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1.
Rev Lat Am Enfermagem ; 27: e3183, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596417

RESUMO

OBJECTIVE: describe the self-care and functionality levels of patients with multiple sclerosis and determine whether sociodemographic, clinical and functional variables interfere with self-care and/or functionality. METHOD: correlational, cross-sectional study with a quantitative approach performed with individuals in outpatient follow-up. We collected sociodemographic and clinical data and applied the Appraisal of Self-care Agency Scale, the Barthel index, the Lawtton and Brody Scale, and the instrument to investigate the performance in Advanced Activities of Daily Living. We performed descriptive and inferential analysis. RESULTS: most patients were classified as "having self-care" (82.14%); with moderate dependence (51.19%) for the basic activities of daily living, partial dependence for the instrumental activities of daily living (55.95%), and more active for the advanced activities of daily living (85.71%). Patients with longer disease duration had a higher number of disabilities and, in those with better socioeconomic and educational profile, the functionality was better. CONCLUSION: disease duration was strongly correlated with a higher number of disabilities and better socioeconomic and educational profiles showed to be protective factors for functionality. Care planning should consider the needs observed by the multidisciplinary team, stimulating the development of self-care, functionality and sociability.


Assuntos
Atividades Cotidianas , Esclerose Múltipla/fisiopatologia , Autocuidado , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
2.
Adv Exp Med Biol ; 1161: 133-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562628

RESUMO

Bioactive lipids, or lipid mediators, are utilized for intercellular communications. They are rapidly produced in response to various stimuli and exported to extracellular spaces followed by binding to cell surface G protein-coupled receptors (GPCRs) or nuclear receptors. Many drugs targeting lipid signaling such as non-steroidal anti-inflammatory drugs (NSAIDs), prostaglandins, and antagonists for lipid GPCRs are in use. For example, the sphingolipid analog, fingolimod (also known as FTY720), was the first oral disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (MS), whose mechanisms of action (MOA) includes sequestration of pathogenic lymphocytes into secondary lymphoid organs, as well as astrocytic modulation, via down-regulation of the sphingosine 1-phosphate (S1P) receptor, S1P1, by in vivo-phosphorylated fingolimod. Though the cause of MS is still under debate, MS is considered to be an autoimmune demyelinating and neurodegenerative disease. This review summarizes the involvement of bioactive lipids (prostaglandins, leukotrienes, platelet-activating factors, lysophosphatidic acid, and S1P) in MS and the animal model, experimental autoimmune encephalomyelitis (EAE). Genetic ablation, along with pharmacological inhibition, of lipid metabolic enzymes and lipid GPCRs revealed that each bioactive lipid has a unique role in regulating immune and neural functions, including helper T cell (TH1 and TH17) differentiation and proliferation, immune cell migration, astrocyte responses, endothelium function, and microglial phagocytosis. A systematic understanding of bioactive lipids in MS and EAE dredges up information about understudied lipid signaling pathways, which should be clarified in the near future to better understand MS pathology and to develop novel DMTs.


Assuntos
Encefalomielite Autoimune Experimental , Metabolismo dos Lipídeos , Lipídeos , Esclerose Múltipla , Doenças Neurodegenerativas , Animais , Modelos Animais de Doenças , Lipídeos/química , Esclerose Múltipla/fisiopatologia , Doenças Neurodegenerativas/enzimologia , Doenças Neurodegenerativas/imunologia , Doenças Neurodegenerativas/fisiopatologia
3.
Postgrad Med ; 131(7): 523-532, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31478421

RESUMO

Objectives: Many people affected by multiple sclerosis (MS) experience cognitive impairment, especially decreases in information processing speed (PS). Neural disconnection is thought to represent the neural marker of this symptom, although the role played by alterations of specific functional brain networks still remains unclear. The aim is to investigate and compare patterns of association between PS-demanding cognitive performance and functional connectivity across two MS phenotypes. Methods: Forty patients with relapsing-remitting MS (RRMS) and 25 with secondary progressive MS (SPMS) had neuropsychological and MRI assessments. Multiple regression models were used to investigate the relationship between performance on tests of visuomotor and verbal PS, and on the verbal fluency tests, and functional connectivity of four cognitive networks, i.e. left and right frontoparietal, salience and default-mode, and two control networks, i.e. visual and sensorimotor. Results: Patients with SPMS were older and had longer disease history than patients with RRMS and presented with worse overall clinical conditions: higher disease severity, total lesion volume, and cognitive impairment rates. However, in both patient samples, cognitive performance across tests was negatively correlated with functional connectivity of the salience and default-mode networks, and positively with connectivity of the left frontoparietal network. Only the visuomotor PS scores of the RRMS group were also associated with connectivity of the sensorimotor network. Conclusions: PS-demanding cognitive performance in patients with MS appears mainly associated with strength of functional connectivity of frontal networks involved in the evaluation and manipulation of information, as well as the default mode network. These results are in line with the hypothesis that multiple neural networks are needed to support normal cognitive performance across MS phenotypes. However, different PS measures showed partially different patterns of association with functional connectivity. Therefore, further investigations are needed to clarify the contribution of inter-network communication to specific cognitive deficits due to MS.


Assuntos
Encéfalo/diagnóstico por imagem , Esclerose Múltipla Crônica Progressiva/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Adulto , Idoso , Encéfalo/fisiopatologia , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiopatologia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Esclerose Múltipla Crônica Progressiva/fisiopatologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Desempenho Psicomotor
4.
NeuroRehabilitation ; 44(4): 587-597, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256089

RESUMO

BACKGROUND: Downslope walking (DSW) is an eccentric-based exercise intervention that promotes neuroplasticity of spinal reflex circuitry by inducing depression of Soleus Hoffman (H)-reflexes in young, neurologically unimpaired adults. OBJECTIVE: The objective of the study was to evaluate the effects of DSW on spinal excitability (SE) and walking function (WF) in people with multiple sclerosis (PwMS). METHODS: Our study comprised two experiments on 12 PwMS (11 women; 45.3±11.8 years). Experiment 1 evaluated acute effects of a single 20-minute session of treadmill walking at three different walking grades on SE, 0% or level walking (LW), - 7.5% DSW, and - 15% DSW. Experiment 2 evaluated the effects of 6 sessions of DSW, at - 7.5% DSW (with second session being - 15% DSW) on SE and WF. RESULTS: Experiment 1 showed significantly greater acute % H-reflex depression following - 15% DSW compared to LW (p = 0.02) and - 7.5% DSW (p = 0.05). Experiment 2 demonstrated significant improvements in WF. PwMS who showed greater acute H-reflex depression during the - 15% DSW session also demonstrated greater physical activity, long-distance WF, and the ability to have greater H-reflex depression after DSW training. Significant changes were not observed in regards to SE. CONCLUSIONS: Though significant changes were not observed in SE after DSW training, we observed an improvement in WF which merits further investigation of DSW in PwMS.


Assuntos
Teste de Esforço/métodos , Reflexo H/fisiologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/terapia , Caminhada/fisiologia , Adulto , Idoso , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Músculo Esquelético/fisiopatologia , Plasticidade Neuronal/fisiologia , Resultado do Tratamento , Adulto Jovem
5.
Postgrad Med ; 131(7): 486-489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31353999

RESUMO

Objective: The objective of this study was to evaluate the efficacy and safety of rituximab (RTX) treatment given off-label to Cypriot patients with multiple sclerosis (MS). Methods: Clinical data from 30 MS patients ever treated with off-label RTX until mid-2018 at the Cyprus Institute of Neurology and Genetics were retrospectively collected and reviewed. The heterogeneous patient cohort included patients with relapsing-remitting MS (RRMS), primary progressive MS (PPMS) and secondary progressive MS (SPMS). Outcome data (relapse rate and EDSS progression) as well as adverse effects for patients with a follow-up period of >12 months (n = 13) were recorded. Results: Following RTX administration, all patients with RRMS remained relapse free and had a stable or slightly improved EDSS score (mean EDSS before treatment = 6, mean EDSS at 12 months = 4.75). Patients with SPMS had a significant reduction in their relapse rate and a stabilization or slight improvement of their EDSS scores (mean EDSS before treatment = 6.25, mean EDSS at 12 months = 5.5). Only one of the patients with PPMS had a follow-up period of >12 months and his EDSS score remained unchanged. Rituximab infusions were generally well tolerated; there were only seven grade 3 or 4 adverse events recorded. Conclusion: Our results are in agreement with larger retrospective studies in which it was demonstrated that RTX was well tolerated and effective in treating RRMS and SPMS patients by reducing relapse rate and stabilizing disease.


Assuntos
Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Rituximab/uso terapêutico , Adulto , Chipre , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Uso Off-Label , Estudos Retrospectivos , Resultado do Tratamento
6.
BMC Neurol ; 19(1): 119, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31179920

RESUMO

BACKGROUND: The use of vestibular rehabilitation principles in the management of gaze and postural stability impairments in people with multiple sclerosis (PwMS) has shown promise in pilot work completed in our lab and in a recently published randomized clinical trial (RCT). However, further work is needed to fully quantify the gaze and postural impairments present in people with multiple sclerosis and how they respond to rehabilitation. METHODS/DESIGN: The study is a single blind RCT designed to examine the benefit of a gaze and postural stability (GPS) intervention program compared to a standard of care (SOC) rehabilitation program in dizzy and balance impaired PwMS. Outcomes will be collected across the domains of body structure and function, activity, and participation as classified by the World Health Organization International Classification of Functioning, Disability, and Health (ICF). Our primary outcomes are the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA). Secondary outcomes include other measures of gaze and postural stability, fatigue, and functional mobility. Participants who are interested and eligible for enrollment will be consented prior to completing a baseline assessment. Following the baseline assessment each participant will be randomized to either the GPS or SOC intervention group and will complete a 6 week treatment period. During the treatment period, both groups will participate in guided exercise 3x/week. Following the treatment period participants will be asked to return for a post-treatment evaluation and again for a follow-up assessment 1 month later. We anticipate enrolling 50 participants. DISCUSSION: This study will be an innovative RCT that will utilize gaze and postural stability metrics to assess the efficacy of vestibular rehabilitation in PwMS. It will build on previous work by examining measures across the ICF and improve the current evidence base for treating PwMS. TRIAL REGISTRATION: ClinicalTrials.gov, May 29th 2018, NCT03521557 .


Assuntos
Fixação Ocular/fisiologia , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Equilíbrio Postural/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia
7.
Life Sci ; 232: 116501, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31163175

RESUMO

AIMS: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). The disease mechanisms driving progressive MS remain unresolved. Without this information, current therapeutic strategies are unsatisfactory in preventing disease progression. Our previous work revealed that DL-3-n-butylphthalide (NBP) treatment reduced demyelination in an ethidium bromide mouse model of demyelination. Here, we examine the effect of NBP in the cuprizone model of demyelination by evaluating the pathologic, functional, and behavioral consequences of treatment with NBP. MATERIALS AND METHODS: Forty mice were divided randomly into 4 groups: a normal diet group, a cuprizone diet group, and two NBP groups (10 and 20 mg/kg). CNS infiltration by microglia, axon health and myelination were assessed using immunohistochemistry and electron microscopy, and the levels of cytoplasmic complexes were assessed by Western blotting. KEY FINDINGS: The results showed the neuroprotective effects of the NBP included suppressing the microglia activation through inhibition of nuclear factor-κB (NF-κB) expression, thus decreasing activation of the NF-κB signaling pathway. In particular, myelin density was increased due to an increased mean number of mature oligodendrocytes (OLs) in the high-dose NBP (20 mg/kg) subgroup through reduced oligodendrocyte apoptosis. Meanwhile, increased expression of myelin sheath proteins, including proteolipid protein (PLP) and myelin basic protein (MBP), was observed in the same subgroup. SIGNIFICANCE: These data suggest that NBP may not only have anti-inflammatory properties but also promote the survival of OLs in a mouse cuprizone model of demyelination. NBP may have a potential role in the treatment of MS.


Assuntos
Benzofuranos/farmacologia , Doenças Desmielinizantes/tratamento farmacológico , Esclerose Múltipla/metabolismo , Animais , Astrócitos/metabolismo , Axônios/patologia , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/fisiologia , Cuprizona/farmacologia , Doenças Desmielinizantes/metabolismo , Modelos Animais de Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microglia/efeitos dos fármacos , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/fisiopatologia , Bainha de Mielina/metabolismo , NF-kappa B/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Oligodendroglia/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos
10.
Clin Drug Investig ; 39(7): 607-624, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31054087

RESUMO

Multiple sclerosis (MS) is a devastating chronic autoimmune demyelinating disease of the central nervous system (CNS), thought to affect more than 2.5 million people worldwide. Regulation of the sleep-wake cycle might influence disease activity and the frequency of relapses in patients. As melatonin (or sleep hormone) involves the regulation of circadian rhythms, much attention has been paid to the management of MS symptoms with melatonin. This review describes the pharmacological mechanisms underlying the neuroprotective effects of melatonin and recent clinical evidence from MS patients. Apparent risks and benefits of melatonin therapies are also discussed. Various in vivo and clinical data presented in this up-to-date review suggest that melatonin may possibly possess a protective role against the behavioral deficits and neuropathological characteristics of MS. Multiple mechanisms of the neuroprotective effects of melatonin such as mitochondrial protection and antioxidant, anti-inflammatory, and anti-apoptotic properties, as well as its anti-demyelinating function are also discussed. A large body of evidence shows that melatonin potently regulates the immune system, demyelination, free radical generation, and inflammatory responses in neural tissue, which are mediated by multiple signal transduction cascades. In the present article, we focus on different pathways that are targeted by melatonin to prevent the development and progression of MS.


Assuntos
Melatonina/uso terapêutico , Esclerose Múltipla/fisiopatologia , Fármacos Neuroprotetores/uso terapêutico , Administração Oral , Animais , Disponibilidade Biológica , Feminino , Humanos , Melatonina/administração & dosagem , Melatonina/farmacocinética , Camundongos , Esclerose Múltipla/tratamento farmacológico , Ratos
11.
Muscle Nerve ; 60(2): 169-175, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31093980

RESUMO

INTRODUCTION: Hereditary transthyretin (hATTR) amyloidosis is a progressive, degenerative disease, with peripheral neuropathy, cardiomyopathy, and other clinical manifestations. In this study we examine the impact of hATTR amyloidosis on quality of life (QOL). METHODS: Neuropathy-specific QOL, measured with the Norfolk QOL-Diabetic Neuropathy questionnaire, was compared between patients with hATTR amyloidosis and patients with type 2 diabetes, whereas generic QOL, measured with the 36-item Short Form Health Survey version 2 (SF-36v2), was compared between patients with hATTR amyloidosis, the general population, and patients with chronic diseases. RESULTS: Neuropathy-specific QOL for patients with hATTR amyloidosis was nearly equivalent to that of patients with type 2 diabetes with diabetic neuropathy accompanied by a history of ulceration, gangrene, or amputation. Generic QOL was worse than that seen in the general population, with physical functioning worse than that for patients with multiple sclerosis and congestive heart failure. DISCUSSION: Patients with hATTR amyloidosis show significant burden on QOL, particularly in physical functioning. Muscle Nerve 60: 169-175, 2019.


Assuntos
Neuropatias Amiloides Familiares/fisiopatologia , Qualidade de Vida , Neuropatias Amiloides Familiares/psicologia , Estudos de Casos e Controles , Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/psicologia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia
12.
Rev. neurol. (Ed. impr.) ; 68(10): 431-441, 16 mayo, 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-180739

RESUMO

La reunión Post-ECTRIMS es un encuentro emblemático en España que persigue revisar y difundir los principales avances en esclerosis múltiple presentados en el congreso anual ECTRIMS. En octubre de 2018, la reunión Post-ECTRIMS celebró en Madrid su undécima edición, contando con los mayores expertos de ámbito nacional en esclerosis múltiple. Como resultado de esta reunión, se presentan dos artículos donde se recogen las novedades más destacadas en la misma. En esta primera parte se incluyen los últimos resultados sobre la influencia de los factores de riesgo modificables y no modificables en la esclerosis múltiple, destacando los progresos realizados en el ámbito genético, donde el descubrimiento de genes asociados a la esclerosis múltiple ha aumentado exponencialmente. Se aborda la complejidad del sistema inmune y se realizan algunas aportaciones sobre los mecanismos de autoinmunidad, en los que se observan relaciones bidireccionales entre las células inmunes y las células residentes del sistema nervioso central, como la microglía y los astrocitos. Los biomarcadores, tanto en suero y líquido cefalorraquídeo como de imagen, ganan cada vez más atención por su papel actual, y sobre todo potencial, en el diagnóstico y pronóstico de la enfermedad y en la evaluación de la eficacia de los tratamientos. Por último, se presentan las observaciones realizadas respecto a los cambios en la conectividad estructural y funcional en los pacientes y su relación con las alteraciones clínicas


The Post-ECTRIMS Meeting is an emblematic event in Spain which seeks to review and disseminate the main advances in multiple sclerosis presented at the ECTRIMS annual congress. In October 2018, the eleventh Post-ECTRIMS meeting was held in Madrid and was attended by the country’s leading experts in multiple sclerosis. As a result of this meeting, we present two articles which outline the most interesting novelties discussed there. This first part includes the latest results obtained regarding the influence of modifiable and non-modifiable risk factors in multiple sclerosis, with emphasis on the progress made in the field of genetics, where the discovery of genes associated with multiple sclerosis has increased exponentially. The complexity of the immune system is addressed and some contributions are made on autoimmunity mechanisms, in which bidirectional relations are observed between immune cells and cells residing in the central nervous system, such as microglial cells and astrocytes. Biomarkers, both in serum and cerebrospinal fluid as well as in imaging, are gaining more and more attention due to their current and, above all, potential role in the diagnosis and prognosis of the disease and in the evaluation of the efficacy of treatments. Finally, the observations made regarding changes in structural and functional connectivity in patients and their relationship with clinical alterations are presented


Assuntos
Humanos , Esclerose Múltipla , Biomarcadores , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/imunologia , Esclerose Múltipla/fisiopatologia , Congressos como Assunto , Espanha
13.
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
14.
Nat Neurosci ; 22(5): 709-718, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30988524

RESUMO

Disruption of the blood-brain barrier (BBB) is critical to initiation and perpetuation of disease in multiple sclerosis (MS). We report an interaction between oligodendroglia and vasculature in MS that distinguishes human white matter injury from normal rodent demyelinating injury. We find perivascular clustering of oligodendrocyte precursor cells (OPCs) in certain active MS lesions, representing an inability to properly detach from vessels following perivascular migration. Perivascular OPCs can themselves disrupt the BBB, interfering with astrocyte endfeet and endothelial tight junction integrity, resulting in altered vascular permeability and an associated CNS inflammation. Aberrant Wnt tone in OPCs mediates their dysfunctional vascular detachment and also leads to OPC secretion of Wif1, which interferes with Wnt ligand function on endothelial tight junction integrity. Evidence for this defective oligodendroglial-vascular interaction in MS suggests that aberrant OPC perivascular migration not only impairs their lesion recruitment but can also act as a disease perpetuator via disruption of the BBB.


Assuntos
Barreira Hematoencefálica/fisiopatologia , Encefalite/fisiopatologia , Esclerose Múltipla/fisiopatologia , Células Precursoras de Oligodendrócitos/fisiologia , Animais , Astrócitos/patologia , Astrócitos/fisiologia , Barreira Hematoencefálica/patologia , Movimento Celular , Células Cultivadas , Encefalite/patologia , Proteínas da Matriz Extracelular/metabolismo , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Camundongos , Esclerose Múltipla/patologia , Células Precursoras de Oligodendrócitos/patologia , Junções Íntimas/metabolismo , Substância Branca/patologia
15.
Complement Ther Med ; 43: 188-195, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30935529

RESUMO

INTRODUCTION: Multiple sclerosis (MS) is a chronic autoimmune disease affecting the myelinated axons of the central nervous system causing neurological deterioration. People living with MS have a poor quality of life (QOL) because of the symptoms caused by the disease and there are various types of treatments to manage the symptoms aside from medication. OBJECTIVE: This meta-analysis examines the effect of exercise, yoga and physiotherapy on the physical, mental and social QOL among individuals living with MS. SETTING: A systematic review with meta-analysis was conducted using PubMed, Medline, and Scopus from 1990 to 2017. The standard mean difference scores were computed in each study for the domains of physical, mental and social functioning. RESULTS: Eighteen studies met the inclusion criteria for this meta-analysis. Aerobic exercise was effective in improving satisfaction with physical functioning,d = 0.35 (95% CI = 0.08 to 0.62), mental functioning d = 0.42 (95% CI = 0.11 to 0.72), and social functioning d = 0.42 (95% CI = 0.15 to 0.69). Physiotherapy was also found to be effective for physical functioning d = 0.50 (95% CI 0.19 to 0.80), mental functioning d = 0.44 (95% CI 0.14 to 0.75) and social functioning d = 0.60 (95% CI 0.21 to 0.90). However yoga and combination of exercises did not have a significant effect on any of the QOL domains. CONCLUSION: These findings suggest that aerobic exercise and physiotherapy improves the satisfaction of MS patients with their physical, mental and social functioning and may be included as normal practice in the treatment of MS.


Assuntos
Exercício/fisiologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Qualidade de Vida/psicologia , Ioga/psicologia , Terapia por Exercício/métodos , Humanos , Modalidades de Fisioterapia/mortalidade
16.
Complement Ther Med ; 43: 240-246, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30935537

RESUMO

There is extensive data supporting a high prevalence of both overweight and obesity status in people with multiple sclerosis, and increases in body mass index has been associated with an increased risk of multiple sclerosis. Body composition may influence the course, treatment and management of multiple sclerosis. One proposed strategy for managing overweight and obesity status and associated secondary effects in people with multiple sclerosis involves increasing the levels of physical activity. In fact, increased levels of physical activity affect various physiological (endurance capacity, strength, balance) and biological processes (fat oxidation, insulin sensitivity, anti-inflammation, neurotrophic factors) which are known to be dysfunctional in multiple sclerosis and which may worsen with increases in obesity. When designing personalized exercise programs it should be kept in mind that current exercise recommendations for people with multiple sclerosis should exceed energy expenditure recommendations to efficiently counteract weight gain. Therefore, it is necessary to consider body composition as a primary endpoint in experimental studies. In addition, designing guidelines for weight control or weight loss in people MS is needed. The most comprehensive weight management guidelines are outlined in the American College of Sports Medicine Position Statement, which recommends between 150-250 min per week of moderate-intensity physical activity for preventing weight gain, and between 225-420 min per week of moderate-intensity physical activity for weight loss. These recommendations seem applicable for people with multiple sclerosis.


Assuntos
Peso Corporal/fisiologia , Exercício/fisiologia , Esclerose Múltipla/fisiopatologia , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Metabolismo Energético/fisiologia , Humanos
17.
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
18.
Cogn Behav Neurol ; 32(1): 1-10, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30896571

RESUMO

OBJECTIVE: To examine the associations between physical function (walking speed and endurance and functional mobility) and cognitive function (information processing speed and verbal memory) in older adults with multiple sclerosis (MS) and healthy controls. BACKGROUND: Older adults with MS have worse physical and cognitive function than older adults without MS and young and middle-aged adults with MS. To date, little is known about the associations between, or coupling of, physical and cognitive function outcomes in older adults with MS. METHODS: We administered physical and cognitive function measures to 40 older adults with MS and 40 demographically matched healthy controls. Pearson product moment correlations were used to examine bivariate linear relationships in the overall sample and in the subsamples of (a) older adults with MS and (b) healthy controls. Linear regression analyses were used to examine the independent associations between demographic characteristics and physical and cognitive function variables in the two subsamples. RESULTS: In the overall sample, all physical function variables were significantly correlated with cognitive function, as measured by information processing speed, and these correlations were mainly due to the subsample of older adults with MS. The linear regression analyses further indicated that information processing speed and years of education consistently explained variance in all physical function variables, beyond the influence of demographic variables, in older adults with MS. CONCLUSIONS: Physical function and information processing speed are strongly correlated in older adults with MS. Future research should examine underlying neurobehavioral mechanisms associated with physical and cognitive function as well as behavioral strategies for jointly improving these functions in older adults with MS.


Assuntos
Envelhecimento , Cognição/fisiologia , Esclerose Múltipla , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Pessoa de Meia-Idade , Limitação da Mobilidade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Resistência Física/fisiologia , Análise de Regressão , Velocidade de Caminhada/fisiologia
19.
Life Sci ; 224: 33-40, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30904492

RESUMO

G protein-coupled receptors (GPCRs) are a large family of transmembrane proteins that are expressed in many organs and serve as important drug targets. A new subgroup, namely orphan GPCRs, comprising many of these receptors has been discovered. These receptors exhibit diverse physiological functions and have been considered in many neurological disorders including Alzheimer's disease, Parkinson's disease, and multiple sclerosis (MS). GPR17, GPR30, GPR37, GPR40, GPR50, GPR54, GPR56, GPR65, GPR68, GPR75, GPR84, GPR97, GPR109, GPR124, and GPR126 are orphan GPCRs that have been reported with considerable effects in the prevention and/or treatment of MS in preclinical studies. In the present article, we reviewed the most recent findings regarding the role of orphan GPCRs in the treatment of MS.


Assuntos
Esclerose Múltipla/fisiopatologia , Receptores Acoplados a Proteínas-G/metabolismo , Animais , Humanos , Transdução de Sinais
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