RESUMO
BACKGROUND AND PURPOSE: BIONAT is a French multicentric phase IV study of natalizumab (NTZ)-treated relapsing-remitting multiple sclerosis (MS) patients. The purpose of this study was to collect clinical, radiological and biological data on 1204 patients starting NTZ, and to evaluate the clinical/radiological response to NTZ after 2 years of treatment. METHODS: Patients starting NTZ at 18 French MS centres since June 2007 were included. Good response to NTZ was defined by the absence of clinical and radiological activity. Data analysed in this first report on the BIONAT study focus on patients who started NTZ at least 2 years ago (n = 793; BIONAT2Y ). RESULTS: NTZ was discontinued in 17.78% of BIONAT2Y. The proportion of patients without combined disease activity was 45.59% during the first two successive years of treatment. Systematic dosage of anti-NTZantibodies (Abs) detected only two supplementary patients with anti-NTZ Abs compared with strict application of recommendations. A significant decrease of IgG,M concentrations at 2 years of treatment was found. CONCLUSIONS: The efficacy of NTZ therapy on relapsing-remitting MS in a real life setting is confirmed in the BIONAT cohort. The next step will be the identification of biomarkers predicting response to NTZ therapy and adverse events.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Vigilância de Produtos Comercializados , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Natalizumab , Estudos ProspectivosRESUMO
BACKGROUND AND PURPOSE: To prospectively investigate causes of death and the circumstances surrounding death in 302 patients with amyotrophic lateral sclerosis (ALS). The functional status of patients immediately before death was also determined. METHODS: Information was obtained from neurologists at ALS centres, patients' files, and, when deaths occurred outside a medical facility, attending physicians. RESULTS: Most patients (63%) died in a medical facility. The most frequently reported cause of death was respiratory failure (77%), including terminal respiratory insufficiency (58%), pneumonia (14%), asphyxia due to a foreign body (3%) and pulmonary embolism (2%). Ten per cent of patients died from other causes: post-surgical or traumatic conditions (5%), cardiac causes (3.4%), suicide (1.3%) and sudden death of unknown origin (0.7%). The cause of death could not be determined in 13% of cases (6% inside a medical facility and 25% outside). At the time of death, only 55% of patients were receiving riluzole, 33% were undergoing non-invasive ventilation, 3% had a tracheotomy and 37% a gastrostomy. CONCLUSION: The information provided by this study helps to improve our understanding of the natural history of the disease and may help optimize the quality of care we can offer patients at the end of life.
Assuntos
Esclerose Lateral Amiotrófica/mortalidade , Insuficiência Respiratória/mortalidade , Idoso , Esclerose Lateral Amiotrófica/fisiopatologia , Asfixia/mortalidade , Comorbidade , Feminino , França/epidemiologia , Cardiopatias/mortalidade , Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Estudos Prospectivos , Embolia Pulmonar/mortalidade , Qualidade de Vida , Insuficiência Respiratória/fisiopatologia , Paralisia Respiratória/mortalidade , Paralisia Respiratória/fisiopatologiaAssuntos
Esclerose Lateral Amiotrófica/tratamento farmacológico , Fator de Crescimento Insulin-Like I/uso terapêutico , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Internet , Compostos de Lítio/uso terapêutico , Aprovação de Drogas , Avaliação Pré-Clínica de Medicamentos , França , Humanos , Estados Unidos , United States Food and Drug AdministrationRESUMO
We report a case of spontaneous rupture of a uterine varicosis in the third trimester of pregnancy resulting in massive peritoneal hemorrhage and maternal shock. This patient with an uncomplicated pregnancy presented symptoms suggestive of abruptio placenta with foetal distress. A caesarean section was performed identifying the cause and permitting the treatment of this syndrome. Since 1950, only 8 cases have been reported.
Assuntos
Complicações na Gravidez , Útero/irrigação sanguínea , Varizes , Adulto , Cesárea , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Ruptura Espontânea , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia , Varizes/diagnósticoAssuntos
Fadiga/etiologia , Esclerose Múltipla/complicações , 4-Aminopiridina/análogos & derivados , 4-Aminopiridina/uso terapêutico , Amantadina/uso terapêutico , Amifampridina , Compostos Benzidrílicos/uso terapêutico , Fadiga/diagnóstico , Fadiga/tratamento farmacológico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Modafinila , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
We assessed the different sets of diagnostic criteria for primary progressive multiple sclerosis (PPMS), in order to determine their sensitivity when applied to a cohort of 261 PPMS patients. According to the Thompson criteria, 168 patients (64.4%) had definite PPMS, 84 patients (32.2%) had probable PPMS, and nine patients (3.4%) had possible PPMS; according to the McDonald criteria, 180 patients (69%) had PPMS; according to the revised McDonald criteria, 194 patients (74.3%) had PPMS. Our findings indicate that the revised McDonald criteria are more sensitive than the original McDonald criteria, but less sensitive than the Thompson criteria.