Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis.

Multiple sclerosis (MS) is frequently associated with depression. Yet there are few clinical trials on treating depression in MS and no agreed recommendations for its assessment and follow-up. We present evidence-based recommendations for several aspects of depression in MS, including screening for depression, recognition of other concomitant psychiatric conditions, suicide risk, disability, fatigue, cognition, adherence to treatment, the effect of drugs used to treat MS on depression and possible pharmacological treatments for depression in MS.

Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis.

OBJECTIVES: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. MATERIALS AND METHODS: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. STATISTICAL ANALYSIS USED: Fisher's exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. RESULTS: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). CONCLUSIONS: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

Normative values of the Brief Repeatable Battery of Neuropsychological Tests in a Brazilian population sample: discrete and regression-based norms.

Objective Cognitive dysfunction is common in multiple sclerosis. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was developed to assess cognitive functions most-frequently impaired in multiple sclerosis. However, normative values are lacking in Brazil. Therefore, we aimed to provide continuous and discrete normative values for the BRB-N in a Brazilian population sample. Methods We recruited 285 healthy individuals from the community at 10 Brazilian sites and applied the BRB-N version A in 237 participants and version B in 48 participants. Continuous norms were calculated with multiple-regression analysis. Results Mean raw scores and the 5th percentile for each neuropsychological measure are provided, stratified by age and educational level. Healthy participants' raw scores were converted to scaled scores, which were regressed on age, sex and education, yielding equations that can be used to calculate predicted scores. Conclusion Our normative data allow a more widespread use of the BRB-N in clinical practice and research.

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis.

The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.

Hypomyelination with atrophy of the basal ganglia and cerebellum: case report.

Hypomyelination with atrophy of the basal ganglia and cerebellum (H-ABC) is a rare disease that has been recently described. It must be remembered as a possible etiology of leukoencephalopathies in children. We describe a typical case of H-ABC in a 11-month-old boy. He presents with global development delay, oral dyskinesia, and global dystonia and spasticity. Magnetic resonance imaging disclosed typical features of H-ABC and clinical laboratory tests were all negative. A slow neurological deterioration has been detected with worsening of involuntary movements.

Merosin-positive congenital muscular dystrophy: neuroimaging findings.

Congenital muscle dystrophy (CMD) is a heterogeneous group of autosomal recessive myopathies. It is known that CMD may affect the central nervous system (CNS). Some authors have shown that merosin-negative CMD patients may have encephalic metabolic disturbances. In order to study metabolic changes within the brain, the authors performed a magnetic resonance spectroscopy (MRS) study in a 1-year-old girl with merosin-positive CMD (MP-CMD). MRS of brain demonstrated that NAA/Cr ratio was decreased (1.52), while Cho/Cr ratio was increased (1.78). These findings suggest that metabolic changes in CNS can also be found in patients with MP-CMD.

[Possible etiologies of West syndrome: evaluation of 95 patients]. / Possíveis etiologias da Síndrome de West: avaliação de 95 pacientes.

OBJECTIVE: To describe the etiologies of West syndrome (WS) among children followed in a rehabilitation center. METHOD: Retrospective study with emphasis in the following items: gender, age at the diagnosis of WS and its etiology. The etiologies were divided into three categories: symptomatic, cryptogenic and idiopathic. Symptomatic cases were classified as follows: pre, post and perinatal. RESULTS: Ninety-five patients were included. Fifty-nine were boys (62%). Mean age at the diagnosis was 4.9 (+/- 5.0) months. There were 25 cryptogenic (26.3%), one idiopathic (1.1%) and 69 (72.6%) symptomatic cases, most of them of perinatal origin. CONCLUSION: Our findings are in agreement with the literature. In the future, as our knowledge in the field of WS and its diagnostic methods increase, there will be a small number of cryptogenic and idiopathic cases.

Postmeningitis headache: case report.

We report a case of a 18-year-old female patient that developed a migraine-like headache following an acute meningococcal meningitis. She had no previous history of recurrent headaches. The pain was intense, pulsatile and throbbing, typically unilateral, without aura. Its frequency increased during the following weeks and a prophylactic treatment with amitriptyline and atenolol was initiated. There was remission of the attacks.

Superficial siderosis of the central nervous system is a rare and possibly underdiagnosed disorder.

METHODS: Series of cases collected from Brazilian centers. RESULTS: We studied 13 cases of patients presenting with progressive histories of neurological dysfunction caused by SS-CNS. The most frequent clinical findings in these patients were progressive gait ataxia, hearing loss, hyperreflexia and cognitive dysfunction. The diagnoses of SS-CNS were made seven months to 30 years after the disease onset. CONCLUSION: SS-CNS is a rare disease that may remain undiagnosed for long periods. Awareness of this condition is essential for the clinician.

[Episodic tension-type headache: clinical evaluation of 50 patients]. / Cefaléia do tipo tensional episódica: avaliação clínica de 50 pacientes.

A case series study of 50 consecutive patients with episodic tension type headache (ETTH) was conducted. Clinical aspects, family history and impact on work activities were studied. The casuistry was made up of 40 women and 10 men. The average age was 30 (+/-12) years. Constrictive pain was present in 40 patients (80%). Sickness was the most commonly reported related phenomenon (20%). As expected, bilateral pain predominated; however, unilateral location was also present (10%). Although classically described as a mild pain, we observed that ETTH can come in intense crisis (16%). Family history of tension type headache was positive in 12 patients. The impact on work activities was substantial (14%). Our findings regarding to clinical aspects are in agreement with the literature. It is important to mention that the impact of ETTH on the individual and society should be reconsidered, and is more substantial than has been reported to date.

Dengue fever in patients with multiple sclerosis taking fingolimod or natalizumab.

Dengue fever is the most prevalent mosquito-borne viral illness in humans. There may be different clinical manifestations of the disease, from mild symptoms to hemorrhagic forms of dengue fever and even neurological complications of this viral infection. Blood cells are usually affected, and thrombocytopenia is the hallmark of the disease. This paper presents 15 cases of dengue fever in patients with multiple sclerosis (MS) taking fingolimod or natalizumab. There were no complications of dengue fever or worse outcomes of MS in these patients, and only four of them needed short-term treatment withdrawal due to lymphopenia.

No evidence of disease activity in multiple sclerosis patients.

INTRODUCTION: Multiple Sclerosis is a chronic inflammatory demyelinating disease that affects 2.5 million people in the world. NEDA (No evidence of disease Activity) -4 is a new concept related to absence of disease activity in the context of MS. It takes into account the following four parameters: relapses; disability progression; lesion load and brain atrophy. Areas covered: The purpose of this paper is to visit the new emerging concepts of NEDA. Although it is considered important and attractive, there is a lack of uniformity. Expert commentary: Although NEDA-4 embraces important markers of disease activity and degeneration, this definition is still evolving and other parameters apart from the loss of brain volume might be included, especially those related to disability, such as cognitive problems, visual function, fatigue and pain.

Safety of switching from natalizumab straight into fingolimod in a group of JCV-positive patients with multiple sclerosis.

OBJECTIVE: To assess safety of the switch between natalizumab and fingolimod without a washout period. METHODS: Prospective data on 25 JCV positive patients who underwent this medication switch were collected and analyzed. RESULTS: After a median period of nine months from the medication switch, there were no safety issues to report. The patients had good disease control and no adverse events were reported. CONCLUSION: Washout may not be necessary in daily practice when switching from natalizumab to fingolimod. Expertise on multiple sclerosis management, however, is essential for drug switching.

Cerebrum-cervical arterial dissection in adults during sports and recreation.

UNLABELLED: Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. METHODS: Retrospective data on patients with arterial dissection related to sports and recreation. RESULTS: Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. CONCLUSION: Arterial dissection may be a complication from practicing sports.

Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis.

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.

Increased multiple sclerosis relapses related to lower prevalence of pain.

OBJECTIVE: The study aims to investigate the presence of pain amongst multiple sclerosis (MS) patients. METHOD: One hundred MS patients responded to questionnaires evaluating neuropathic and nociceptive pain, depression and anxiety. Statistical analysis was performed using the Mann-Whitney U, Chi-Square and two-tailed Fisher's exact tests and multivariate logistic regression. RESULTS: Women had a statistically higher prevalence of pain (p = 0.037), and chances of having pain after the age of 50 reduced. Women with pain had a statistically significant lower number of relapses (p = 0.003), restricting analysis to those patients with more than one relapse. After the second relapse, each relapse reduced the chance of having pain by 46%. Presence of pain was independent of Expanded Disability Status Scale (EDSS) anxiety, and depression. CONCLUSION: Our findings suggest a strong inverse association between relapses and pain indicating a possible protective role of focal inflammation in the control of pain.

Motor Imagery and Its Effect on Complex Regional Pain Syndrome: An Integrative Review.

The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory-motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.

The Influence of Fear of Falling on Orthostatic Postural Control: A Systematic Review.

Posture is a complex sensory-motor behavior that can be influenced by the fear of falling (FoF) during environmental changes. The aim of this paper is to investigate the influence of FoF on orthostatic postural control in healthy individuals by a systematic review. Thirteen articles were selected. Some other articles (31 references) were used to contextualize and discuss the topic. Studies in the environment made changes on the environment, in which participants were positioned in high hydraulic platforms at different heights, showed a decrease in the center of pressure in the anteroposterior oscillation where the platform was higher. This change in postural control strategy and the FoF are correlated. It can modulate the activity of the muscle spindle (H-reflex) and probably induce postural freezing phenomenon (anticipated postural anxiety). We can conclude that further studies are needed to understand the physiological echanisms involved in FoF and its relation to changes in postural control strategy.

[Depressive symptoms and anxiety in patients with chronic and episodic tension-type headache]. / Sintomas depressivos e ansiedade em pacientes com cefaléia do tipo tensional crônica e episódica.

BACKGROUND: Tension-type headache (TTH) is recognized as the most prevalent type of headache. Despite this, there is a limited understanding of the entity's physiology, epidemiology, and clinical presentation. Anxiety and depression are recognized comorbidities present among patients with TTH. OBJECTIVE: To quantify the prevalence of anxiety and depression among patients with episodic and chronic TTH. METHOD: fifty patients with episodic TTH and fifty patients with chronic TTH completed Beck's anxiety and depression surveys. Only patients presenting with moderate to severe scores were considered. RESULTS: among the patients with episodic TTH, anxiety and depression were observed in 30 (60%) and 16 (32%) patients respectively. Among the patients with chronic TTH, anxiety was observed in 22 (44%) patients, and depression was observed in 20 (40%). CONCLUSION: both comorbidities are important among patients with episodic and chronic TTH. Neglecting this association may result in failure of symptomatic and prophylactic treatment ultimately leading to lost quality of life.