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1.
Mult Scler Relat Disord ; 57: 103321, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35158439

RESUMO

We report on nine patients (eight cases of MS and one case of NMOSD) who presented a disease relapse in close temporal association with their first AZD1222 vaccination dose against COVID-19. These patients had been stable for a median period of six years, with no evidence of disease activity and no change in their medication. After a median of 13 days (7 to 25 days) from vaccination, they developed a new relapse with increased disability and new lesions on magnetic resonance imaging. Although this association may be rare, it might be an adverse event of AZD1222.


Assuntos
COVID-19 , Esclerose Múltipla , Neuromielite Óptica , ChAdOx1 nCoV-19 , Humanos , Recidiva , SARS-CoV-2 , Vacinação
2.
J Clin Neurosci ; 61: 112-113, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30396814

RESUMO

Previous infection with John Cunningham virus (JCV) increases the risk of progressive multifocal leukoencephalopathy in patients with multiple sclerosis (MS) undergoing treatment with natalizumab. Patients who test negative for JCV antibodies must be assessed every six months due to the risk of seroconversion. Data from the United States of America, Portugal, Holland, France, United Kingdom and Sweden have shown a strong correlation between the use of natalizumab and JCV seroconversion. The authors present now data on patients from Brazil, as there are no data from Latin American countries published on this subject yet. A group of 86 patients with MS with negative results for antibodies against JCV were included in this analyses with at least two JCV antibodies testing. Twenty-five patients (29% of the total group) did not use natalizumab at any time, while the remaining 71% used natalizumab for a median period of 800 days (equivalent to 28 monthly infusions). Seroconversion was observed in 19 patients (22.1%). There was no association of seroconversion with gender, age, previous pulses of corticosteroid or specific MS-modifying drugs. The use of natalizumab was strongly associated to seroconversion (p < 0.0001). The present results confirm the influence of natalizumab therapy on JCV antibodies in several countries and continents.


Assuntos
Anticorpos Antivirais/imunologia , Fatores Imunológicos/efeitos adversos , Vírus JC/imunologia , Natalizumab/efeitos adversos , Soroconversão/efeitos dos fármacos , Adulto , Brasil , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Esclerose Múltipla/tratamento farmacológico , Natalizumab/uso terapêutico
3.
Neurol Ther ; 8(2): 477-482, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31267407

RESUMO

INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a "late onset" (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD. METHODS: Retrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units. RESULTS: The ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals). CONCLUSION: This series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.

4.
J Child Neurol ; 34(9): 487-490, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31012355

RESUMO

Neuromyelitis optica spectrum disorder is a severe and disabling disease that manifests with severe relapses of optic neuritis, longitudinally extensive myelitis, and/or brainstem syndromes. The disease is complex and, although onset typically occurs in middle age, children and adolescents may be affected. The present study adds to the literature through detailed clinical data from 36 Brazilian patients with neuromyelitis optica spectrum disorder starting before age 21. This was a retrospective assessment of medical records from 14 specialized units in Brazil. The results showed that the course of neuromyelitis optica spectrum disorder was worse in patients with disease onset before the age of 12 years. Gender and ethnic background did not influence disability accumulation. Over a median period of 8 years, 14% of the patients who presented the initial symptoms of neuromyelitis optica spectrum disorder before the age of 21 years died. In conclusion, the present study adds to the reports from other authors examining the severity of early-onset neuromyelitis optica spectrum disorder.


Assuntos
Neuromielite Óptica/epidemiologia , Adolescente , Idade de Início , Criança , Pré-Escolar , Avaliação da Deficiência , Progressão da Doença , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
5.
Mult Scler Relat Disord ; 27: 392-396, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30504040

RESUMO

BACKGROUND: The 2015 criteria for diagnosing neuromyelitis optica spectrum disorder (NMOSD) have encouraged several groups across the world to report on their patients using these criteria. The disease typically manifests with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndromes, often leading to severe disability. Some patients are seropositive for antibodies against aquaporin-4 (AQP4), others are positive for anti-myelin oligodendrocyte glycoprotein (MOG), while a few are negative for both biomarkers. The disease is complex, and only now are specific therapeutic clinical trials being carried out. The present study adds to the literature through detailed clinical data from 153 medical records of Brazilian patients. METHODS: Retrospective assessment of medical records from nine specialized units in Brazil. RESULTS: NMOSD was more prevalent in females (4.1:1), who had significantly fewer relapses than males (p = 0.007) but presented similar levels of disability over time. African ancestry was associated with higher levels of disability throughout the disease course (p < 0.001), although the number of relapses was similar to that observed in white patients. Concomitant autoimmune diseases were relatively rare in this population (6.5%). Positivity for anti-AQP4 antibodies was identified in 62% of the patients tested, while 3% presented anti-MOG antibodies. Anti-AQP4 antibodies were not associated to worse disease course. The last medical record showed that six patients had died and 13 were wheelchair-bound. Seventy percent of the patients did not respond to first-line therapy (azathioprine and/or corticosteroids), and five patients continued to relapse even after four different courses of treatment. CONCLUSION: The present study adds to the reports from other countries presenting original data on Brazilian patients diagnosed with NMOSD according to the 2015 criteria.


Assuntos
Neuromielite Óptica/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Aquaporina 4/imunologia , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glicoproteína Mielina-Oligodendrócito/imunologia , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/imunologia , Índice de Gravidade de Doença , Adulto Jovem
6.
Arq Neuropsiquiatr ; 77(9): 617-621, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553391

RESUMO

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.


Assuntos
Cefaleia/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Esclerose Múltipla/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Cefaleia/tratamento farmacológico , Humanos , Masculino , Transtornos de Enxaqueca/tratamento farmacológico , Prevalência , Distribuição por Sexo , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Arq Neuropsiquiatr ; 75(8): 104-113, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28813090

RESUMO

Significant advances in the understanding and management of Duchenne muscular dystrophy (DMD) took place since international guidelines were published in 2010. Our objective was to provide an evidence-based national consensus statement for multidisciplinary care of DMD in Brazil. A combination of the Delphi technique with a systematic review of studies from 2010 to 2016 was employed to classify evidence levels and grade of recommendations. Our recommendations were divided in two parts. We present Part 1 here, where we describe the guideline methodology and overall disease concepts, and also provide recommendations on diagnosis, steroid therapy and new drug treatment perspectives for DMD. The main recommendations: 1) genetic testing in diagnostic suspicious cases should be the first line for diagnostic confirmation; 2) patients diagnosed with DMD should have steroids prescribed; 3) lack of published results for phase 3 clinical trials hinders, for now, the recommendation to use exon skipping or read-through agents.


Assuntos
Medicina Baseada em Evidências , Glucocorticoides/uso terapêutico , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/tratamento farmacológico , Brasil , Ensaios Clínicos como Assunto , Técnica Delphi , Seguimentos , Testes Genéticos , Humanos , Distrofia Muscular de Duchenne/genética , Equipe de Assistência ao Paciente , Literatura de Revisão como Assunto , Resultado do Tratamento
8.
Arq Neuropsiquiatr ; 73(10): 828-33, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26291989

RESUMO

Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Uso de Tabaco/psicologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Brasil/epidemiologia , Características Culturais , Depressão/psicologia , Avaliação da Deficiência , Métodos Epidemiológicos , Feminino , Humanos , Estilo de Vida , Masculino , Fatores Socioeconômicos , Uso de Tabaco/epidemiologia
9.
Arq. neuropsiquiatr ; 77(9): 617-621, Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1038747

RESUMO

ABSTRACT 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.


RESUMO 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.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Cefaleia/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Esclerose Múltipla/epidemiologia , Brasil/epidemiologia , Prevalência , Estudos Transversais , Inquéritos e Questionários , Resultado do Tratamento , Distribuição por Sexo , Avaliação da Deficiência , Cefaleia/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico
11.
Arq. neuropsiquiatr ; 75(8): 104-113, Aug. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-888315

RESUMO

ABSTRACT Significant advances in the understanding and management of Duchenne muscular dystrophy (DMD) took place since international guidelines were published in 2010. Our objective was to provide an evidence-based national consensus statement for multidisciplinary care of DMD in Brazil. A combination of the Delphi technique with a systematic review of studies from 2010 to 2016 was employed to classify evidence levels and grade of recommendations. Our recommendations were divided in two parts. We present Part 1 here, where we describe the guideline methodology and overall disease concepts, and also provide recommendations on diagnosis, steroid therapy and new drug treatment perspectives for DMD. The main recommendations: 1) genetic testing in diagnostic suspicious cases should be the first line for diagnostic confirmation; 2) patients diagnosed with DMD should have steroids prescribed; 3) lack of published results for phase 3 clinical trials hinders, for now, the recommendation to use exon skipping or read-through agents.


RESUMO Avanços na compreensão e no manejo da distrofia muscular de Duchenne (DMD) ocorreram desde a publicação de diretrizes internacionais em 2010. Nosso objetivo foi elaborar um consenso nacional baseado em evidências de cuidado multidisciplinar dos pacientes com DMD no Brasil. Utilizamos a técnica de Delphi combinada com revisão sistemática da literatura de 2010 a 2016 classificando níveis de evidência e graus de recomendação. Nossas recomendações foram divididas em duas partes. Apresentamos aqui a parte 1, descrevendo a metodologia utilizada e conceitos gerais da doença, e fornecemos recomendações sobre diagnóstico, tratamento com corticosteroides e novas perspectivas de tratamentos medicamentosos. As principais recomendações: 1) testes genéticos deveriam ser a primeira linha para confirmação de casos suspeitos; 2) pacientes com diagnóstico de DMD devem receber corticosteroides; 3) por enquanto, a falta de publicações de resultados dos ensaios clínicos de fase 3, dificulta recomendações de uso medicamentos que "saltam exons" ou "passam" por código de parada prematura.


Assuntos
Humanos , Medicina Baseada em Evidências , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/tratamento farmacológico , Glucocorticoides/uso terapêutico , Equipe de Assistência ao Paciente , Brasil , Literatura de Revisão como Assunto , Testes Genéticos , Ensaios Clínicos como Assunto , Seguimentos , Técnica Delphi , Resultado do Tratamento , Distrofia Muscular de Duchenne/genética
12.
Arq. neuropsiquiatr ; 73(10): 828-833, Oct. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-761538

RESUMO

Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.


Propósito Artigos recentes sugerem que pacientes com esclerose múltipla (EM) tem tendência ao abuso de álcool. Isto poderia se dever à combinação de uma doença crônica e incapacitante e um perfil psiquiátrico típico da EM. O objetivo do presente estudo foi avaliar estes achados em uma população de pacientes com EM culturalmente diferente.Método O presente estudo caso-controle transversal avaliou 168 pacientes com EM e 168 controles, todos brasileiros.Resultados Não houve evidência que pacientes com EM usassem mais álcool ou tabaco do que os controles. Na verdade, os controles apresentavam um consumo significativamente maior de álcool. O único aspecto associado ao maior consumo de álcool foi a ansiedade, tanto para pacientes quanto para controles.Conclusão Ao contrário de outros dados da literatura, pacientes com EM neste nosso estudo não bebem ou fumam mais do que a população controle.


Assuntos
Adulto , Feminino , Humanos , Masculino , Consumo de Bebidas Alcoólicas/psicologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Uso de Tabaco/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Brasil/epidemiologia , Características Culturais , Avaliação da Deficiência , Depressão/psicologia , Métodos Epidemiológicos , Estilo de Vida , Fatores Socioeconômicos , Uso de Tabaco/epidemiologia
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