Multiple sclerosis in Central America and Caribbean countries: frequency and clinical characterization of an emergent disease.

Background: Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results: Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3-3.5 × 100,000 inhabitants, and the lowest, 0.07-0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion: This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.

Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study.

Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0-52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren's syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0-3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08-0.41) and 0.73/100,000 (incidence 0.02-0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.

Costs of multiple sclerosis in Panama from societal, patient perspectives and health-related quality of life.

The purpose of this work is to estimate the costs associated with managing patients with MS in Panama and evaluating the impact of the disease on their health-related quality of life (HRQoL). Multicentric observational, retrospective, cross-sectional study. The costs were estimated from societal and patient perspectives and expressed in USD, 2015. The focus of the study is based on prevalence and on a "bottom-up" approach. To estimate the total cost per patient, annual reported use for each resource was multiplied by its unit cost. To evaluate HRQoL, patients completed the EQ-5D-3L questionnaire. 108 patients took part in the study. 82.41% were women with 44.78 (SD: 12.27) years. 61.11% presented mild (EDSS = 0-3.5), 25.93% moderate (EDSS = 3.5-6) and 12.96%, severe disability (EDSS≥6.5). The mean annual cost from the patient's perspective was estimated at 777.99 USD (SD: 1,741.45) per patient. The mean cost from a societal perspective was estimated at 23,803.21 USD (SD: 13,331.83) per patient. Disease-modifying therapies (DMT) accounted for the main component of the cost. A deterioration in HRQoL was observed as the disease advances and as disability increases, with mobility and usual activities being the areas most affected by its progression. From both perspective, the cost per MS patient in Panama is high. In addition to the high economic impact, MS also exerts a negative impact on patient HRQoL, which increases as the disease advances.

Enfermedad de motoneurona anterior: esclerosis lateral amiotrófica, Hospital Santo Tomás 1974-1985 / Anterior of motor neuron disease: amyotrophic lateral sclerosis, Hospital Santo Tomás 1974-1985

Se efectúa un estudio longitudinal y retrospectivo del comportamiento y manejo médico de la Esclerosis Lateral Amiotrófica (ELA), en el Hospital Santo Tomás (HST) de 1974-1985. Se revisaron 32 expedientes clínicos con diagnósticos de Enfermedad de Motoneurona Anterior (EMA), de los cuales 13 de ellos correspondían a ELA, 9 casos a otro tipo de EMA y 10 de ellos no llenaban los criterios diagnósticos para ser incluídos. El comportamiento clínico y evolución son similares a los descritos en la literatura mundial. Llamamos la atención a la correlación clínica, neuro-radiológica y electrofisiológica, para confirmar el diagnóstico. Se revisa la literatura

Enfermedades neurológicas asociadas al virus HTLV-1 en Panamá / Neurological Diseases Associated with Virus HTLV-1 in Panama

Estudios en seroprevalencia del virus Linfotrópico humano de Células T-(HTLV-1) efectuados entre 1984-86 en la República de Panamá demostraron una seroprevalencia nacional de 1 a 2 (por ciento). En la actualidad se realizan estudios clínicos epidemiológicos de enfermedades neurológicas asociados al HTLV-1 desde 1985. Se ha incluido 256 casos clínicos evaluados en los servicios de neurología del Hospital Santo Tomás y del Complejo Hospitalario Metropolitano del Seguro Social de 38 diferentes enfermedades neurológicas de etiología desconocida que se han ligado de alguna forma al virus de HTLV-1. Doce casos de paraparesia espástica progresiva fueron identificados y asociados a virus HTLV-1 como causa etiológica. La relación de hombres a mujeres se mantuvo 1 a 1 con edad promedio de inicio de la enfermedad 44 años y sin predilección racial. La asociación de este virus con la esclerosis múltiple plantea dudas importantes. Se reconoce en Panamá una seroprevalencia al virus de HTLV-1 similar a la reportada en países vecinos y la identificación de la paraparesia espástica tropical asociada a esta