RESUMO
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.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Mães , Esclerose Múltipla Recidivante-Remitente/prevenção & controle , Esclerose Múltipla/tratamento farmacológico , Período Pós-Parto/efeitos dos fármacos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Imunoglobulinas Intravenosas/farmacologia , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/imunologia , Resultado da Gravidez , Transtornos Puerperais/prevenção & controle , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: Natalizumab is a new and efficient treatment for multiple sclerosis (MS). The risk of developing progressive multifocal leukoencephalopathy (PML) during the use of this drug has created the need for better comprehension of JC virus (JCV) infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. METHOD: Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR). RESULTS: In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2%) patients. DISCUSSION: Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , DNA Viral/análise , Vírus JC/genética , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Adulto , Brasil/epidemiologia , Feminino , Humanos , Vírus JC/imunologia , Leucoencefalopatia Multifocal Progressiva/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/virologia , Natalizumab , Reação em Cadeia da Polimerase em Tempo Real , Fatores de RiscoRESUMO
Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil.
Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Distribuição por Idade , Idade de Início , Brasil/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Estudos Retrospectivos , Distribuição por Sexo , Fatores de TempoRESUMO
Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil. .
Esclerose múltipla (EM) com início na infância e adolescência constitui um desafio para o diagnóstico e manejo da doença. A proposta do presente estudo foi avaliar as características da EM de início precoce em pacientes brasileiros. Métodos Coleta de dados retrospectiva de arquivos de unidades especializadas em atendimento da EM. Resultados A partir de 20 unidades de EM de nove estados brasileiros, foram coletados 117 casos de EM com início antes dos 18 anos de idade. Estes pacientes tinham uma média de 10 anos de duração da doença, de maneira geral apresentavam pouca incapacidade , com um surto a cada dois anos e meio. A média de idade no início da doença era 13,7 anos. Conclusão O presente estudo apresenta uma grande série de casos brasileiros de EM pediátrica. Embora alguns pacientes tenham apresentado forma grave de EM, de maneira geral o grupo de pacientes cuja EM iniciou-se na infância ou adolescência apresentou uma forma relativamente leve da doença no Brasil. .
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Esclerose Múltipla/epidemiologia , Distribuição por Idade , Idade de Início , Brasil/epidemiologia , Progressão da Doença , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Estudos Retrospectivos , Distribuição por Sexo , Fatores de TempoRESUMO
Objective Natalizumab is a new and efficient treatment for multiple sclerosis (MS). The risk of developing progressive multifocal leukoencephalopathy (PML) during the use of this drug has created the need for better comprehension of JC virus (JCV) infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. Method Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR). Results In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2%) patients. Discussion Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab. .
Objetivo Natalizumabe é um tratamento novo e eficaz para esclerose múltipla (EM). O risco constatado de desenvolver leucoencefalopatia multifocal progressiva (LEMP) durante o uso desta droga criou a necessidade de melhor estudar a infecção pelo vírus JC (JCV). O objetivo do presente estudo foi avaliar a prevalência de DNA-JCV em paciente brasileiros usando natalizumabe. Método Detecção qualitativa de JCV no soro foi realizada através de reação em cadeia por polimerase (PCR) em tempo real. Resultados DNA-JCV foi detectado em 86 pacientes (51,2%) de um grupo de 168 pessoas com EM recebendo tratamento com natalizumabe,). Discussão Dados do DNA-JCV no Brasil complementam as avaliações mundiais sobre a prevalência de JCV em pacientes com EM que necessitam tratamento natalizumabe. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticorpos Monoclonais Humanizados/efeitos adversos , DNA Viral/análise , Vírus JC/genética , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Brasil/epidemiologia , Vírus JC/imunologia , Leucoencefalopatia Multifocal Progressiva/epidemiologia , Esclerose Múltipla/virologia , Reação em Cadeia da Polimerase em Tempo Real , Fatores de RiscoRESUMO
Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO.
Assuntos
Neuromielite Óptica/epidemiologia , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Adulto , Brasil/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Avaliação da Deficiência , Progressão da Doença , Feminino , Humanos , Neuromielite Óptica/diagnóstico , Gravidez , RecidivaRESUMO
OBJECTIVE: To assess the prevalence and the profile of adverse events (AE) of natalizumab in patients with multiple sclerosis (MS). METHODS: Data collection from neurologists attending to patients with MS at specialized units in Brazil. RESULTS: Data from 103 patients attending the infusion centers of 16 MS units in 9 Brazilian states were included in the study. The total number of infusions was 1,042. Seventy-nine patients (76.7%) did not present any AE. Twenty-four patients (23.3%) presented only mild AE. There were three major AE, including two deaths. These three occurrences, although not necessarily being drug-related, must be taken into consideration. CONCLUSION: The profile of AEs for natalizumab shows that 97% of patients have none or only mild AE. However, still due to safety worries, the use of this medication should be restricted to MS units under the care of specialized neurologists.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Natalizumab , Estudos Retrospectivos , Adulto JovemRESUMO
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anticorpos Monoclonais Humanizados/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Brasil , Estudos RetrospectivosRESUMO
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.