Lymphocyte count in peripheral blood is not associated with the level of clinical response to treatment with fingolimod.

BACKGROUND: Fingolimod is an efficient and safe drug for treating relapsing-remitting multiple sclerosis (RRMS). In vivo, fingolimod is phosphorylated and binds to "sphingosine-1-phosphate"(S1P) receptors that are expressed in a wide range of cells, including lymphocytes. Under the effect of fingolimod, lymphocytes are retained in lymphoid tissues through the regulation of S1P1 receptors. The aim of the present study was to assess whether the degree of lymphopenia was correlated to the positive treatment response of RRMS patients with fingolimod. METHODS: Data was sourced from the MSBase Registry. Patients were divided into two groups, according to the lymphocyte count on peripheral blood examination. Annualized Relapse Rate (ARR), time to first relapse and time to six-month confirmed disability progression were compared between groups. RESULTS: Group one consisted of 202 patients who reached 750 lymphocytes/mm3 during treatment while the comparison group two included 101 patients who never reached less than 1000 lymphocytes/mm3 in peripheral blood during the observation period. There were no differences between groups in ARR, time to first relapse or time to six-month confirmed disability progression. CONCLUSION: The degree of lymphopenia in peripheral blood was not associated to the positive treatment response of fingolimod in RRMS patients.

Correlation of clinical findings and brain volume data in multiple sclerosis.

Brain volume measurements are becoming an important tool for assessing success in controlling multiple sclerosis (MS) activity. MSmetrix (icometrix) is an easy-to-use platform, specific for MS magnetic resonance imaging (MRI) of the brain. It provides data on total brain volume, grey matter volume and lesion load volume. The objective of the present study was to assess whether disability and the number of relapses during the previous year correlated with brain volume measurements from MSmetrix. Data on 185 icometrix reports from patients with MS were used to evaluate the potential correlation between brain volume measurements and clinical parameters. There was a significant correlation between higher disability and decreased brain volume (total and grey matter). Increased lesion load in the brain and higher number of relapses in the previous year were also independently correlated with decreased brain tissue volume and with increased disability. This is the first study with real-world data to show that icometrix is a relevant tool for the study of brain volume loss in MS.

Perfil descritivo de esclerose múltipla com início até os 16 anos nos pacientes de um centro de referência do estado de São Paulo / Descriptive profile of multiple sclerosis starting until the age of 16 in the reference center of the state of São Paulo / Perfil descriptivo de esclerosis múltiple con inicio hasta los 16 años de edad en los pacientes del centro de referencia del litoral de la provincia de São Paulo

OBJETIVO: Descrever o perfil de pacientes com esclerose múltipla iniciada até os 16 anos de idade no litoral do estado de São Paulo, Brasil. DESCRIÇÃO DOS CASOS: Análise retrospectiva das características dos pacientes que tiveram o episódio inicial de esclerose múltipla até os 16 anos. Nesta situação encontravam-se nove meninas e quatro meninos (7,1% da população total de esclerose múltipla da região). A idade média por ocasião do diagnóstico foi de 13,9 anos (variação entre 8 e 16), sendo a média atual de 19,5 anos (12 a 28). A apresentação inicial da doença foi: ataxia (quatro casos), neurite óptica (dois), motora cortical (dois), sensitiva cortical (dois), distonia (dois) e esclerose múltipla medular (um). Todos os pacientes iniciaram com a forma remitente-recorrente da esclerose múltipla e dois deles, atualmente, apresentam a forma progressiva secundária. COMENTÁRIOS: A esclerose múltipla com início até os 16 anos precisa ser adequadamente registrada e discutida entre pediatras, neurologistas e neuropediatras. Poucos médicos têm bom conhecimento desta condição e a demora no diagnóstico e no tratamento pode ter consequências devastadoras para essas crianças e adolescentes.

OBJECTIVE: To describe the profile of patients with multiple sclerosis starting at or before the age of 16 in the coastal region of the state of São Paulo, Brazil. CASES DESCRIPTION: Retrospective analysis of the characteristics of patients who presented the initial episode of multiple sclerosis at or before the age of 16. There were nine girls and four boys in this situation (7.1% of the total population with multiple sclerosis in such area). The average age at diagnosis was 13.9 years old (ranging from 8 to 16), and the current average age is 19.5 years old (12 to 28). The initial presentation was: ataxia (four cases), optic neuritis (two), cortical motor (two), cortical sensitive (two), dystonia (two), and spinal cord multiple sclerosis (one). All patients started with the relapsing-remitting form of the disease, and two of them now present a secondary progressive course. COMMENTS: Multiple sclerosis with onset at or before the age of 16 needs to be properly registered and discussed among pediatricians, neurologists, and neuropediatricians. Very few doctors have good knowledge about this condition, and delay in diagnosing and treating may have devastating consequences for the future of these children and adolescents.

OBJETIVO: Describir el perfil de los pacientes con esclerosis múltiple iniciada hasta los 16 años de edad, en la región del litoral de la provincia de São Paulo, Brasil. DESCRIPCIÓN DE LOS CASOS: Análisis retrospectivo, a partir de los registros médicos, de las características de los pacientes que tuvieron episodio inicial de esclerosis multiple hasta los 16 años de edad. Fueron nueve muchachas y cuatro muchachos en esta situación (7,1% de la población total de esclerosis multiple en la región). El promedio de edad en el momento del diagnóstico fue de 13,9 años (variación 8-16), siendo el promedio de edad actual de 19,5 años (12-28). La presentación inicial de la enfermedad fue ataxia (4 casos), neuritis óptica (2 casos), motora cortical (2 casos), sensitiva cortical (2 casos), distonía (2 casos) y esclerosis multiple medular (1 caso). Todos los pacientes iniciaron con la forma remitente-recurrente de la esclerosis multiple y dos de ellos ahora presentan la forma progresiva secundaria. COMENTARIOS: esclerosis multiple con inicio hasta los 16 años de edad necesita ser adecuadamente registrada y discutida entre pediatras, neurólogos y neuropediatras. Pocos médicos tienen buen conocimiento de esta condición y la demora en el diagnóstico y tratamiento pueden tener consecuencias devastadoras para estos niños y adolescentes.