Perfil Epidemiológico dos Pacientes com Distonia e/ou Espasticidade de um Ambulatório de Toxina Botulínica / Epidemiological Profile of Patients with Dystonia and/or Spasticity of a BotulinumToxin Outpatient care

A distonia e espasticidade são condições neurológicas relacionadas a incapacidades funcionais e a limitação em atividades elementares da vida diária, que resultam em perdas físicas, psicológicas e sociais aos pacientes acometidos. O tratamento das doenças com toxina botulínica tem apresentado grande sucesso nas duas últimas décadas devido ao seu perfil de segurança, eficácia e pela raridade de efeitos adversos ou ausência de consequências relevantes. Foram avaliadas características clínicas como: sexo, idade da primeira consulta, diagnóstico, comorbidade, tempo entre aplicações, alergia, terapêutica e contraindicação ao uso de toxina. A maior parte dos pacientes é do sexo masculino, e a idade média foi de 46 anos. O Trauma Crânio Encefálico foi a primeira causa. A comorbidade mais presente foi a Hipertensão Arterial. Mais de 2/3 dos pacientes retornaram para nova aplicação dentro de 3 meses. Sobre a terapêutica, quase metade realizou o uso de antiespasmódicos

Dystonia and spasticity are neurological conditions related to functional incapacity and limitation on daily activities, which result in physical, psychological and social loss to the patients. The treatment of those diseases using botulinum toxin has shown a big success in thepast two decades due to it's security, efficacy and unusual side effects. The evaluated characteristics were: sex, age at the first appointment, diagnosis, comorbidity, period between the injections, allergy, drugs and contra indication to use the toxin. Most of the patients are men, and the median age was 46 years. The Cranioencefalic Trauma was the main cause. The most common comorbidity was Systemic arterial hypertension. More than ⅔ of the patients returned to a new injection within 3 months. Almost half of them used antispasmodic drugs

The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis.

BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on medical evidence and may interfere with disease control by immunomodulatory drugs. The present study was designed to help discuss the effect of DMT for MS on pregnancy and on disease course. PATIENTS AND METHODS: Retrospective data from 152 pregnancies of 132 women with MS were collected by the physician in charge of the case. All data were entered into a specific file for qualitative and quantitative statistical analysis. RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of obstetric and neonatal complications was similar in both groups, except for the newborn weight and height which was smaller for mothers receiving medications. Mothers' post-delivery relapse rate and EDSS scores in the follow-up period were significantly higher in the absence of treatment. CONCLUSION: It is possible that, with further such supportive data, international guidelines on MS treatment in young women who intend to get pregnant may need to be revised.

Necrose retininana aguda em paciente com lúpus eritematoso sistêmico / Necrosis retininana acute in patient with systemic lupus erythematosus

O Lúpus Eritematoso Sistêmico (LES) é uma doença proteiforme que pode ter manifestações oculares como vasculites retinianas, uveites e neuropatias óticas. Todavia pela imunodepressão causada tanto pela própria doença como pelo seu tratamento, esses pacientes estão sujeitos a várias formas de infecção que também podem causar manifestações oftalmológicas exigindo um diagnóstico diferencial cuidadoso. Descrevemos aqui o caso de um paciente com overlap entre LES e esclerodermia que desenvolveu vasculite retinina e necrose de retina secundária a infecção por herpes

Systemic lupus erythematosus (SLE) is a disease that can have variable eye manifestations such as ocular retinal vasculitis, uveitis and optic neuropathies. However because of the immunosuppression caused either by the disease itself or its treatment, these patients are subject to various forms of infection that can also cause ophthalmologic manifestations, requiring a careful differential diagnosis. Here we describe the case of a patient with overlap between SLE and scleroderma and retinal vasculitis that developed retinal necrosis secondary herpes infection