[Recommendations for optimising the treatment of multiple sclerosis in Latin America]. / Recomendaciones para la optimización del tratamiento de la esclerosis múltiple en Latinoamérica.

INTRODUCTION: Multiple sclerosis (MS) is the most common primary demyelinating disease affecting the central nervous system. In recent years the development of new drugs that have been shown to modify the natural history of MS have had a substantial impact on the treatment of the disease. AIMS: To harmonise and integrate the evidence available on optimising the treatment of patients with MS. DEVELOPMENT: In order to fulfil our main aim, a group of experts from different Latin American countries drew up a list of statements related to the use of immunomodulatory agents in the different clinical forms of the disease and the strategies that should be considered in cases in which the therapeutic response was suboptimal. Each of the participants used a structured scale to express the extent to which he or she agreed or disagreed, and a consensus was considered to have been reached when acceptance of each of the statements was equal to or higher than 80%. CONCLUSIONS: These recommendations will provide neurologists with the tools needed to make decisions that optimise the treatment of MS patients.

[The treatment of multiple sclerosis in Latin America: current practice and optimal standards. The findings of a survey among neurologists at an interactive workshop]. / Tratamiento de la esclerosis múltiple en Latinoamérica: práctica actual y estándares óptimos. Resultados de una encuesta a neurólogos durante un taller interactivo.

INTRODUCTION: Considerable progress has been made in the treatment of patients with relapsing-remitting multiple sclerosis (MS) over the last decade. Exactly how these changes are reflected in daily practice, however, is still not very well known. AIM: To hold interactive workshops so as to be able to evaluate the opinions of Latin-American neurologists about the therapeutic decisions taken with regard to MS. MATERIALS AND METHODS: By means of an interactive voting system, professionals attending each workshop replied to ten pre-established questions about when to start treatment, the use of magnetic resonance imaging (MRI) to supervise treatment, the definition of therapeutic failure and the role of treatment using immunosuppressants. The results were compared with those obtained in similar workshops attended by European and North American neurologists held six months earlier. RESULTS: The use of immunomodulators was considered to be useful in isolated demyelinating syndromes, as 40-50% endorsed their use in clinically stable patients. MRI was seen to be the most sensitive method of monitoring the effectiveness of the therapy -70.6% of them proposed the application of annual scans, which suggests a more frequent use in Latin America than in Europe or the USA. On defining therapeutic failure, the clinical criteria were more important than the MRI scan, and a switch from beta interferons to glatiramer acetate or vice versa was recommended. Treatment with immunosuppressants was considered to be useful in reducing the accumulated disability, but there was no agreement on how to use them. In Latin America, decisions about when to begin treatment seem to lie somewhere between the more favourable posture adopted in USA and the more conservative stance in Europe. CONCLUSIONS: This survey reflects the controversies that affect the therapeutic decisions concerning MS in Latin America and highlights the areas in which more data are needed to optimise the standards of treatment.

[Multiple sclerosis in Mexico: a multicentre study]. / Esclerosis múltiple en México: un estudio multicéntrico.

INTRODUCTION: Multiple sclerosis (MS) is considered to be a low prevalence disease in Mexico; its characteristics have been described in isolated studies in small populations concentrated in a single region of the country and using heterogeneous methodological tools. AIMS. In this study, our aim was define the clinical profile and some socio demographic aspects of MS in Mexico using validated homogeneous criteria and tools. PATIENTS AND METHODS: Eight hospitals representing the five most densely populated regions of the country, the north, centre and south of Mexico, took part in the study. Data were obtained through a survey created, validated and published in Spanish (k interobserver 0.73 and k intraobserver 0.76), which consisted of 142 questions arranged in 10 sections and which was applied by 12 neurologists. The procedure was verified with 50 randomly selected surveys. A total of 337 surveys were applied, which were analysed by descriptive statistics using the EPI INFO, version 6.04b, software application. All the patients presented MS that had been clinically defined with the help of paraclinical studies according to Schumaher and Poser's criteria. RESULTS: A sample of 337 patients was studied; 99.1% were mestizos, with an average age of 37 9 years, 69.7% were females and 30.3% males. 95% had access to the Social Security system and 96% had been born in Mexico to Mexican parents. No cases were found among native Mexicans. The clinical profile of the disease did not differ to that reported in other countries; the pattern observed corresponded to that found in northern latitudes. CONCLUSION: This is the first multicentre study carried out in Mexico with a population that is highly representative of the whole country and with a homogeneous methodology.

Rett's syndrome with Lennox-Gastaut pattern.

Three Latin American female patients studied in two different centers (Mexico City and Houston, Texas) had the clinical criteria of Rett's Syndrome, including progressive intellectual deterioration, stereotyped movements, loss of purposeful hand use, ataxia, and progressive disability. The three patients had normal laboratory studies including imaging studies (CT and MRI) but consistently abnormal EEGs with Lennox-Gastaut pattern. The usefulness of the EEG in the differential diagnosis and the association of this electrographic phenomenon are stressed.