Early clinical effect of cladribine in patients with highly active multiple sclerosis in Mexico.

Background: Cladribine shows efficacy in multiple sclerosis (MS), but Latin American (LATAM) real-world data is limited, despite potential sociodemographic variations. Objective: Investigate baseline characteristics and clinical response in highly active MS patients in Mexico, identifying predictors of early treatment response. Method: A multicenter cohort study analyzed retrospective data from individuals with "highly active" MS in the Cladribine Patient Support Program across 11 Mexican clinics. Criteria included one-year prior treatment with another disease-modifying treatment and recent relapse with specific MRI findings. Primary outcomes focused on achieving NEDA-3 status after 12 months. Results: In the follow-up, 67.5% maintained NEDA-3 status. Baseline EDSS scores decreased significantly from 1.50 to 1.00 (p = 0.011), with no confirmed disability worsening. No significant differences were observed between NEDA-3 achievers and non-achievers in demographic and clinical variables. No severe adverse events were reported. Conclusion: Cladribine showed early and effective control of active MS in Mexican patients, demonstrating a secure profile with minimal adverse events. This study provides valuable real-world evidence in the LATAM context.

[Neuromyelitis optica spectrum disorder in a patient with human immunodeficiency virus]. / Neuromielitis óptica en paciente con virus de inmunodeficiencia humana.

Background: Neuromyelitis optica spectrum (NMO) is an autoimmune condition with preferential target at the optic nerves and spinal cord. Although HIV infection can also cause neuritis and myelitis, the entity of HIV related to NMO has recently been elucidated, however, little is known about the context of this disease. Objective: To describe the clinical characteristics, imaging, treatment, and functional prognosis in an HIV-positive patient who developed an episode of longitudinally extensive transverse myelitis (LETM) with positive anti-AQP4 antibodies. Clinic case: 36-year-old man with a history of HIV diagnosed in 2017, on antiretroviral treatment. On March 2021 he was admitted for study due to complete spinal cord syndrome, corroborating in MRI a longitudinally extensive lesion from T8-L1, with CSF with and AQP4 seropositivity, a diagnosis of NMO was integrated by Wingerchuk criteria and rituximab is started with symptomatic improvement, objectifying it with the Expanded Disability Status Scale (EDSS) from 4 to 1. Conclusion: NMO entity related to HIV is rare, this phenomenon being classically found at the time of diagnosis or after the start of treatment when the immune system is still capable of developing an exaggerated immune response, however in the case we report the debut of NMO occurred 3 years after diagnosis, contrasting with previously reported cases, so we suggest that some other mechanisms could be involved, such as altered regulation of B cells and a direct viral effect.

Introducción: la neuromielitis óptica (NMO) es una condición autoinmune con blanco preferencial a nivel de nervios ópticos y médula espinal. Recientemente se ha elucidado la entidad de VIH relacionada a NMO; no obstante, aún se conoce poco sobre el contexto de esta enfermedad. El objetivo de este trabajo es describir las características clínicas, de imagen, tratamiento y el pronóstico funcional en un paciente VIH positivo, quien desarrolló un episodio de mielitis longitudinalmente extensa (LETM) con anticuerpos anti-AQP4 positivos. Caso clínico: hombre de 36 años con antecedente de VIH diagnosticado en 2017, en tratamiento antirretroviral y antecedente de sarcoma de Kaposi. Inicia su padecimiento en marzo de 2021 con dolor en región lumbar, acompañado de debilidad y anestesia en miembros pélvicos, agregándose incontinencia vesical y distensión abdominal. A la exploración se integra síndrome medular completo con nivel en T8-T9, corroborándose en RM lesión longitudinalmente extensa desde T8-L1, con LCR con proteinorraquia y seropositividad a AQP4. Se integra diagnóstico de NMO por criterios de Wingerchuk y se inicia tratamiento con rituximab con mejoría sintomática, objetivándola con una escala expandida del estado (EDSS) de 4 a 1. Conclusión: la entidad de NMO relacionada al VIH es poco frecuente, siendo clásicamente encontrado este fenómeno al momento del diagnóstico o posterior al inicio del tratamiento, cuando el sistema inmune aún resulta capaz de desarrollar una respuesta inmune exagerada. Sin embargo, en el caso que reportamos el debut de la NMO fue posterior a tres años del diagnóstico, contrastando con los casos previamente reportados, por lo que sugerimos que podrían intervenir algunos otros mecanismos, como la alteración en la regulación de las células B y un efecto viral directo.

Clinical practice patterns in multiple sclerosis management: Mexican consensus recommendations.

BACKGROUND: Multiple sclerosis affects more than 2 million people. Clinical decisions are performed under evidence-based medicine. The appearance of new disease-modifying therapies and changes in diagnostic criteria complicates the decision-making process in clinical practice. OBJECTIVES: To characterize the criteria for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), and relapsing-remitting multiple sclerosis (RRMS) by Mexican neurologists in a real-world setting. METHODS: A two-round modified Delphi method (RAND/UCLA) was applied. RESULTS: In RIS, LP, spinal cord MRI and VEP should be included in diagnostic testing; DMT initiation is not necessary. A follow-up MRI within 3 months are recommended. In CIS, corticosteroid therapy should be initiated at first relapse; both simple and Gd-enhanced MRI is mandatory. LP, selective blood tests, and NMO-IgG/AQP4 antibodies should be performed as complementary. IFN beta or GA were the most suitable DMTs for treating high-risk CIS. Patients with RRMS should begin with DMT at diagnosis, include a follow-up MRI if a patient had 2 relapses within 6 months. GA and oral DMTs are the most eligible DMTs for mild RRMS. Monoclonal antibodies-based therapy is chosen when disability is present. Radiological criteria for switching DMT included >1 Gd+ lesion and >2 new T2 lesions. CONCLUSIONS: Although many coincidences, there are still many hollows in the medical attention of MS in Mexico. This consensus recommendation could be helpful to implement better evidence-based recommendations and guidelines in a real-world setting.

Demographic and clinical characterization of multiple sclerosis in Mexico: The REMEMBer study.

BACKGROUND: Multiple sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system with high prevalence in young adults around the world. The vast majority of epidemiological studies and statistics are based on European and American data, so most clinical guidelines and medical consensus are based on this information. There is very limited evidence in Mexico regarding demographic and clinical aspects of MS. Therefore, this study comprehensively described the epidemiological and clinical features of MS in a large cohort of patients from eight tertiary-level centers in Mexico. METHODS: A cross-sectional multicenter study was conducted. A group of neurologists, the "Registro Mexicano de Esclerosis Multiple" (REMEMBer) group, compiled the information of MS patients (January to December 2019) from eight tertiary-level centers. Clinical and demographic data were extracted. RESULTS: A total of 1,185 patients were included. The mean age was 40.65 ± 11.43 years old. Women represented more than half of the whole cohort (64.9% vs. 35.1%). Of the whole cohort, forty-three percent of MS patients had a relative with at least one autoimmune disease (MS: 24%, other autoimmune disorders: 74.9%) or thyroid disease (28%). Furthermore, the mean age of clinical onset was 31.23 ± 9.71 (range: 16-68) years old, and the disease duration was 9.33 ± 7.25 (0.46-40.19) years. The most prevalent phenotype of MS was relapsing-remitting (87.76%). Primary (1.18%) and secondary (9.11%) progressive, as well as clinically isolated syndrome (CIS, 1.43%), were also found. Clinical phenotypes (facial, hearing, and speech disorders, and movement impairment and ataxia) and the frequency of thyroid disorders were different between genders. CONCLUSION: In Mexico, the frequency of MS seems to be higher in the female gender (2:1 women/men ratio) compared to other series. In addition, there was a predominance of facial, hearing and speech disorders, as well as movement impairment and ataxia. Thyroid diseases were more common in women with multiple sclerosis than men.

BDNF and Tau as biomarkers of severity in multiple sclerosis.

AIM: Determine if serum levels of tau and BDNF can be used as severity biomarkers in multiple sclerosis (MS). PATIENTS & METHODS: Subjects with MS, older than 18 and younger than 55 years old were included; 74 patients with a diagnosis of relapsing-remitting MS, 11 with secondary-progressive MS, and 88 controls were included. Total tau and BDNF were measured by Western blot. RESULTS: Increased tau and decreased BDNF in MS patients compared with controls was found. Total-tau has a peak in relapsing-remitting MS, the second decile of the multiple sclerosis severity score, and in the lowest expanded disability status scale and is no different than controls for secondary-progressive MS patients and the most severe cases of MS. CONCLUSION: BDNF is a good biomarker for diagnosis of MS but not for severity or progression. Tau appears to have a more active role in the progression of MS.

[Clinical and demographic characteristics of patients with multiple sclerosis]. / Características clínicas y demográficas de los pacientes con esclerosis múltiple.

BACKGROUND: Multiple sclerosis (MS) is a disease whose physiopathogenesis shows a complex interaction of genetic and environmental factors. Given that those factors have not been documented in our country, we describe the clinical and demographic characteristics from a sample of patients with MS. METHODS: We carried out an observational, descriptive, cross-sectional, and retrolective study in a Center for Demyelinating Diseases. We took the information from the clinical records of a sample of patients with multiple sclerosis, who arrived to the center from April 2014 to July 2015. RESULTS: We obtained data from 313 patients, out of which 65.5 % were women. Mean age was 41 years (SD 11.22). Minimum age of diagnosis was 12 years and maximum, 66 years; mean age of diagnosis was 32 years (SD 9.72). With regards to clinical variables, 3.4 % presented radiologically isolated syndrome (RIS), 82 % relapsing-remitting MS (RRMS), 13.9 % secondary-progressive MS (SPMS), and 0.8 % primary-progressive MS (PPMS). Of all the patients, 10 % had first or second degree relatives with diagnosis of this disease; 16 % had foreign ancestors; 27 % were smokers. Treatment consisted of glatiramer acetate, 28 %; intramuscular interferon beta 1a, 18 %; subcutaneous interferon beta 1a, 16 %; subcutaneous interferon beta 1b, 30 %; fingolimod, 3 %; and others, 5 %. CONCLUSIONS: Clinical and demographic characteristics are similar to those reported in international literature. More studies would be needed to typify Mexican population with MS.

Introducción: la esclerosis múltiple (EM) es una enfermedad que presenta una compleja interacción de factores genéticos y ambientales en su fisiopatogenia. Dado que esos factores han sido poco abordados en México, describimos las características clínicas y demográficas de una muestra de pacientes con EM. Métodos: estudio observacional, descriptivo, transversal y retrolectivo, realizado en un hospital de tercer nivel. Se obtuvo información de expedientes clínicos de una muestra de pacientes con el diagnóstico de EM, captados de abril de 2014 a julio de 2015. Resultados: se obtuvieron datos de 313 pacientes, 65.5 % mujeres, con edad promedio de 41 años (DE 11.22). La edad mínima del diagnóstico fue de 12 años y la máxima de 66; el promedio de edad del diagnóstico fue 32 años (DE 9.72). De la variante clínica 3.4 % tuvo síndrome neurológico aislado (CIS), EM remitente-recurrente 82 %, EM secundaria progresiva 13.9 % y EM primaria progresiva 0.8 %. El 10 % de los pacientes tenía parentesco de primer o segundo grado con diagnóstico de EM. El 16 % tuvo ascendencia extranjera. El 27 % tenía hábito tabáquico. Los tratamientos utilizados fueron el acetato de glatiramero 28 %, interferon beta 1a IM 18 %, interferon beta 1a SC 16 %, interferon beta 1b SC 30 %, fingolimod 3 % y otros 5 %. Conclusiones: las características clínicas y demográficas son similares a lo reportado en la literatura internacional. Se requieren más estudios para caracterizar mejor a la población mexicana con EM.

Enfermedad de Devic. Reporte de caso y revisión de literatura / Devic's disease. A case report and literature review

Resumen La neuromielitis óptica (NMO) o enfermedad de Devic, es una enfermedad inflamatoria infrecuente del sistema nervioso central (SNC) que afecta predominantemente el nervio óptico y la médula espinal. El mecanismo de la enfermedad es dado por la producción de anticuerpos IgG cuyo principal blanco inmunitario es el canal acuaporina 4 (AQP4), los cuales desencadenan un proceso inflamatorio y desmielinizante en dichas estructuras. Presentamos el caso de una paciente, quien desarrolló episodios sensitivos crónicos fluctuantes con afección visual, sin mejoría con el tratamiento convencional; durante el abordaje diagnóstico se encontraron lesiones desmielinizantes y anticuerpos anti-AQP4 positivos, por lo que se concluyó el diagnóstico de NMO, y respondió de manera positiva al tratamiento con anticuerpos monoclonales.

Abstract Optic neuromyelitis or Devic's disease is a rare inflammatory disease of the central nervous system (CNS) that predominantly affects the optic nerve and spinal cord. The mechanism of the disease is given by the production of IgG antibodies whose main target is the acuaporine channel 4 (AQP4) that trigger an inflammatory and demyelinating process in the aforementioned structures. We present the case of a patient who developed chronic and fluctuating sensitive episodes with visual impairment, without improvement after conventional treatment. During the diagnostic approach we found demyelinating lesions and positive AQP4-antibodies, this lead to a diagnosis of optic neuromyelitis. A positive response was obtained to the therapy with monoclonal antibodies.