SP) interage com o sistema nervoso autônomo (SNA) e com o eixo hipotálamo-hipófise-adrenal (IlliA). Sabendo-se que esses sistemas modulam a função imune inata e têm sido implicados na resposta inflamatória associada com doenças auto-imunes, os efeitos da administração de SP intracerebroventricular (i.c.v.) na quantificação de linfócitos e na atividade citotóxica"natural killer" (NK) de células esplênicas foram estudados na Encefalomielite Alérgica Experimental (EAE), um modelo de estresse inflamatório crônico. Neste trabalho investigou-se a influência da SP e do seu antagonista sobre as subpopulações celulares CD3+, CD4+, CD8+, CDJNKR-PI+, CD3~-PI+, quantificadas por citometria de fluxo e a atividade imunológica citotóxica NK, obtida por ensaio de liberação de cromo radioativo CrSI, no curso desse processo inflamatório. A possibilidade de avaliar a atividade do eixo IlliA nessa doença foi verificada pelas dosagens hormonais séricas do hormônio adrenocorticotrófico (ACTH) e corticosterona, e da arginina vasopressina (A VP), na eminência média. Os resultados mostraram que na EAE houve um aumento no baço nos subtipos celulares CD3+ (64,2 :!: 0,8 %), CD4+ (59,6 :!: 0,6 %), CD8+ (14,5 :!: 0,5 %) e CDTNKR-PI + (8,8 :!: 0,3 %) às custas de uma atividade esplênica citotóxica NK (5,2 :!: 0,6 %) significativamente menor que nos controles normais [CD3+ (47,8 :!: 2,2 %), CD4+ (45,6 :!: 1,3 %), CD8+ (10,7 :!: 0,4 %), CD3NKR-PI+ (4,9 :t 0,4 %), NKac (8,9 :!: 0,7 %), CD3~-PI+ (1,6:!: 0,2 %) , ACTH (10,2 :!: 1,4 pg/rnl), corticosterona (2,2 :!: O ng/rnl)]. Esses dados foram correlacionados a um aumento dos níveis plasmáticos de ACTH (92,2 :!: 38,5 pg/rnl) e corticosterona (152,1 :!: 42,5 ng/rnl). A administração de 20 nrnoles de SP aumentou a retenção de células CD4+ (5I,3:!: 1,7 %) e CD8+ (I5,0:!: 0,8 %) no baço, com um aumento da porcentagem de células CD3NKR-Pl+ (10,4 :!: 0,9 %) e conseqüente diminuição da citotoxicidade NKac (5,4 :!: 0,6 %) no pico dos sintomas clínicos, comparados aos controles salina [CD4+ (41,2 :!: 4 %), CD8+ (1I,8:!: 1,5 %), CD3NKR-PI+ (6,5:!: 1,7 %), NKac (7,6:!: 0,2 %), ACTH (47,1 :!: 6,1 pg/rnl), corticosterona (120,3 :!: 17,8 ng/rnl)]. Isto foi acompanhado por um decréscimo nos níveis dos hormônios adrenocorticotróficos (21,3 :f: 2,3 pg/rnl) e corticosterona (44,1 :f: 16,2 ng/mI). As células CD3~-P1+ [antagonista + salina (0,5 :f: 0,04 %) e antagonista + SP (0,6:f: 0,1 %)], um outro tipo celular implicado na auto-imunidade, foram reduzidas pela injeção do antagonista da SP, quando comparadas ao grupo salina (1,3 :f: 0,1 %), sugerindo um papel para a SP no fluxo migratório desse tipo celular no baço. Concluindo, os dados obtidos neste trabalho sugerem que a SP influencia o eixo HHA , podendo também modular o tráfego celular linfocitário e a resposta imune no baço e, portanto, deve ser um elemento importante nos processos de modulação da EAEAbstract: Substance P centrally injected (ICV) in rats acts on the autonomic nervous system and the hypotha1amic-pituitary-adrenal axis (HPA) to moduJate innate llmnune function and iDf1ammatory response in autoimmune diseases. The effects of modulation in migration and in natural killer cell activity of splenocytes in these systems were studied in experimental allergic encephalomyelitis (EAE) a model of autoimmune disease which acts as a chronic inf1ammatory stress. The migration characteristics observed by flow citometry were ofthe CD3+, CD4+, CD8+, CD3+m<R-Pl+ and NKT splenocyte subpopulations. The innate llmnune function measured was that of the cytotoxic NK activity measured by CrSI liberation assay in the peak of the inflammatory processo The hypothaJamic-pituitaryadrenal axis alterations were measured by quanti.fying the plasma hormone levels of adrenocorticotropic hormone (ACTH) and corticosterone and the median eminence values of arginine vasopressin. In this chronic inflammatory model was observed an increased retention in the spleen ofCD3+ (64,2:J: 0,8 %), CD4+ (59,6:J: 0,6 %), CD8+ (14,5:J: 0,5 %) and CD3+m<R.-Pl+ (8,8:J: 0,3. %) cellular subtypes with a dimini~hed NK cytotoxic activity (5,2:J: 0,6 %) when compared to healthy control rats [CD3+ (47,8 :J: 2,2 %), CD4+ (45,6 :J: 1,3 %), CD8+ (10,7 :J: 0,4 %), CD3+m<R.-Pl+ (4,9 :J: 0,4 %), NK cytotoxic activity (8,9:J: 0,7 %), ACTH (10,2 :J: 1,4 pg/m1), corticosterone (2,2 :J: O ng/m1)].. There was a inverse correlation with high levels of ACTH (92,2 :J: 38,5 pg/ml) and corticosterone (152,1 :J: 42,5 ng/ml): Substance P 20 nanomols ICV injected also increased the retention ofCD4+ (51,3 :J: 1,7 %), CD8+ (15,0:J: 0,8 %) and CD3+m<R-~I+ (10,4:J: 0,9 %) in the spleen ofEAE rats with a lower NK cytotoxic activity (5,4 :J: 0,6 %) in the peak ofthe clínical symptoms and decreased levels of ACTH (21,3 :J: 2,3 pg/ml) and corticosterone (44,1 :J: 16,2 nglml) when compared to injected saline controls [CD4+ (41,2 :J: 4 %), CD8+ (11,8 :J: 1,5 %) and CD3-+m<R-Pl+ (6,5 :J: 1,7 %) NK cytotoxic activity (7,6:J: 0,2 %), ACTH (47,1 :J: 6 pglm1), corticosterone (120,3 :J: 17,8 ng/m1) ]. When treated with a substance P antagonist NKT cells presented a decreased splenic retention [antagonist + saline (0,5 :J: 0,04 %) e antagonist + SP (0,6 :J: 0,1 %)] when compared to saline-treated group (1,3 :J: 0,1 %), suggesting a role for substance P in the migration control ofthis type of cell. We can conc1ude that the results ofthis work suggest a role for substance P in the moduJation of the HP A axis, to the lymphocyte traffic control and to the innate immune response in chronic autoimmune inflammatory diseasesDoutoradoClinica MedicaDoutor em Clínica Médic

High levels of alexithymia in patients with multiple sclerosis

Abstract Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS. Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. Conclusion: Alexithymia was a relevant finding in patients with MS

Nearly one-half of Brazilian patients with multiple sclerosis using natalizumab are DNA-JC virus positive

Objective Natalizumab is a new and efficient treatment for multiple sclerosis (MS). The risk of developing progressive multifocal leukoencephalopathy (PML) during the use of this drug has created the need for better comprehension of JC virus (JCV) infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. Method Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR). Results In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2%) patients. Discussion Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab

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.