Whole spinal transverse myelitis in neuromyelitis optica spectrum disorder.

BACKGROUND: Spinal cord is one of the prominent targets of autoimmune mechanisms in Neuromyelitis Optica Spectrum Disorder (NMOSD). Rarely, NMOSD causes damage to the entire length of the spinal cord, from cervical segments to conus medullaris, which has not been characterized in the existing literature. MATERIAL AND METHOD: We reviewed medical records, demographic information, and magnetic resonance imaging (MRI) sequences of 174 NMOSD patients from January 2011 to January 2023 who were admitted to Isfahan Multiple Sclerosis center to find patients with whole spinal transverse myelitis (TM). RESULTS: Whole spinal TM was present in five patients (2.9 %). Three patients were seropositive for Aquaporin-4 (AQP4) antibody; Myelin Oligodendrocyte Glycoprotein antibody (MOG IgG) tested negative for all of them. Lower limb weakness was the most frequent clinical complaint. Two patients presented with optic neuritis; One patient reported having episodes of nausea and vomiting. These patients, overall, yielded a higher expanded disability status scale (EDSS) score than the other NMOSD patients. CONCLUSION: Whole spinal TM is a rare finding in NMOSD, which is strongly associated with a higher severity and a worse outcome of the disease. The role of anti-AQP4 antibodies in the extent of myelitis in NMOSD has yet to be investigated.

Patent foramen ovale leading to mismanagement in a mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes patient.

Key Clinical Message: The stroke-like episodes and brain MRI lesions in MELAS usually have a nonischemic pattern, are resolved over time, and have a migrating pattern that helps us distinguish them from ischemic cerebral infarcts. Nevertheless, conditions such as intracardiac thromboses, PFO, and hypercoagulable state may be present concomitantly, leading to mismanagement. Therefore, further investigation and echocardiography are suggested in MELAS patients. Abstract: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is the most common maternally-inherited mitochondrial disorder presenting by stroke-like episodes, seizures, encephalopathy and muscle weakness. We report the clinical, imaging, echocardiography and muscle biopsy findings of a patient presenting by unique characteristics which have not been reported in previous cases of MELAS. The reported case is a 34 year old man with the history of three times hospitalization due to muscle weakness, encephalopathy, progressive cognitive decline, and gradual visual loss. Muscle biopsy revealed Ragged Red Fibers concomitant with mitochondrial disorders. PFO was found in echocardiography leading to mismanagement of this patient and MR imaging showed ischemic lesions with a progressive pattern. This is the first reported case of MELAS accompanying with PFO. All previous reported cases of MELAS have mentioned a fluctuating characteristic for the ischemic lesions; hence this is the first case of MELAS with the progressive pattern of ischemic lesions.

Evaluation of the prevalence of bovine leukemia virus DNA in peripheral blood mononuclear cells of multiple sclerosis patients.

Multiple sclerosis (MS) is an immune system-mediated neurodegenerative disease. Recent studies suggest that viral agents, especially the Epstein Barr virus (EBV), are etiological agents for MS. The roles of other viruses in MS have been investigated. Studies have shown an increase in the level of antibodies against bovine leukemia virus (BLV) in patients with MS. In this regard, our study aimed to examine the presence of BLV DNA in peripheral blood mononuclear cells (PBMCs) of MS patients in Iran. In this cross-sectional study, the presence of BLV in 109 Iranian MS patients and 60 healthy controls was evaluated. The isolated PBMCs were used for DNA extraction and PCR, using specific primers for two distinct genes. The mean age of the participants was 39 ± 9.5 years, and 27 (24.77%) of them were male. Clinical evaluation of these patients showed the most frequent MS type to be relapsing-remitting MS (RRMS) (71; 65.14%). BLV evaluation did not show any BLV DNA presence in the PBMCs of individuals in either the MS or healthy control groups. Therefore, our study showed no evidence of BLV infection in Iranian MS patients.

Third COVID-19 vaccine dose for people with multiple sclerosis who did not seroconvert following two doses of BBIBP-CorV (Sinopharm) inactivated vaccine: A pilot study on safety and immunogenicity.

Background: People with multiple sclerosis (pwMS) on anti-CD20 therapies (aCD20) and fingolimod have shown inadequate humoral responses to COVID-19 vaccines. Objective: The objective of the study was to pilot larger studies by demonstrating the safety and comparing the immunogenicity of different types of third doses in seronegative pwMS after two doses of BBIBP-CorV inactivated vaccine. Methods: In December 2021, subject to receiving their third dose, being COVID-19-naiive, and receiving no corticosteroid within two months, we measured the level of anti-SARS-CoV-2-Spike IgG in pwMS seronegative after two shots of BBIBP-CorV inactivated vaccine. Results: We included 20/29 pwMS who received adenoviral vector (AV), 7/29 who received inactivated, and 2/29 who received conjugated third doses. No serious adverse events were reported two weeks post-third dose. The pwMS receiving AV third doses showed significantly increased IgG concentrations, while only the ones not on aCD20 and fingolimod responded to inactivated third doses. An ordinal logistic multivariable generalized linear model indicated that age (per year ß: -0.10, P = 0.04), type of disease-modifying therapy (aCD20 ß: -8.36, P <0.01; fingolimod ß: -8.63, P = 0.01; others: reference), and type of third dose (AV or conjugated ß: 2.36, P = 0.02; inactivated: reference) are predictive of third dose immunogenicity among pwMS who remain seronegative after two shots of BBIBP-CorV vaccine. Statistical significance was not achieved for variables sex, MS duration, EDSS, duration of DMT, duration of third dose to IgG test, and duration from last aCD20 infusion to third dose. Conclusion: This preliminary pilot study highlights the need for further research to determine the optimal COVID-19 third dose vaccination strategy for pwMS living in areas where BBIBP-CorV vaccine has been used.

Longitudinal extensive transverse myelitis due to tuberculosis: A case report.

Neurotuberculosis is a potentially fatal disease that can present with upper or lower motor neuron symptoms. Longitudinally extensive transverse myelitis (LETM) is characterized by contiguous inflammatory lesions of the spinal cord extending to three or more vertebral segments. The causes of LETM include infections, neoplasm, and autoimmune diseases. Mycobacterium tuberculosis is a rare cause of transverse myelitis. Here, we report a 21-year-old Afghan female who was referred with chronic progressive quadriparesis and showed LETM on cervical MRI. This report indicates that tuberculosis should be considered as a differential diagnosis of LETM, especially in endemic areas.

Revisiting the antiviral theory to explain interferon-beta's effectiveness for relapsing multiple sclerosis.

Treatments with interferon-beta (IFNß) - a cytokine with established antiviral effects - were initially considered for multiple sclerosis (MS), as epidemiological data pointed towards a viral etiological agent for it. Later, when no specific agent was found for MS, theories explaining IFNß's mechanism of action (MOA) relied on anti-inflammatory mechanisms, which did not explain its ineffectiveness for disease progression independent of relapse activity (PIRA) in progressive forms of MS. Now, with new evidence backing the Epstein-Barr virus (EBV) as a conditional agent in MS etiopathogenesis as well as linking the reactivation of a wide range of other Herpesviridae with MS onset/relapse, it may be time to revisit the antiviral theory to explain IFNß's MOA, look at the evidence from the past two decades from that perspective, and address the paucity of knowledge with new direct studies and discussions.

N-Methyl-D-Aspartate (NMDA)-Type Glutamate Receptors and Demyelinating Disorders: A Neuroimmune Perspective.

N-methyl-D-aspartate receptors (NMDARs) are ionotropic glutamate receptors, highly important in regulating substantial physiologic processes in the brain and the nervous system, and disturbance in their function could contribute to different pathologies. Overstimulation and hyperactivity of NMDARs, termed glutamate toxicity, could promote cell death and apoptosis. Meanwhile, their blockade could lead to dysfunction of the brain and nervous system. A growing body of evidence has demonstrated the prominent role of NMDARs in demyelinating disorders and anti- NMDAR encephalitis. Herein, we provide an overview of NMDARs' dysfunction in the physiopathology of demyelinating disorders such as multiple sclerosis and neuromyelitis optica spectrum disorders.

Focal epilepsy presenting as tongue tremor: A case report.

Plenty of etiologies are reported to cause tongue tremor. Focal epilepsy presenting as isolated tongue tremor is a rare condition, suggesting how variable the focal seizure presentation may be. This paper reports a case of focal epilepsy due to presence of a cavernous angioma in the region of cortical motor area related to tongue movements. It is an clinical example of pathological conditions affecting the tongue area in motor homunculus.

Detection of anti-NMDA receptor antibodies following BBIBP-CorV COVID-19 vaccination in a rituximab-treated person with multiple sclerosis presenting with manifestations of an acute relapse.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a relatively unknown autoimmune entity. Scant reports of post-infection/vaccination anti-NMDAR encephalitis exist. We, hereby, reviewed the relevant cases and added to the literature a possible case of anti-NMDAR encephalitis following COVID-19 vaccination with BBIBP-CorV (Sinopharm). A 50-year-old Persian woman with previously known rituximab-treated MS presented complaining of worsening neurological symptoms all gradually starting and worsening after receiving the second dose of BBVIP-CorV 2 weeks before. Notable findings in her physical examination included ataxic gait and Babinski sign. Considering an acute MS relapse, corticosteroid pulse therapy was initiated, and she was referred for MRI, which revealed multiple new plaques. Her serum sample interestingly tested positive for anti-NMDAR antibodies. CSF analysis was unfortunately not performed. She responded well to the corticosteroid pulse therapy and showed substantial resolution of the symptoms. Considering its relatively low cost of workup and the benefits of correct early diagnosis, clinicians are advised to consider autoimmune encephalitis encountering patients with progressive neurological symptoms after the administration of vaccines, including the ones for COVID-19 which are currently being used extensively.

Centrally-located transverse myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS.

OBJECTIVES: Differentiating neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) from multiple sclerosis (MS) is important since MS therapies might result in progression and relapse of the former diseases. Evidence of long extending transverse myelitis (LETM) in magnetic resonance imaging (MRI) is one of the requirements to make an NMOSD diagnosis. However, centrally located lesions on spinal MRI may bring higher sensitivity and specificity to the NMOSD and MOG-AD diagnosis. METHODS: We aimed to assess the association between NMOSD diagnosis and the presence of centrally located lesions at disease onset. We reviewed 102 medical records from the Isfahan MS clinic who presented with cervical cord lesions and 17 MS, 23 NMOSD, and 6 MOG-AD patients were selected. We collected demographic, clinical, and MRI data of patients who had clinical presentations of cervical cord lesion at disease onset, and the characteristics of the lesion were studied. RESULTS: There was an association between NMOSD diagnosis and presence of a centrally located lesion (CLTM) (P < 0.001), presence of an LETM (P < 0.001), and an intermediate to high axial cord expansion (P < 0.001). CLTM and LETM can also be found in MOG-AD patients. The presence of CLTM (sensitivity and specificity: 95.65% and 69.56%), possessed higher sensitivity and specificity for NMO diagnosis than LETM presence (sensitivity and specificity: 78.26% and 43.47%). CONCLUSION: A diagnostic criteria including the centrality, location, and expansion of the transverse myelitis lesions, in addition to LETM, may be more accurate in the diagnosis of NMOSD and MOG-AD and their distinction from MS.

Inducing chimeric antigen receptor (CAR) regulatory T cells in-vivo: A novel concept for a potential feasible cure of demyelinating diseases.

Chimeric antigen receptor (CAR) regulatory T cell (Treg) therapy has approved promising in murine experiments. It comprises from ex-vivo introduction of CARs to the Tregs of the recipient, and infusing them back thereafter. This process requires enormous amounts of equipment and expertise and therefore, cannot be considered feasible for people with demyelinating diseases, even if it proves to be effective and safe in the future. The presented novel concept introduces feasibility to CAR Treg therapy, by shifting most of the ex-vivo processes in-vivo. Inter-disciplinary discussions on such concepts is encouraged among experts in different fields.

Atherosclerosis and multiple sclerosis: An overview on the prevalence of risk factors.

BACKGROUND: Atherosclerosis is the leading cause of ischemic heart disease and coronary artery disease. The process of atherosclerosis develops over a period of years and is mainly immune-mediated. Data regarding the prevalence of vascular disease and atherosclerosis among people with multiple sclerosis (pwMS) is inconsistent, therefore, we aimed to provide an overview of the prevalence of atherosclerotic risk factors in pwMS. METHODS: This is a cross-sectional study over a period of one year among pwMS visiting the Isfahan MS center. Study data have been extracted using participants' files and a checklist that was completed by the observers. Only people with relapsing-remitting (RRMS) and secondary progressive (SPMS) forms of MS were included in the study. Participants with primary progressive (PPMS) disease are only described and have been excluded from analyses. RESULTS: Of the 396 pwMS (343 with RRMS and 53 with SPMS), in descending order, the reported risk factors were tobacco smoking (18.4%), dyslipidemia (10%), hypertension (8.8%), and diabetes mellitus (4.5%). In people with RRMS, 17.4% were smokers, 9.9% had dyslipidemia, 8.1% had hypertension, and 4.3% had diabetes mellitus. In SPMS patients 24.5% reported a history of smoking, 13.2% had hypertension, 9.4% had dyslipidemia, and 3.7% had diabetes mellitus. Smoking was insignificantly associated with higher expanded disability status scale (Z: 1.70, p-value = 0.090). Male sex (RR [95%CI]: 1.628 [1.172, 2.261], p-value = 0.004) and increasing age (RR [95%CI]: 1.024 [1.008, 1.040], p-value = 0.003) were associated with a higher number of risk factors. CONCLUSION: The highest observed atherosclerosis risk factor among pwMS was smoking. Diabetes mellitus was the least reported risk factor in our population as a whole. Overall, and in participants with RRMS, dyslipidemia and hypertension were the second and third most commonly reported risk factors, however, hypertension exceeded dyslipidemia in participants with SPMS. Male sex and increasing age were associated with a higher number of atherosclerosis risk factors.

Autoimmune encephalitis: the first observational study from Iran.

BACKGROUND: Even within the most populous countries in the Middle East, such as Iran, autoimmune encephalitis cases have been rarely reported. OBJECTIVE: We aimed to describe the demographic, clinical, and paraclinical characteristics of Iranian patients with autoimmune encephalitis positive for anti-neuronal autoantibodies. METHODS: This cross-sectional study included all patients diagnosed with autoimmune encephalitis and referred to our hospital, in Isfahan, Iran, from March 2016 to May 2020. Patients' demographic, clinical, laboratory, radiological, and electroencephalographic features were obtained from their medical records. RESULTS: We identified a total of 39 (21 females, 53.8%) patients with autoimmune encephalitis (mean age = 34.9 ± 12.8 years). The most commonly detected antibody was anti-NMDAR (n = 26, 66.7%), followed by anti-GABABR (n = 8, 20.5%), anti-Zic4 (n = 4, 10.3%), and anti-GAD65 (n = 1, 2.6%) antibodies, in descending order of frequency. Two anti-NMDAR-positive patients had a history of systemic lupus erythematosus (SLE), and four had a prior history of herpes simplex encephalitis. Clinical presentations in patients positive for anti-Zic4 antibodies included cognitive decline (n = 4, 100%), seizures (n = 3, 75%), parkinsonism (n = 1, 25%), and stiff-person syndrome (n = 1, 25%). CONCLUSION: This was the first case series of Iranian patients with autoimmune encephalitis with some interesting observations, including SLE-associated anti-NMDAR encephalitis, as well as an unusual concurrence of anti-Zic4 antibody positivity and cognitive problems, seizures, parkinsonism, and stiff-person syndrome.

The Effect of IFN-ß Treatment on Plasma Levels of BDNF and IL-6 in Relapsing-Remitting Multiple Sclerosis Patients.

BACKGROUND: In recent investigations addressing neurodegenerative diseases, especially multiple sclerosis (MS), the roles of brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) have been examined. METHODS: Forty-five relapsing-remitting MS (RRMS) patients, including 32 IFN-ß-treated and 13 newly identified untreated cases as well as 45 sex- and age-matched healthy controls, were recruited in the study. Plasma levels of BDNF and IL-6 were assessed using the ELISA method. Data were analyzed by SPSS (ver.21). RESULTS: There were significant differences between the case and healthy control groups in terms of the plasma levels of BDNF (p value = 0.044) and IL-6 (p value <0.001). Besides, the treatment with IFN-ß had no significant impact on the level of BDNF or IL-6 in RRMS patients as compared to healthy controls (p value = 0.716 and 0.623 for BDNF and IL-6, respectively). Furthermore, the increase in the plasma levels of BDNF and IL-6 indicated a direct correlation in the case group (r = 0.508, p value = 0.008). In detail, following the classification of the case group into 2 subgroups of IFN-ß-treated and untreated patients, a direct positive correlation was observed between the plasma levels of BDNF and IL-6 in IFN-ß-treated patients (r = 0.495, p value = 0.026). CONCLUSION: The IFN-ß treatment seems not to be effective for upregulating BDNF and IL-6 in RRMS patients.

Acute relapse and poor immunization following COVID-19 vaccination in a rituximab-treated multiple sclerosis patient.

With the progress of COVID-19 vaccination programs worldwide, some new adverse events associated with the available vaccines may unfold, especially in subpopulations, representatives of whom were not included in phase I, II, and III clinical trials of these vaccines, such as patients with autoimmune diseases, including multiple sclerosis (MS). A 34-year-old woman presented with severe right hemiplegia and ataxia. She was diagnosed with relapsing-remitting MS (RRMS) 13 years ago and treated with rituximab (an anti-CD20 monoclonal antibody) during the last 15 months. She had received her first dose of adenovirus-vectored COVID-19 vaccine Gam-COVID-Vac (Sputnik V) three months after her last infusion of rituximab and three days before experiencing her latest MS relapse episode, preceded by mild symptoms (fatigue, myalgia, generalized weakness, etc.). Magnetic resonance imaging revealed several new periventricular, juxtacortical, brainstem, and cerebellar peduncle lesions. She received corticosteroid therapy for five consecutive days, and her neurological deficits slightly improved. Twenty-one days after receiving the first dose of the vaccine, her anti-SARS-CoV-2 antibodies were below the lower detection limit. However, a decision was made to adhere to the vaccination schedule and not risk the patient's safety against an unfortunate COVID-19 contraction, and thus, she was advised to receive the second Gam-COVID-Vac dose after discontinuation of oral steroid taper. The safety of adenovirus-based vaccines in patients with autoimmune diseases requires further investigation. Meanwhile, clinicians should raise awareness among their patients regarding the potentially limited efficacy of COVID-19 vaccination in those treated with anti-CD20 treatments. After careful, individualized risk-benefit assessments, planning a delay/pause in such treatments to create a time window for patients to receive the vaccine and develop anti-SARS-CoV-2 immunity may be recommended.

"NMDA receptor spectrum disorder" in the differential diagnosis of demyelinating disorders of the CNS: optic neuritis and myelitis.

OBJECTIVE: The aim of this study was to investigate the frequency of anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody positivity in patients presenting with transverse myelitis (TM) and/or optic neuritis (ON), to describe their neurologic and radiological characteristics, and to compare these characteristics with those reported in previous studies. MATERIAL AND METHODS: This study included 179 patients (ON: 96, TM: 74, ON and TM: 9) who visited Isfahan Multiple Sclerosis Center from January 2017 to September 2019, for approximately 32 months. The respective neurological examinations were performed. Demographic data of the patients, as well as findings from radiological and serological investigations were obtained. RESULTS: Frequencies of anti-NMDAR seropositivity in patients with TM, ON, and concurrent TM and ON were approximately 3.4%, 1.4%, and 11.1%, respectively. None exhibited any psychiatric symptoms. CONCLUSION: Based on the frequency of seropositivity for anti-NMDAR antibody in our patients, positivity for this antibody appears to be more frequent than previously anticipated in patients presenting with these conditions. We recommend that the anti-NMDAR antibody presence in CSF/serum be checked and considered in addition to the routine examinations performed upon confronting demyelinating conditions such as TM and ON. We suggest considering the term "NMDAR spectrum disorder" to more clearly distinguish the potentially overlapping conditions with different etiologies in patients with CNS disorders.

Surgical left atrial appendage closure: Success rate and its relationship with cerebrovascular accident.

Background: Several surgical procedures such as excision or exclusion are recommended for the closure of the left atrial appendage (LAA). This study was conducted with the aim to evaluate the success rate of different surgical techniques for LAA closure, their respective complications, and the rate of post-surgical cerebrovascular accident (CVA). Methods: This retrospective study included 150 consecutive patients who underwent LAA closure most commonly after mitral valve surgery within 3 to 6 months after surgery. An expert echocardiographic fellow collected the data on patients' surgical LAA closure methods and history of CVA, types of prosthetic valves, mortality, and bleeding. Results: The failure rate for complete LAA closure was 36.7% (55 patients) in our study. The greatest success rate of complete LAA closure was seen in purse-string method (75.5%), followed by resection method (71.4%), while the lowest success rate (≈ 33.3%) was observed in ligation method. A significant relationship was observed between clots on the surface of metallic valve and postoperative CVA (P = 0.001; likelihood ratio: 32).In multivariate analysis, there was also no statistically significant relationship between partial LAA closure and the incidence of post-surgical CVA (P > 0.050). Conclusion: We observed the highest success rate of complete LAA closure in purse-string method followed by resection method. Interestingly, our results showed that despite the higher rate of residual LAA clot in cases of partial LAA closure, the occurrence of post-surgical CVA was mostly related to the presence of clots on the surface of metallic mitral prostheses rather than the presence of partial LAA closure.

Anti-HSV-2 antibody in patients with MS and NMO.

BACKGROUND: Multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating disorders of the central nervous system. There is growing evidence that viruses may play a causal role in these diseases. Human herpes viruses have been of special attention since their DNA have been detected in many of MS patients' samples. Human herpes simplex virus 2 (HSV-2) is a member of this family which has not been investigated thoroughly in MS and NMO. METHODS: We took blood samples from 90 subjects including 30 RRMS patients, 30 NMO patients and 30 healthy controls. After serum isolation, all serum samples were frozen at -70 °C to be used for enzyme linked immunosorbent assay (ELISA) for detection of specific antibodies against HSV-2. Presence or absence of antibodies against HSV-2 was determined based on the cut-off calibrator and index values were then determined. A value of <0.9: negative, between 0.9 and 1.1: equivocal and <1.1: positive. RESULTS: Mean age of all subjects was 33.36 and female to male ratio was 4.3/1. None of the subjects were seropositive for anti-HSV-2 antibody. Analysis indicated no significant differences (P-value >0.05) among antibody levels between MS (0.19 ±â€¯0.08), NMO (0.22 ±â€¯0.16) and control (0.21 ±â€¯0.09) groups. There were also no correlations between mean antibody index or O.D. and subjects' sex, family history, blood group, smoking history, age and presence of visual-motor-sensory or other forms of disability in any of the three MS, NMO and control groups (P-value >0.05). CONCLUSION: We found no associations between patients' diagnosis of MS or NMO and mean anti-HSV-2 antibody index and O.D. levels.

Paraneoplastic neuromyelitis optica associated with fever of unknown origin as an early manifestation: A case report.

Tumors have been frequently reported to be associated with neuromyelitis optica (NMO). Here we review a case of a 34-year-old woman who presented with complaint of one-sided visual loss. All Lab tests exhibited negative results which decreased the possibility of Auto-immune or neuro-inflammatory disorders. Magnetic resonance imaging (MRI) of the brain and spinal cord was done as a part of work up, which showed Meningioma in anterior fossa without any other findings supporting neuro-demyelinating disorders. After complete surgical removal of the meningioma, patient's visual loss was completely resolved. 4 weeks later, she was admitted to the hospital for the second time with fever fulfilling the Fever of Unknown Origin (FUO) criteria. One week after she was discharged, she came back with paraplegia. MRI with Gadolinium showed an enhancing lesion involving T6-T9 segments of the thoracic spine. In order to rule in NMO, we checked for antibody to aquaporin-4 (AQP4-Ab) and the result was positive. This is the first report showing a probable association between FUO and NMO. Our case also demonstrates how variable the clinical presentations of NMO can be. We suggest that the diagnosis of NMO should be considered in the appropriate clinical setting despite of the presence of unconventional manifestations.

Interleukin-10 and brain-derived neurotrophic factor responses to the Mat Pilates training in women with multiple sclerosis / Respostas da Interleucina-10 e do fator neurotrófico derivado do cérebro ao treinamento de Mat Pilates em mulheres com esclerose múltipla

AIMS: To determine the effect of Mat Pilates on serum levels of interleukin-10 and brain-derived neurotrophic factor in women with multiple sclerosis. METHODS: Thirty women with multiple sclerosis with mild to moderate disability were recruited and randomly divided into equal Pilates training and Control groups. Patients in the training group accomplished a Pilates program three times a week for eight weeks. The Control group maintained their routine lifestyle. The serum level of interleukin-10 and brain-derived neurotrophic factor were measured before and after the protocol. The differences between groups were assessed by using analysis of covariance test to compare post-tests by considering covariate pre-tests (assuming a p-value <0.05 as significant). RESULTS: There were no significant changes in interleukin-10 (13.09 ±5.36 ng/ml in the Pilates training group compared to 13.21 ±4.76 ng/ml in the Control group, p =0.81), whereas an increase in brain-derived neurotrophic factor was observed after eight-week Pilates training (11550.14±2619.60 ng/ml in the Pilates training group compared to 9664.35±3161.66 ng/ml in the Control group, p=0.03). CONCLUSIONS: The results suggest that the intensity and duration of this protocol was not related to significant changes in interleukin-10, but was followed by an increase in brain-derived neurotrophic factor in these patients. Based on this finding, physical activity according to the individual's ability is recommended for patients with multiple sclerosis, in parallel with drug therapy.

OBJETIVOS: Determinar o efeito do Mat Pilates sobre os níveis séricos de interleucina-10 e fator neurotrófico derivado do cérebro em mulheres com esclerose múltipla. MÉTODOS: Trinta mulheres com esclerose múltipla e deficiência física leve a moderada foram recrutadas e divididas aleatoriamente em grupos iguais, um de treinamento em Pilates e outro de controle. As pacientes do grupo de treinamento cumpriram um programa de Pilates três vezes por semana durante oito semanas. O grupo controle manteve seu estilo de vida de rotina. O nível sérico de interleucina-10 e o fator neurotrófico derivado do cérebro foram medidos antes e após o protocolo. As diferenças entre os grupos foram avaliadas usando o teste de análise de covariância para comparar pós-testes, considerando pré-testes como covariáveis (assumindo p-valor <0,05 como significativo). RESULTADOS: Não houve alterações significativas na interleucina-10 (13,09±5,36 ng/ml no grupo treinamento em Pilates, em comparação a 13,21±4,76 ng/ml no grupo controle, p=0,81), mas foi observado um aumento no fator neurotrófico derivado do cérebro após o treinamento de Pilates por oito semanas (11550,14±2619,60 ng/ml no grupo treinamento em Pilates em comparação a 9664,35±3161,66 ng/ml no grupo controle, p=0,03). CONCLUSÕES: Os resultados sugerem que a intensidade e duração desse protocolo não se relacionou com mudança significativa na interleucina-10, mas foi seguido por um aumento no fator neurotrófico derivado do cérebro nessas pacientes. Com base neste achado, a atividade física de acordo com a capacidade individual é recomendada para pacientes com esclerose múltipla, paralelamente à terapia medicamentosa.