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1.
Medicine (Baltimore) ; 98(38): e17184, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567960

RESUMO

Although both multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating diseases, their psychiatric disturbances may differ given differences in the neurological manifestations. We used subjective and objective measurements to compare the psychiatric disturbances in patients with MS and NMO.Psychiatric disturbances were assessed in 24 MS and 35 NMO patients using the Beck Hopelessness Scale, Symptom Checklist-95 and the brief version of World Health Organization Quality of Life. Personality was assessed using the Big Five Inventory-10. Disease-related function was assessed using the Fatigue Severity Scale, Short-Form McGill Pain Questionnaire, and the Global Assessment of Function. Positivity offset (PO) and negativity bias (NB) and heart rate variability (HRV) were measured using a modified implicit affect test and photoplethysmograph, respectively. Data were analyzed using analysis of covariance with age and sex as covariates.MS patients had higher levels of depression, anxiety, panic attacks, obsessive-compulsiveness, aggression, paranoia, interpersonal sensitivity, self-regulation problems, stress vulnerability, and lower psychological quality of life (QOL) compared with NMO patients. The PO and NB and HRV values were not significantly different between groups. However, NMO patients had lower QOL, and higher levels of hopelessness, suicidality, and fatigue than the normal range. Disease duration was associated with hopelessness in NMO patients and with several psychiatric disturbances, but not hopelessness, in MS patients.Subjective psychiatric disturbances were more severe in patients with MS than in those with NMO, whereas PO and NB and HRV in patients with NMO were comparable with those of MS patients. Our findings highlight the need for different clinical approaches to assess and treat psychiatric disturbances in patients with MS and NMO.


Assuntos
Transtornos Mentais/etiologia , Esclerose Múltipla/psicologia , Neuromielite Óptica/psicologia , Adulto , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Neuromielite Óptica/complicações , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno de Pânico/etiologia , Transtornos Paranoides/etiologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia
2.
Ideggyogy Sz ; 72(9-10): 317-323, 2019 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31625698

RESUMO

Gait disturbance is a major symptom in patients with multiple sclerosis. The Expanded Disability Status Scale (EDSS) was first used in clinical trials of multiple sclerosis for the assessment of disability, however it has become more and more widely used in clinical practice as well. Nowadays its use is essential in application of the new diagnostic criteria, the new clinical form classification and in monitoring the efficacy of therapies. EDSS is based on a standardised neurological examination, but focuses on those symptoms that are frequent in multiple sclerosis. Based on the examination it assesses seven functional systems: visual, brainstem, pyramidal, cerebellar, sensory, bowel-bladder and cerebral functions. EDSS scores can be determined based on the scores given in the functional systems and on testing the walking distance. In newer versions the "Ambulation score" has been added. This chapter clarifies the scores based on the maximal walking distance and the need for a walking aid to walk this distance. The Neurostatus/EDSS training method improves the reproducibility of the standardised neurological examination that forms the basis of the EDSS scoring. Of the tests assessing walking, the Timed-25 Foot Walk Test and the self-administered 12-Item Multiple Sclerosis Walking Scale are suitable for routine evaluation of walking performance. An increase of more than 20% in the Timed-25 Foot Walk may be considered a significant change in gait.


Assuntos
Pessoas com Deficiência , Marcha , Esclerose Múltipla/diagnóstico , Caminhada/fisiologia , Avaliação da Deficiência , Marcha/fisiologia , Humanos , Esclerose Múltipla/complicações , Reprodutibilidade dos Testes
4.
Health Qual Life Outcomes ; 17(1): 136, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382960

RESUMO

BACKGROUND: Fatigue has a major influence on the quality of life of people with multiple sclerosis. The Fatigue Severity Scale is a frequently used patient-reported measure of fatigue impact, but does not generate the health state utility values required to inform cost-effectiveness analysis, limiting its applicability within decision-making contexts. The objective of this study was to use statistical mapping methods to convert Fatigue Severity Scale scores to health state utility values from three preference-based measures: the EQ-5D-3L, SF-6D and Multiple Sclerosis Impact Scale-8D. METHODS: The relationships between the measures were estimated through regression analysis using cohort data from 1056 people with multiple sclerosis in South West England. Estimation errors were assessed and predictive performance of the best models as tested in a separate sample (n = 352). RESULTS: For the EQ-5D and the Multiple Sclerosis Impact Scale-8D, the best performing models used a censored least absolute deviation specification, with Fatigue Severity Scale total score, age and gender as predictors. For the SF-6D, the best performing model used an ordinary least squares specification, with Fatigue Severity Scale total score as the only predictor. CONCLUSIONS: Here we present algorithms to convert Fatigue Severity Scales scores to health state utility values based on three preference-based measures. These values may be used to estimate quality-adjusted life-years for use in cost-effectiveness analyses and to consider the health-related quality of life of people with multiple sclerosis, thereby informing health policy decisions.


Assuntos
Fadiga/psicologia , Esclerose Múltipla/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Tomada de Decisão Clínica/métodos , Estudos de Coortes , Análise Custo-Benefício , Inglaterra , Fadiga/etiologia , Feminino , Humanos , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença
6.
Cochrane Database Syst Rev ; 5: CD009903, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-31150100

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis of MS. This condition has been named 'chronic cerebrospinal venous insufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS. This is an update of a review first published in 2012. OBJECTIVES: To assess the benefit and safety of venous PTA in people with MS and CCSVI. SEARCH METHODS: We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Specialised Register up to 30 August 2018, CENTRAL (in the Cochrane Library 2018, issue 8), MEDLINE up to 30 August 2018, Embase up to 30 August 2018, metaRegister of Controlled Trials, ClinicalTrials.gov., the Australian New Zealand Clinical Trials Registry, and the World Health Organization (WHO) International Clinical Trials Registry platform. We examined the bibliographies of the included and excluded studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in which PTA and sham interventions were compared in adults with MS and CCSVI. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias, and extracted data. We reported results as risk ratios (RR) with 95% confidence intervals (CI). We performed statistical analyses using the random-effects model; and we assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included three RCTs (238 participants) in this update. One hundred and thirty-four participants were randomised to PTA and 104 to sham treatment. We attributed low risk of bias to two (67%) studies for sequence generation and two (67%) studies for performance bias. All studies were at a low risk of detection bias, attrition bias, reporting bias and other potential sources of bias.There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure (RR 3.33, 95% CI 0.36 to 30.44; 3 studies, 238 participants); nor did it increase the proportion of patients who improved on a functional composite measure including walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity over 12-month follow-up (RR 0.84, 95% CI 0.55 to 1.30; 1 study, 110 participants); nor did it reduce the proportion of patients who experienced new relapses at six- or 12-month follow-up (RR 0.87, 95% CI 0.51 to 1.49; 3 studies, 235 participants). There was no effect of venous PTA on disability worsening measured by the Expanded Disability Status Scale, which was reported at follow-up intervals of six months (one study), 11 months (one study) and 12 months (one study). Quality of life was reported in two studies with no difference between treatment groups. Moderate or severe pain during or post venography was reported in both PTA and sham-procedure participants in all included studies. Venous PTA was not effective in restoring blood flow assessed at one-month (one study) or 12-month follow-up (one study). AUTHORS' CONCLUSIONS: This systematic review identified moderate-quality evidence that, compared with sham procedure, venous PTA intervention did not provide benefit on patient-centred outcomes (disability, physical or cognitive functions, relapses, quality of life) in people with MS. Venous PTA has proven to be a safe technique but in view of the available evidence of its ineffectiveness, this intervention cannot be recommended in people with MS. All ongoing trials were withdrawn or terminated and hence this updated review is conclusive. No further randomised clinical studies are needed.


Assuntos
Angioplastia/métodos , Circulação Cerebrovascular/fisiologia , Esclerose Múltipla/complicações , Insuficiência Venosa/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Venosa/etiologia
7.
Semin Ophthalmol ; 34(4): 270-278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158038

RESUMO

In the past decade, the available disease-modifying therapies for multiple sclerosis have broadened significantly, providing physicians and patients with multiple options with different mechanisms of action, administration routes, and risk-benefit profiles. Multiple sclerosis often presents with ophthalmic manifestations due to inflammatory demyelination of the afferent and efferent visual pathways, and evidence of disease can factor into the decision to initiate or substitute a particular therapy. Furthermore, some of these drugs have toxicities that can manifest with ophthalmic complications, of which ophthalmologists should be aware.


Assuntos
Esclerose Múltipla/complicações , Neurite Óptica/tratamento farmacológico , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Terapia Baseada em Transplante de Células e Tecidos/métodos , Humanos , Imunossupressores/uso terapêutico , Imunoterapia/métodos , Esclerose Múltipla/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Neurite Óptica/etiologia
8.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(2. Vyp. 2): 42-48, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31156240

RESUMO

AIM: To study the influence of psychopathological factors and personality traits on the results of the study of quality of life (QoL) in patients with multiple sclerosis (MS). MATERIAL AND METHODS: Forty-three patients with relapsing MS were included in the study (74.4% female; mean age 33.1 years). SF-36 was used to evaluate QoL. Effects of psychopathological factors, cognitive regulation of emotions and personality traits on QoL were studied. Statistical analysis was performed using multiple linear model. RESULTS AND DISCUSSION: A wide number of strategies of cognitive regulation of emotions has conflicting effects on the physical component of QoL; subscales of anhedonic depression and anxious arousal (MASQ), which probably represent depressive and anxiety disorders, decrease the physical component of QoL. The key factors of the mental component of QoL include psychopathological factors (mostly obsessive-compulsive symptoms) and personality traits (the more intense they are the lower is QoL). Strategies of cognitive regulation of emotions have low impact on the mental component of QoL.


Assuntos
Esclerose Múltipla , Personalidade , Qualidade de Vida , Adulto , Ansiedade , Depressão , Feminino , Humanos , Masculino , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Inquéritos e Questionários
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(2. Vyp. 2): 86-93, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31156246

RESUMO

Data of clinical-epidemiological studies on the risk of cancer in patients with multiple sclerosis (MS) are discussed. A trend towards increased risks of brain tumors and urological cancers has been shown. The author considers risk factors, including disease modifying therapies (DMT), for different cancers. It has been concluded that longitudinal observational and large cohort studies along with MS registers are needed to clarify a role of DMD in the development of malignant neoplasms.


Assuntos
Esclerose Múltipla , Neoplasias , Comorbidade , Humanos , Esclerose Múltipla/complicações , Neoplasias/complicações , Fatores de Risco
10.
BMC Neurol ; 19(1): 142, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238966

RESUMO

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The majority of approaches for managing MS fatigue typically require participation in a structured, time-limited program with a fixed sequence of topics and activities. MS INFoRm (Multiple Sclerosis: An Interactive Fatigue Management Resource) is a self-directed MS fatigue management resource incorporating principles of self-management and adult learning. Positive results from a feasibility pilot study of a USB-delivered version of MS INFoRm led to the current trial and adaptation of MS INFoRm to a website format. The specific aims of the proposed study are to (a) to determine the effectiveness and efficacy of 3-month use of MS INFoRm on fatigue impact (primary outcome) among persons with MS, (b) to determine whether 3-month use of MS INFoRm results in improvement in secondary outcomes of self- efficacy for managing MS fatigue, self-reported cognitive function, participation and autonomy, and depression, and (c) to determine whether any improvements in primary and secondary outcomes are maintained among the MS INFoRm users after 6-months. METHODS/DESIGN: Parallel group, two arm, double-blinded superiority trial with a 1:1 allocation. Two hundred persons with MS will be randomly assigned to either an intervention (MS INFoRm) or usual care control group in which they will be given 3-month access to either the MS INFoRm website (intervention group) or a control webpage containing widely available resources on MS fatigue (control group). Baseline, immediate post-intervention (3-months), and follow-up (6-months post intervention) evaluations will take place on primary (Modified Fatigue Impact Scale) and secondary (Multiple Sclerosis Self-Efficacy Scale, Perceived Deficits Questionnaire, Center for Epidemiologic Studies Depression Scale, and Impact on Participation and Autonomy Questionnaire) measures. Hypothesis testing will involve independent samples t-tests and mixed effects ANOVAs. DISCUSSION: People with MS may benefit from easily accessible and self-directed fatigue management resources based on self-management and adult learning principles. The proposed study will provide crucial evidence about the potential of MS INFoRm as a self-management tool that can be made widely available to persons with MS as a means to effectively reduce the daily impact of MS fatigue. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03362541 . Posting date December 5, 2017.


Assuntos
Fadiga/etiologia , Fadiga/terapia , Internet , Esclerose Múltipla/complicações , Autogestão/métodos , Adulto , Método Duplo-Cego , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Projetos de Pesquisa , Inquéritos e Questionários
11.
Rev. neurol. (Ed. impr.) ; 68(11): 468-479, 1 jun., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180792

RESUMO

La reunión Post-ECTRIMS se celebró por undécimo año consecutivo el pasado octubre de 2018 en Madrid, con el objetivo de analizar los avances en esclerosis múltiple destacados en el último congreso anual ECTRIMS. Fruto de esta reunión, formada por los líderes de opinión en esclerosis múltiple de ámbito nacional, se presentan dos artículos de revisión. En esta segunda parte, se incluye el creciente número de evidencias que confirman la seguridad de la exposición a los tratamientos modificadores de la enfermedad en mujeres que planifican un embarazo, y el efecto beneficioso de la lactancia, siempre y cuando la enfermedad no esté muy activa. Se abordan los datos que muestran cómo la aplicación de los criterios de McDonald de 2017 en población pediátrica ha mejorado considerablemente el diagnóstico en comparación con los criterios anteriores. En cuanto a la esclerosis múltiple progresiva, los resultados de los fármacos neuroprotectores son poco concluyentes, pero se proponen biomarcadores para mejorar la evaluación de la respuesta terapéutica. Los estudios sobre tratamientos de reparación de la mielina sugieren que la remielinización en la esclerosis múltiple es posible. De igual manera, se exponen indicios favorables sobre el trasplante de células madre hematopoyéticas, siempre que se seleccione adecuadamente a los pacientes. Por otro lado, se revisan las similitudes y diferencias de las recomendaciones de las nuevas guías de práctica clínica publicadas. Por último, los resultados positivos de la rehabilitación cognitiva y motora con el uso de las nuevas tecnologías vaticinan la incorporación sistemática de estas herramientas en el tratamiento de la enfermedad en un futuro próximo


The Post-ECTRIMS Meeting was held for the eleventh consecutive year in October 2018 in Madrid, with the aim of analysing the advances made in multiple sclerosis that were highlighted at the latest ECTRIMS annual congress. Based on the issues discussed at this meeting, attended by the nation’s foremost opinion leaders on multiple sclerosis, two review articles are presented. This second part includes the growing body of evidence confirming the safety of exposure to disease-modifying treatments in women planning a pregnancy, and the beneficial effect of breastfeeding, provided that the disease is not very active. It addresses data showing how the application of the 2017 McDonald criteria in the paediatric population has significantly improved diagnosis compared to the previous criteria. With regard to progressive multiple sclerosis, the results of neuroprotective drugs are inconclusive, but biomarkers are proposed to improve the evaluation of the therapeutic response. Studies on myelin repair treatments suggest that remyelination in multiple sclerosis is possible. Likewise, there are favourable indications for haematopoietic stem cell transplantation, provided that patients are selected appropriately. On the other hand, we also conduct a review of the similarities and differences of the recommendations in the new clinical practice guidelines. Finally, the positive results of cognitive and motor rehabilitation with the use of new technologies point to the systematic incorporation of these tools in the treatment of the disease in the near future


Assuntos
Humanos , Criança , Esclerose Múltipla/epidemiologia , Fármacos Neuroprotetores/uso terapêutico , Transplante de Células-Tronco/tendências , Resultado do Tratamento , Esclerose Múltipla/complicações , Esclerose Múltipla/reabilitação , Sociedades Médicas/normas , Farmacovigilância , Planejamento Familiar , Complicações na Gravidez , Aleitamento Materno , Transtornos Neurológicos da Marcha/reabilitação , Necessidades e Demandas de Serviços de Saúde
12.
J Clin Neurosci ; 65: 28-33, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31072740

RESUMO

BACKGROUND: Impairment of cognition and speech are common in multiple sclerosis (MS) patients, but their relationship is not well understood. OBJECTIVE: To describe the relationship between articulation rate characteristics and processing speed and to investigate the potential role of objective speech analysis for the detection of cognitive decline in MS. METHODS: A total of 122 patients with clinically definite MS were included in this cross-sectional pilot study. Patients underwent three speaking tasks (oral diadochokinesis, reading text and monologue) and assessment of processing speed (Symbol Digit Modalities Test [SDMT], Paced Auditory Serial Addition Test-3 s [PASAT-3]). Association between articulation rate and cognition was analyzed using linear regression analysis. We estimated the area under the receiver operating characteristics curves (AUC) to evaluate the predictive accuracy of articulation rate measures for the detection of abnormal processing speed. RESULTS: We observed an association between articulation rate and cognitive measures (rho = 0.45-0.58; p < 0.001). Faster reading speed by one word per second was associated with an 18.7 point (95% confidence interval [CI] 14.9-22.5) increase of the SDMT score and 14.7 (95% CI 8.9-20.4) point increase of PASAT-3 score (both p < 0.001). AUC values of articulation rate characteristics for the identification of processing speed impairment ranged between 0.67 and 0.79. Using a cutoff of 3.10 in reading speed, we were able to identify impairment in both the SDMT and PASAT-3 with 91% sensitivity and 54% specificity. CONCLUSION: Slowed articulation rate is strongly associated with processing speed decline. Objective quantitative speech analysis identified patients with abnormal cognitive performance.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Disartria/etiologia , Esclerose Múltipla/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Curva ROC , Análise de Regressão
13.
Acta Neurol Scand ; 140(3): 204-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31121055

RESUMO

OBJECTIVES: Modifiable lifestyle factors are implicated in multiple sclerosis (MS) symptoms but their role in mood is unclear. This study aimed to investigate associations between lifestyle and depression and anxiety in Australian participants with MS. MATERIALS AND METHODS: Self-reported data from the Australian Multiple Sclerosis Longitudinal Study included the Hospital Anxiety and Depression Scale (HADS) and lifestyle measurements from 1500 participants. SNAP score (range 0-5) was the sum of non-smoking, sufficient fruit/vegetable intake, non-hazardous alcohol consumption, sufficient physical activity and healthy BMI. Analyses by log-binomial and linear regression were adjusted for confounding. RESULTS: Symptoms of depression and anxiety were prevalent in 27% and 40%, respectively; 20% had both. Mean SNAP score was 2.7/5; only 3% met all healthy lifestyle recommendations. Only 10% reported adequate fruit/vegetable intake, and 22% reported a combination of unhealthy BMI, inadequate physical activity and inadequate nutrition. A healthier SNAP score was associated with lower depression prevalence (adjusted prevalence ratio 0.83 [95% CI 0.75, 0.92] per unit increase) and depression severity (adjusted ß-0.44 [95% CI -0.64, -0.24]), but not with anxiety. CONCLUSIONS: Modifiable lifestyle factors are associated with lower frequency and severity of depression, but not anxiety, in Australian people with multiple sclerosis. The associations between a healthier SNAP score and lower depression are likely bi-directional. SNAP risk factor prevalence and co-occurrence, especially inadequate nutrition and low physical activity, were high among Australians with MS.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Esclerose Múltipla/psicologia , Adulto , Afeto , Exercício , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/epidemiologia , Fatores de Risco
14.
A A Pract ; 12(9): 308-312, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048600

RESUMO

Non-paresthesia-free spinal cord stimulation (PF-SCS) has been successfully used in treating central pain syndromes in multiple sclerosis (MS) patients. However, the efficacy of PF-SCS in MS is unknown. Here, we present the case of an MS patient (13-year history) with late-stage disease. Her concomitant central pain and spasticity failed multiple attempts of medical management despite escalating multimodal pharmacological regimens. A trial and subsequent permanent placement of dorsal column spinal cord stimulator with paresthesia-free programming was successful in managing her central pain, illustrating a potential role of PF-SCS in treating patients with MS.


Assuntos
Esclerose Múltipla/complicações , Neuralgia/terapia , Paralisia/terapia , Estimulação da Medula Espinal/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular , Neuralgia/etiologia , Medição da Dor , Resultado do Tratamento
15.
Neurología (Barc., Ed. impr.) ; 34(4): 259-269, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180816

RESUMO

Antecedentes: La esclerosis múltiple (EM) es una enfermedad en cuyo curso influyen el género, los factores hormonales y el embarazo. Objetivos: Realizar un análisis de la influencia de esos factores para aportar información sobre los mecanismos etiopatogénicos involucrados en la enfermedad. Métodos: Revisión exhaustiva de publicaciones científicas (búsqueda en la base de datos PubMed utilizando los términos: esclerosis múltiple, EM, EAE, embarazo, factores hormonales, tratamiento y términos relacionados), de los avances presentados en una reunión organizada por el Comité Europeo para el Tratamiento e Investigación de Esclerosis Múltiple (ECTRIMS), celebrado en marzo de 2013 en Londres, así como de las recomendaciones de reconocidos expertos internacionales. Resultados y conclusiones: Se ofrecen recomendaciones para el asesoramiento y la gestión de personas con EM antes de la concepción, durante el embarazo y después del parto. Se comentan también los conocimientos actuales sobre el efecto del tratamiento en la madre, el feto y el recién nacido. Realizamos recomendaciones para investigaciones futuras a fin de subsanar deficiencias de conocimiento y aclarar incoherencias de los datos actualmente disponibles


Background: The course of multiple sclerosis (MS) is influenced by sex, pregnancy and hormonal factors. Aims: To analyse the influence of the above factors in order to clarify the aetiopathogenic mechanisms involved in the disease. Methods: We conducted a comprehensive review of scientific publications in the PubMed database using a keyword search for 'multiple sclerosis', 'MS', 'EAE', 'pregnancy', 'hormonal factors', 'treatment', and related terms. We reviewed the advances presented at the meeting held by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in March 2013 in London, as well as recommendations by international experts. Results and conclusions: We provide recommendations for counselling and treating women with MS prior to and during pregnancy and after delivery. Current findings on the effects of treatment on the mother, fetus, and newborn are also presented. We issue recommendations for future research in order to address knowledge gaps and clarify any inconsistencies in currently available data


Assuntos
Humanos , Feminino , Gravidez , Esclerose Múltipla/complicações , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Fatores Sexuais , Hormônios Esteroides Gonadais/fisiologia , Aleitamento Materno
16.
Psychiatr Danub ; 31(Suppl 1): 118-125, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30946730

RESUMO

BACKGROUND: Multiple sclerosis is a chronic neurologic condition with a variety of symptoms which have a great impact on quality of life even in the early stages. The aim of this study was to investigate, and to compare overall subjective quality of life with self-perceived health in patients with early stages of MS. SUBJECTS AND METHODS: Thirty patients with MS (22 women, 8 men; mean age 37.3±9.7years; relapsing-remitting MS; EDSS<2.5; all on immunomodulatory therapy: IFN, GA) were enrolled in the study. The QOL was assessed using the Personal well-being index (PWI) and health was measured by the Short Form 36-Item Health Survey (SF-36) questionnaire. RESULTS: Results indicate that MS patients in early stage experience similar health and quality of life, comparing to the general adult population. Analysis of self-reported change in health by categories showed that 50% patients access their health about the same as a year before, 9 rate their health as worse as one year before and 5 rate their health even better. Correlation analysis revealed that SF-36 domain Mental health correlates with most PWI domains. CONCLUSION: This study demonstrates that MS patients in early stage experience similar quality of life as general adult population. Also, it was revealed that health domain Mental health is correlated with various quality of life domains, suggesting that mental health is of great significance for subjective quality of life perception. However, it is important to emphasize the distinction between the health and quality of life, due to the fact that one can perceive his/hers own health as impaired, but at the same time can have satisfactory quality of life.


Assuntos
Nível de Saúde , Esclerose Múltipla , Qualidade de Vida , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Recidiva , Inquéritos e Questionários
17.
Klin Monbl Augenheilkd ; 236(4): 425-428, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30999347

RESUMO

BACKGROUND: Optic neuritis (ON) is a frequent manifestation of demyelinating attack in multiple sclerosis (MS). Initial visual loss can vary from minimal to complete. Visual improvement occurs in about 95% of patients, some of them recovering to normal [visual acuity (VA), color vision, visual field (VF)]. We analyzed retinal ganglion cell layer (RGCL) thickness in MS patients who recovered their normal vision after ON to determine whether a relative preservation of RGCL existed in these patients. MATERIALS AND METHODS: We conducted a retrospective study of all patients with MS and ON examined by one of us (F. X. B.) between 2013 and 2018. Inclusion criteria were strictly unilateral ON, full recovery of vision, computerized visual field, and OCT examinations. Full recovery of vision was defined as VA ≥ 10/10, Ishihara ≥ 11/13, and VF mean defect (MD) ≤ 2.6 dB. Evaluation of RGCL was obtained with spectral domain optical coherence tomography (SD-OCT). The normal fellow eye of all patients served as the control group. Relative thinning of RGCL, expressed as percentage, was calculated by comparing results from the affected eye to the fellow eye of the same patient. RESULTS: Twenty-one patients (21 affected eyes - Group 1, 21 normal fellow eyes - Group 2) satisfying the inclusion criteria were retrieved from our database. All patients exhibited the relapsing-remitting form of MS. There were 16 women and 5 men. Mean age was 39.3 years old. There were no statistically significant differences between Group 1 and Group 2 for either VA (p = 0.3934) or Ishihara (p = 0.140), but a significant difference was found for VF MD (p = 0.0405). A markedly significant difference for RGCL thickness (p = 0.0001) was found, without any correlation with the degree of visual recovery. A subgroup of patients (n = 14) was examined at the time of initial visual loss. We correlated their results of visual function to the final RGCL thickness, and a correlation was found between either the initial VA loss or the initial VF loss and the final loss of RGCL (R2 = 0.4075 and R2 = 0.00739, respectively). CONCLUSIONS: In our study, all patients with ON lost a significant amount of RGCL despite a full recovery of vision, as defined by our criteria. The percentage of RGCL loss varied from 5 - 27% and could not be correlated with any final visual indices. However, a correlation was found with the degree of initial visual loss. Despite sometimes marked RGCL loss after ON, patients with MS can recover normal visual function, according to standard clinical tests.


Assuntos
Esclerose Múltipla , Neurite Óptica , Células Ganglionares da Retina , Adulto , Feminino , Humanos , Masculino , Esclerose Múltipla/complicações , Neurite Óptica/etiologia , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Testes de Campo Visual
18.
J Clin Neurosci ; 65: 77-82, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31014906

RESUMO

Multiple sclerosis (MS) and cervical stenosis (CS) are two unique pathologies that can present with overlapping symptoms. In patients with concurrent MS and CS, the exact cause for worsening of symptoms is often difficult to decipher. In this study, we aimed to review the medical literature on the benefits of surgical decompression surgery in patients with coexisting CS and MS. We systematically reviewed the literature for articles published prior to December 1st, 2018 describing outcomes (improvement of symptoms of radiculopathy, myelopathy, and neck pain) in patients with coexisting MS and CS undergoing cervical decompression surgery. Effect sizes were calculated demonstrating the effect of surgical decompression on improving symptoms. We identified eight articles that satisfied our selection criteria, of which six provided data regarding symptoms after surgery. Our meta-analysis indicates that cervical decompression surgery in patients with coexisting MS and CS is beneficial in improving symptoms of myelopathy (ES 0.74, 95% CI 0.38-1.10, p < 0.0001), radiculopathy (ES 1.29, 95% CI 0.15-2.42, p < 0.001), and neck pain (ES 1.66, 95% CI 1.02-2.31, p < 0.0001). Our meta-analysis indicates that there is paucity of high level of evidence studies regarding the benefit of cervical decompression surgery in patients with concomitant CS and MS. However, the literature suggests that cervical decompression may be beneficial to such patients, providing stabilization or improvement in symptoms of myelopathy, radiculopathy, and neck pain. Spine surgeons must carefully delineate the cause of symptoms in patients to decide whether this is the optimal treatment for each individual patient.


Assuntos
Constrição Patológica/cirurgia , Esclerose Múltipla/cirurgia , Adulto , Vértebras Cervicais/cirurgia , Constrição Patológica/complicações , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Cervicalgia/complicações , Radiculopatia/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
19.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936345

RESUMO

Leber's hereditary optic neuropathy (LHON) is a mitochondrially inherited disorder characterised by bilateral, painless visual loss which leads to severe optic atrophy. It can be associated with other conditions including multiple sclerosis (MS), movement disorders, epilepsy and cardiac arrhythmias. The association of LHON with an MS-like illness is often referred to as Harding's disease (or Harding's syndrome). We report two siblings, who both harbour the 11 778 mitochondrial DNA (mtDNA) mutation, but who manifest markedly different clinical phenotypes; a male with classical LHON and a female with an MS-like illness. LHON affects males four to five times more often than females. By contrast, Harding's disease is seen predominantly in females, in a pattern comparable to that seen in MS. The pathogenic basis behind the variation in penetrance and phenotype between genders and individual family members remains unclear.


Assuntos
Esclerose Múltipla/fisiopatologia , Atrofia Óptica Hereditária de Leber/fisiopatologia , Mutação Puntual/genética , Transtornos da Visão/etiologia , DNA Mitocondrial/genética , Família , Feminino , Transtornos Neurológicos da Marcha/genética , Transtornos Neurológicos da Marcha/fisiopatologia , Aconselhamento Genético , Humanos , Imunoterapia , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/genética , Atrofia Óptica Hereditária de Leber/diagnóstico , Atrofia Óptica Hereditária de Leber/genética , Encaminhamento e Consulta , Distúrbios da Fala/genética , Distúrbios da Fala/fisiopatologia , Resultado do Tratamento , Transtornos da Visão/genética , Transtornos da Visão/fisiopatologia
20.
Invest Ophthalmol Vis Sci ; 60(5): 1372-1383, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30938772

RESUMO

Purpose: Eye movement abnormalities are common in multiple sclerosis (MS), and infrared oculography is a noninvasive method for quantification. This study aims to describe and classify abnormalities of visual fixation and their clinical relevance in MS. Methods: A validated standardized infrared oculography protocol, Demonstrate Eye Movement Networks with Saccades, was used for quantifying gaze stability during a fixation task in MS patients and healthy controls. Saccadic intrusions, gaze drift, and stability of fixation around the drift line were used to subclassify MS patients by performing receiver operating characteristic analyses of different parameters. The relationship between the presence of abnormalities of fixation and visual functioning was analyzed using logistic regression models, which was adjusted for possible confounders. Results: This cross-sectional study included 213 subjects with MS and 57 healthy controls. Square wave jerk abnormalities were present in 24% of MS patients. The prevalence was higher in more disabled subjects. The presence of larger square wave jerks (with a higher amplitude) in the MS patients was related to complaints of focusing on stationary objects (odds ratio, 2.2; P = 0.035) and a lower vision-related quality of life (odds ratio, 2.56; P = 0.012). Conclusions: This study provided a comprehensive overview of the characteristics of problems with visual fixation in subjects with MS. The most important and most common finding was the presence of larger square wave jerks during fixation, which was related to visual functioning in daily life.


Assuntos
Fixação Ocular/fisiologia , Esclerose Múltipla/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Qualidade de Vida , Curva ROC
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