RESUMEN
Multiple sclerosis (MS) is a chronic, neurological, immune-mediated disease that can worsen in the postpartum period. There is no consensus on the use of immunoglobulin for prevention of disease relapses after delivery. We have shown that the controversial beneficial effect of immunoglobulin given immediately after birth could not be observed in patients with MS.
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Inmunoglobulinas Intravenosas/uso terapéutico , Madres , Esclerosis Múltiple Recurrente-Remitente/prevención & control , Esclerosis Múltiple/tratamiento farmacológico , Periodo Posparto/efectos de los fármacos , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Inmunoglobulinas Intravenosas/farmacología , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/inmunología , Resultado del Embarazo , Trastornos Puerperales/prevención & control , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
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.
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Depresión/diagnóstico , Depresión/terapia , Fatiga/diagnóstico , Fatiga/terapia , Esclerosis Múltiple/terapia , Cognición , Depresión/complicaciones , Humanos , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Medición de Riesgo , Prevención del SuicidioRESUMEN
While mass immunization against coronavirus disease 2019 (COVID-19) rolls out around the globe, safety concerns and adverse events that need prompt evaluation are also emerging. Neurological complications such as transverse myelitis raise concerns as cases were observed in clinical trials. Cerebrospinal fluid analysis is routine in these cases and the characteristics of the abnormalities found are of great help not only in establishing the diagnosis but also in understanding this rare condition. We present a case of extensive longitudinal transverse myelitis after vaccination with AZD1222, AstraZeneca COVID-19 vaccine, which was the first case reported in Brazil. The abnormalities found in the study of the cerebrospinal fluid in our case are reported and discussed using data from recent publications.
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BACKGROUND: Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. OBJECTIVE: To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. METHODS: Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. RESULTS: Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. CONCLUSIONS: This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management.
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Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Femenino , Acetato de Glatiramer , Humanos , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/uso terapéutico , Neurólogos , EmbarazoRESUMEN
BACKGROUND: Basic steps in the management of patients with Multiple Sclerosis (MS), such as good patient understanding of the disease and active participation in its management are extremely important, as they directly influence treatment adherence and success. Therefore, this study aimed to evaluate the perception of MS patients and neurologists pertaining to the most common disease symptoms, disabilities that impact on quality of life, and patient concerns and difficulties during medical visits, as information that can be used to improve the doctor-patient relationship. METHODS: A cross-sectional study involving two groups: the first composed of neurologists and the second of patients. Participants of the first group were selected by a Steering Committee (15 predetermined neurologists representing each region of Brazil and specialized in MS and neuroimmunological disorders, who also assumed the role of creating the survey and questionnaire). Participants of the second group were selected following dissemination of a questionnaire on the AME's social networks (Amigos Múltiplos pela Esclerose, a non-governmental organization to support patients with MS). Questions about sociodemographic data, disease impact on quality of life, symptoms perception, and concerns and issues regarding disease care were put to both groups. RESULTS: A total of 317 patients and 182 neurologists answered the questionnaires. Significant divergences were found between the perceptions of patients and neurologists in relation to orientation and information given during medical appointments, and also regarding patient participation in treatment and therapy choice. Considering the topic assessing impact on quality of life, more than 70% of neurologists perceived that autonomy to work and travel, and future planning were aspects that most affected patient lives, however, almost 50% of patients reported that disease monitoring did not affect their life in any way. Analysis of data regarding MS symptoms revealed neurologists to consider physical symptoms, such as ambulation issues, imbalance, falls and urinary incontinence, to be those most interfering with patient quality of life, whereas patients considered non-physical symptoms, such as fatigue, pain, cognitive and memory problems to be more significant. Patients with primary progressive MS complained more about ambulation issues, imbalance and falls (p<0.05), when compared to patients with other disease phenotypes. CONCLUSION: Significant differences in disease perception were found in this study. While neurologists tended to overestimate the consequences and symptoms of the disease, for most patients, the disease impact on activities did not appear to be as significant, with more complaints regarding non-physical symptoms. Although neurologists described involving patients in treatment decisions and providing them with appropriate orientation during medical appointments, the opposite was reported by patients. These results may help to improve treatment adherence and disease outcomes by redefining the doctor-patient relationship.
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Esclerosis Múltiple , Brasil , Estudios Transversales , Humanos , Esclerosis Múltiple/terapia , Neurólogos , Percepción , Relaciones Médico-Paciente , Calidad de VidaRESUMEN
Multiple Sclerosis (MS) is a chronic inflammatory disorder in the central nervous system for which biomarkers for diagnosis still remain unknown. One potential biomarker is the myelin basic protein. Here, a nanoimmunosensor based on atomic force spectroscopy (AFS) successfully detected autoantibodies against the MBP85-99 peptide from myelin basic protein. The nanoimmunosensor consisted of an atomic force microscope tip functionalization with MBP85-99 peptide, which was made to interact with a mica surface coated either with a layer of anti-MBP85-99 (positive control) or samples of cerebrospinal fluid (CSF) from five multiple sclerosis (MS) patients at different stages of the disease and five non-MS subjects. The adhesion forces obtained from AFS pointed to a high concentration of anti-MBP85-99 for the two patients at early stages of relapsing-remitting multiple sclerosis (RRMS), which were indistinguishable from the positive control. In contrast, considerably lower adhesion forces were measured for all the other eight subjects, including three MS patients with longer history of the disease and under treatment, without episodes of acute MS activity. We have also shown that the average adhesion force between MBP85-99 and anti-MBP85-99 is compatible with the value estimated using steered molecular dynamics. Though further tests will be required with a larger cohort of patients, the present results indicate that the nanoimmunosensor may be a simple tool to detect early-stage MS patients and be useful to understand the molecular mechanisms behind MS.
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Autoanticuerpos/líquido cefalorraquídeo , Técnicas Biosensibles , Esclerosis Múltiple/diagnóstico , Proteína Básica de Mielina/inmunología , Autoanticuerpos/inmunología , Biomarcadores/líquido cefalorraquídeo , Técnicas Biosensibles/instrumentación , Diagnóstico Precoz , Femenino , Humanos , Masculino , Microscopía de Fuerza Atómica , Simulación de Dinámica Molecular , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/inmunología , Esclerosis Múltiple Recurrente-Remitente/líquido cefalorraquídeo , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/inmunología , Fragmentos de Péptidos/inmunología , Sensibilidad y EspecificidadRESUMEN
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 800â¯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 (pâ¯<â¯0.0001). The present results confirm the influence of natalizumab therapy on JCV antibodies in several countries and continents.
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Anticuerpos Antivirales/inmunología , Factores Inmunológicos/efectos adversos , Virus JC/inmunología , Natalizumab/efectos adversos , Seroconversión/efectos de los fármacos , Adulto , Brasil , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Masculino , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/uso terapéuticoRESUMEN
Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.
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Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. OBJECTIVE: The objective of the present study was to characterize findings of alexithymia in patients with MS. METHODS: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. RESULTS: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. CONCLUSION: Alexithymia was a relevant finding in patients with MS.
Alexitimia é um traço de personalidade caracterizado pelas dificuldades na identificação e descrição dos sentimentos. Alguns pesquisadores descrevem altos índices de alexitimia em pacientes com esclerose múltipla (EM), porém os dados na literatura são escassos. OBJETIVO: O objetivo do presente estudo foi caracterizar achados de alexitimia em pacientes com EM. MÉTODOS: Este estudo transversal incluiu 180 pacientes com EM e um grupo controle pareado. Dados de pacientes com EM incluíram a duração da doença, número de surtos clínicos de desmielinização e grau de incapacidade neurológica avaliados pela Escala Expandida do Grau de Incapacidade (EDSS). Foram também utilizadas a escala Hospitalar de Ansiedade e Depressão (HAD) e a escala de Alexitimia de Toronto (TAS) foram utilizadas. RESULTADOS: Cada grupo era constituído por 126 mulheres e 54 homens, com mediana de idade de 37 anos e mediana de escolaridade de 16 anos. Pacientes com EM apresentaram maior grau de depressão (p<0.01), ansiedade (p=0.01) e alexitimia (p<0.01) que os controles. Para pessoas com EM, traços depressivos (p<0.01), ansiosos (p=0.03), maior idade (p=0.02), menor nível educacional (p=0.02), maior grau de incapacidade (p<0.01) e o fato de não estar ativamente trabalhando (p=0.03) levaram a maiores níveis de alexitimia. CONCLUSÃO: Alexitimia foi um importante achado em pacientes com EM.
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Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV). OBJECTIVE: To identify the serologic profile of JCV in patients with MS. METHODS: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program. RESULTS: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months. CONCLUSION: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.
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Anticuerpos Antivirales/sangre , Virus JC/inmunología , Leucoencefalopatía Multifocal Progresiva/inmunología , Esclerosis Múltiple/virología , Infecciones por Polyomavirus/inmunología , Adulto , Brasil/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Leucoencefalopatía Multifocal Progresiva/sangre , Masculino , Esclerosis Múltiple/sangre , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/efectos adversos , Infecciones por Polyomavirus/epidemiología , Prevalencia , Seroconversión , Factores SexualesRESUMEN
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.
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Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Academias e Institutos , Brasil , Humanos , Neurología , Recurrencia , Vitamina D/uso terapéuticoRESUMEN
Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.
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Esclerosis Múltiple/sangre , Deficiencia de Vitamina D/sangre , Vitamina D/sangre , Adulto , Brasil , Estudios de Casos y Controles , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Geografía Médica , Humanos , Masculino , Esclerosis Múltiple/complicaciones , Deficiencia de Vitamina D/complicacionesRESUMEN
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.
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Dengue/complicaciones , Clorhidrato de Fingolimod/uso terapéutico , Factores Inmunológicos/uso terapéutico , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/uso terapéutico , Adulto , Brasil , Dengue/fisiopatología , Femenino , Clorhidrato de Fingolimod/efectos adversos , Humanos , Factores Inmunológicos/efectos adversos , Masculino , Esclerosis Múltiple/fisiopatología , Natalizumab/efectos adversos , Índice de Severidad de la EnfermedadRESUMEN
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.
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Sustitución de Medicamentos , Clorhidrato de Fingolimod/administración & dosificación , Inmunosupresores/administración & dosificación , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/administración & dosificación , Adulto , Femenino , Clorhidrato de Fingolimod/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Virus JC/efectos de los fármacos , Virus JC/inmunología , Leucoencefalopatía Multifocal Progresiva/complicaciones , Leucoencefalopatía Multifocal Progresiva/virología , Masculino , Esclerosis Múltiple/complicaciones , Natalizumab/efectos adversos , Estudios Prospectivos , Resultado del Tratamiento , Carga ViralRESUMEN
BACKGROUND: Fampridine is a broad-spectrum voltage-dependent potassium channel blocker that enhances synaptic transmission. The drug has been shown to be able to ameliorate conduction in demyelinated axons, thereby leading to improved gait in patients with multiple sclerosis (MS). OBJECTIVE: To assess the "real-life" efficacy and safety of fampridine prescribed for gait disorders in MS. This was an observational and prospective study carried out at MS Units participating in the Brazilian Multiple Sclerosis Study Group. METHODS: Patients with MS and gait disorders were prescribed fampridine (10âmg twice a day), irrespectively of the degree of disability determined by MS. Neurological disability determined by MS was assessed with the expanded disability scale score (EDSS). Outcomes for efficacy and safety of the drug were evaluated by the 25 foot-walk test and by the adverse events of fampridine. RESULTS: The time taken to walk 25 feet decreased by 20% or more in 62 patients (70%). Twenty-five patients were considered to be non-responders to this treatment. Improvement in walking speed was independent of improvement of disability. Mild or moderate adverse events were reported in 8% of patients. CONCLUSION: Fampridine is an efficient and safe therapeutic option for patients with MS and gait disorders.
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4-Aminopiridina/uso terapéutico , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/tratamiento farmacológico , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológico , Bloqueadores de los Canales de Potasio/uso terapéutico , 4-Aminopiridina/farmacología , Adulto , Anciano , Femenino , Trastornos Neurológicos de la Marcha/epidemiología , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/epidemiología , Bloqueadores de los Canales de Potasio/farmacología , Estudios ProspectivosRESUMEN
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.
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Genetic susceptibility is a well-recognized factor in the onset of multiple sclerosis (MS). The objective of this study was to determine the frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid, in an ethnically mixed group of MS patients in the city of São Paulo, Brazil. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. OCB were found in 49 (54.4%) out of 90 patients with clinically definite MS; out of the 23 brown/black patients, 17 (73.9%) were OCB+; out of the 66 white patients, 32 (48.5%) were OCB+; and the only patient yellow was OCB+ (p = 0.05). Analysis of the IgG index was also consistent with the findings, but with lower statistical significance. The data presented in our study show that the ethnic differences in MS extend to the immune response.
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Esclerosis Múltiple/genética , Bandas Oligoclonales/genética , Población Negra/genética , Brasil , Femenino , Humanos , Inmunoglobulina G/genética , Focalización Isoeléctrica , Masculino , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/patología , Bandas Oligoclonales/líquido cefalorraquídeoRESUMEN
Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of evidences and types of recommendations as have been defined and widely accepted by the international scientific community. It aims to provide sufficient information to support the BCTRIMS Expanded Consensus on Treatment of MS.
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Adyuvantes Inmunológicos/uso terapéutico , Medicina Basada en la Evidencia , Glucocorticoides/uso terapéutico , Interferón beta/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , HumanosRESUMEN
There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.
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Medicina Basada en la Evidencia , Esclerosis Múltiple/tratamiento farmacológico , HumanosRESUMEN
Tuberculosis continues to be a serious health problem worldwide. The disease continues to be underdiagnosed and not properly treated. In conditions that affect the immune system, such as multiple sclerosis (MS), latent tuberculosis may thrive and reactivate during the use of immunomodulatory and immunosuppressive drugs. Among the best treatment options for patients with latent or active tuberculosis who have MS are IFN-ß, glatiramer acetate and mitoxantrone. Drugs leading to a reduced number and/or function of lymphocytes should be avoided or used with caution. Tuberculosis must always be investigated in patients with MS and treated with rigor.