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Background: Fatigue is one of the most common and distressing symptoms among persons with multiple sclerosis (pwMS). Objective: The aim of this study is to evaluate fatigue as a predictor for disease worsening among pwMS. Methods: In this retrospective cohort study of New York State MS Consortium (NYSMSC) registry, MS patients reporting moderate-to-severe fatigue at study enrollment ( n = 2714) were frequency matched to less-fatigued subjects ( n = 2714) on age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype. Change from baseline patient-reported outcomes (PROs), as measured by LIFEware™, categorized participants into two groups: those with stable/improved outcomes and those who worsened. In a subgroup of patients with longitudinal data ( n = 1951), sustained EDSS worsening was analyzed using Cox proportional hazards modeling to explore the effect of fatigue. Results: The median survival time from study enrollment to sustained EDSS worsening was 8.7 years (CI: 7.2–10.1). Participants who reported fatigue at baseline were more likely to experience sustained EDSS worsening during follow-up (HR: 1.4, 95% CI: 1.2–1.7). Patients who were fatigued at baseline were also more likely to report worsening psychosocial limitations (all ps ⩽ 0.01). Conclusion: In addition to being a common symptom of MS, severe fatigue was a significant predictor for EDSS worsening in the NYSMSC.

Made available in DSpace on 2018-11-26T22:40:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01. Added 1 bitstream(s) on 2019-10-09T18:27:56Z : No. of bitstreams: 1 S0004-282X2018000800539.pdf: 336862 bytes, checksum: 861f2018734ed5dc938f69878cf50b6e (MD5) Biogen Idec Genzyme Merck Novartis Rocha Teva Roche Sanofi-Genzyme World Federation of Neurology European Committee on Treatment and Research in Multiple Sclerosis Biogen Schering Biogen Indec Merck-Serono Teva (EMOCEMP Study-NCT) Euroimmun AG Shire Quest/Athena Diagnostics Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Bayer Partners MS Center, Harvard Medical School Distrito Federal Research Foundation (FAP-DF) Libbs Sanofi Serono Teva Pharmaceuticals Sonofi-Genzyme Novartis-PPD Merck Serono Bayer Health Care Ipsen Sanofi Genzyme The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS. Univ Sao Paulo, Fac Med Ribeirao Preto, Hosp Clin Ribeirao Preto, Ribeirao Preto, SP, Brazil Pontificia Univ Catolica Rio Grande do Sul, Porto Alegre, RS, Brazil Univ Sao Paulo, Fac Med, Hosp Clin, Sao Paulo, SP, Brazil Univ Fed Minas Gerais, Ctr Invest Esclerose Multipla Minas Gerais, Belo Horizonte, MG, Brazil Univ Jose Rosario Vellano, Belo Horizonte, MG, Brazil Univ Fed Estado Rio de Janeiro, Rio De Janeiro, RJ, Brazil Hosp Restauracao, Recife, PE, Brazil Clin Goncalves Dias, Curitiba, Parana, Brazil Univ Estadual Campinas, Campinas, SP, Brazil Clin Privada, Cuiaba, MT, Brazil Hosp Sao Rafael, Salvador, BA, Brazil Univ Fed Fluminense, Niteroi, RJ, Brazil Fundacac Ctr Integrado Apoio Portador Deficiencia, Joao Pessoa, Paraiba, Brazil Univ Brasilia, Brasilia, DF, Brazil Univ Catolica Brasilia, Brasilia, DF, Brazil Santa Casa Misericordia Londrina, Londrina, PR, Brazil Univ Fed Goias, Fac Med, Goiania, Go, Brazil Clin Neurol & Endocrinol, Brasilia, DF, Brazil Univ Estadual Paulista, Sao Paulo, SP, Brazil Inst Neurol Curitiba, Curitiba, Parana, Brazil Univ Regiao Joinville, Joinville, SC, Brazil Univ Fed Amazonas, Hosp Univ Getulio Vargas, Manaus, Amazonas, Brazil Pontificia Univ Catolica Sao Paulo, Sorocaba, SP, Brazil Senne Liquor Diagnost, Sao Paulo, SP, Brazil Hosp Cruz Azul, Sao Paulo, SP, Brazil Fac Sao Leopoldo Mandic, Campinas, SP, Brazil Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil Univ Fed Uberlandia, Uberlandia, MG, Brazil Hosp Base Dist Fed, Brasilia, DF, Brazil Imperial Hosp Caridade, Florianopolis, SC, Brazil Escola Bahiana Med & Saude Publ, Salvador, BA, Brazil Univ Estadual Paulista, Sao Paulo, SP, Brazil Teva (EMOCEMP Study-NCT): 61080516.4.1001.5336

Objectives To report the results from the Brazilian database on multiple sclerosis (MS) and pregnancy. Methods Retrospective data from MS patients who became pregnant at any time of their disease were sent to a Brazilian database, using a specific file for this purpose. Results Data on 128 women (142 pregnancies) from 30 neurologists working in 21 cities in Brazil were collected. Patients’ average age at pregnancy was 29.8 years (range 16–42). EDSS at start of pregnancy was 1.5 ± 1.4; and the relapse rate in the year preceding pregnancy was 1.2 ± 1.5. Exposure to medication at any time during pregnancy was high (69.7%): 48.6% to interferon beta; 14.1% to glatiramer acetate; and 7% to other immunomodulatory and immunosuppressive drugs. There was a significant decrease in relapse rate during pregnancy. The prevalence of complications was relatively low, with 4.9% of obstetric and 1.4% neonatal unfavorable outcomes. Conclusions Our patients had low degrees of disability, short histories of disease, high drug exposure, and relatively high relapse rate in the year previous to pregnancy. Obstetric and neonatal outcomes were successful in over 90% of our patients.

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.

The idiopathic inflammatory demyelinating disease (IIDD) spectrum has been investigated among different populations, and the results have indicated a low relative frequency of neuromyelitis optica (NMO) among multiple sclerosis (MS) cases in whites (1.2%-1.5%), increasing in Mestizos (8%) and Africans (15.4%-27.5%) living in areas of low MS prevalence. South America (SA) was colonized by Europeans from the Iberian Peninsula, and their miscegenation with natives and Africans slaves resulted in significant racial mixing. The current study analyzed the IIDD spectrum in SA after accounting for the ethnic heterogeneity of its population. A cross-sectional multicenter study was performed. Only individuals followed in 2011 with a confirmed diagnosis of IIDD using new diagnostic criteria were considered eligible. Patients' demographic, clinical and laboratory data were collected. In all, 1,917 individuals from 22 MS centers were included (73.7% female, 63.0% white, 28.0% African, 7.0% Mestizo, and 0.2% Asian). The main disease categories and their associated frequencies were MS (76.9%), NMO (11.8%), other NMO syndromes (6.5%), CIS (3.5%), ADEM (1.0%), and acute encephalopathy (0.4%). Females predominated in all main categories. The white ethnicity also predominated, except in NMO. Except in ADEM, the disease onset occurred between 20 and 39 years old, early onset in 8.2% of all cases, and late onset occurred in 8.9%. The long-term morbidity after a mean disease time of 9.28±7.7 years was characterized by mild disability in all categories except in NMO, which was scored as moderate. Disease time among those with MS was positively correlated with the expanded disability status scale (EDSS) score (r=0.374; p=