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A few decades ago, women diagnosed with multiple sclerosis were discouraged from becoming pregnant. However, with new knowledge about the disease and treatments, this recommendation has changed, and it is pregnancy after the diagnosis of the disease is no longer contraindicated, with family planning being essential in this process. This review aims to provide a comprehensive overview of the family planning process for people with multiple sclerosis.

Precision medicine has revolutionized the field of neuroimmunology, with innovative approaches that characterize diseases based on their biology, deeper understanding of the factors leading to heterogeneity within the same disease, development of targeted therapies, and strategies to tailor therapies to each patient. This review explores the impact of precision medicine on various neuroimmunological conditions, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), optic neuritis, autoimmune encephalitis, and immune-mediated neuropathies. We discuss advances in disease subtyping, recognition of novel entities, promising biomarkers, and the development of more selective monoclonal antibodies and cutting-edge synthetic cell-based immunotherapies in neuroimmunological disorders. In addition, we analyze the challenges related to affordability and equity in the implementation of these emerging technologies, especially in situations with limited resources.

Background People with multiple sclerosis (PwMS) show an increased risk of sexual dysfunction (SD), both in women and men. Objective The aim of the present study was to apply the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and evaluate our results by comparing them with those in in the literature, as well as to assess the ease of applying the scale and the engagement of the patients in discussing the topic of sexuality. Methods We developed and applied a web-based Google form questionnaire that the respondents completed online, which included the MSISQ-19, for the assessment of sexual function. Baseline characteristics were reported as proportions and mean ± standard deviation (SD) or median ± interquartile range (IQR) as appropriate according to data distribution. Categorical variables were stratified by sex and compared with chi-squared tests. Statistical analyses were performed using STATA v. 16 (StataCorp., College Station, TX, USA). Results Of the 621 respondents, 541 were included in the analysis. Among the patients with MS, a total of 347 (64.14%) exhibited SD. When stratified by gender, the frequencies of SD were not significantly different. Conclusion There is a high incidence of sexual dysfunction among PwMS and we need to identify the reasons for this and implement strategies to treat and counsel our patients. The MSISQ-19 can be used to help clinicians to assess sexual functioning in a quick and easy way and give patients the possibility to address this topic and receive appropriate help and support.

Background Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. Objective To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. Methods Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. Conclusion We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

ABSTRACT Background: Recent changes to the diagnostic criteria for multiple sclerosis (MS) and new medications have had a major impact on the way in which specialists manage the disease. Objective: To investigate factors considered by Brazilian neurologists in managing MS, and to identify how these contribute to diagnosis and treatment. Methods: Potential participants were selected by a steering committee (MS experts who developed this survey). Only MS specialists were included in the study (neurologists who had completed a neuroimmunology fellowship or who were treating more than 30 MS patients). Links to the online questionnaire were distributed between March 2019 and January 2020. This questionnaire was composed of sections with hypothetical MS scenarios. Results: Neurologists from 13 Brazilian states responded to the survey (n = 94). In the clinically isolated syndrome (CIS) scenario, the respondents agreed to treat patients with a high risk of MS diagnosis, whereas in the radiologically isolated syndrome (RIS) half of the respondents opted not to treat, even among high-risk patients. In cases of low-activity relapsing-remitting MS (RRMS), the choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to fingolimod and natalizumab, as RRMS severity increased. The topics in which disagreement was found included practices regarding use of disease-modifying therapy (DMT) for pregnant patients and the washout period required for some DMTs. Conclusions: This study enabled identification of areas of agreement and disagreement about MS treatment among Brazilian neurologists, which can be used to update future protocols and improve patient management.

ABSTRACT Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.

The use of cannabidiol in some neurological conditions was allowed by Conselho Regional de Medicina de São Paulo and by Agência Nacional de Vigilância Sanitária (ANVISA). Specialists on behalf of Academia Brasileira de Neurologia prepared a critical statement about use of cannabidiol and other cannabis derivatives in neurological diseases.

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil.

Objective To assess the prevalence and the profile of adverse events (AE) of natalizumab in patients with multiple sclerosis (MS). Methods Data collection from neurologists attending to patients with MS at specialized units in Brazil. Results Data from 103 patients attending the infusion centers of 16 MS units in 9 Brazilian states were included in the study. The total number of infusions was 1,042. Seventy-nine patients (76.7%) did not present any AE. Twenty-four patients (23.3%) presented only mild AE. There were three major AE, including two deaths. These three occurrences, although not necessarily being drug-related, must be taken into consideration. Conclusion The profile of AEs for natalizumab shows that 97% of patients have none or only mild AE. However, still due to safety worries, the use of this medication should be restricted to MS units under the care of specialized neurologists.

ObjectiveTo assess the prevalence and the profile of adverse events (AE) of natalizumab in patients with multiple sclerosis (MS).MethodsData collection from neurologists attending to patients with MS at specialized units in Brazil.ResultsData from 103 patients attending the infusion centers of 16 MS units in 9 Brazilian states were included in the study. The total number of infusions was 1,042. Seventy-nine patients (76.7%) did not present any AE. Twenty-four patients (23.3%) presented only mild AE. There were three major AE, including two deaths. These three occurrences, although not necessarily being drug-related, must be taken into consideration.ConclusionThe profile of AEs for natalizumab shows that 97% of patients have none or only mild AE. However, still due to safety worries, the use of this medication should be restricted to MS units under the care of specialized neurologists.ObjetivoAvaliar a prevalência e o perfil dos eventos adversos (EA) por natalizumabe em pacientes com esclerose múltipla (EM).MétodosColeta de dados fornecidos por neurologistas de unidades especializadas em EM no Brasil.ResultadosNo estudo, foram incluídos dados de 103 pacientes em tratamento em centros de infusão de 16 unidades de EM em 9 estados brasileiros. O número total de infusões foi 1.042. Setenta e nove pacientes (76,7%) não apresentaram nenhum EA. Vinte e quatro pacientes (23,3%) apresentaram apenas EA leves. Foram relatados três importantes EA, incluindo duas mortes. Embora não necessariamente ligadas à droga, estas EA devem ser levadas em consideração.ConclusãoO perfil de EA para natalizumabe mostrou que em 97% dos pacientes não houve EA ou houve apenas EA leves. No entanto, dadas as preocupações com segurança da droga, o uso deste medicamento deve continuar restrito às unidades de EM sob os cuidados de neurologistas especializados.

A fadiga é sintoma comum na esclerose múltipla (EM). O objetivo deste estudo é relacionar a fadiga nos portadores de EM aos distúrbios autonômicos. Participaram deste estudo, 50 pacientes portadores de EM na forma clínica remitente recorrente. Trinta e três (66%) eram mulheres e 17 (34%) homens; pontuação menor ou igual a 3,5 na Escala de EDSS. Foram aplicados em todos os pacientes cinco testes cardiovasculares, já padronizados, para avaliação das funções simpáticas e parassimpáticas. Os resultados encontrados no teste do exercício isométrico foram elevações da pressão arterial de 14,62±9,13 mmHg para o grupo com fadiga e de 21,68±7,18 mmHg para o grupo sem fadiga, sendo estatisticamente significante (pFatigue is a common symptom in multiple sclerosis (MS). The objective of this study was to relate fatigue and autonomic disturbances in MS. Fifty patients with MS relapsing remitting clinical form participated of this study. Thirty three (66%) were women and 17 (34%) men. Score less or equal to 3.5 in the EDSS. Five non invasive cardiovascular tests were applied in all patients for the sympathetic and parasympathetic evaluation. The results obtained in the hand grip test were increase in the blood pressure of 14.62±9.13 mmHg for the group with fatigue and of 21.68±7.18 mmHg for the non fatigue group. This difference was statistically significant (p

OBJETIVO: Adaptação transcultural e validação da escala modificada de impacto de fadiga (MFIS-BR). MÉTODO: A MFIS foi traduzida para língua portuguesa e retrovertida para o inglês. Dois estudos piloto foram realizados até ser obtida a MFIS-BR, que foi aplicada em 57 pacientes com esclerose múltipla e 45 controles. O reteste foi 30 dias depois. RESULTADOS: Na análise estatística a reprodutibilidade da consistência interna foi semelhante à escala original (0,74-0,86). A MFIS-BR mostrou-se capaz de identificar os diferentes grupos. Com respeito à reprodutibilidade o coeficiente de correlação interclasses mostrou excelente concordância (0,264-1,0). CONCLUSÃO: A MFIS-BR preenche os critérios de aplicabilidade e sensibilidade de forma semelhante à escala original.OBJECTIVE: The aim of this study is a cross-cultural adaptation and validation of the modified fatigue impact scale for Portuguese (MFIS- BR). METHOD: The MFIS was translated to Portuguese and retranslated to English. Two studies pilot had been carried through to be gotten the MFIS-BR, that was applied to 57 consecutive stable MS patients and 45 healthy controls. The retest was applied 30 days later. RESULTS: In the dwarfed statistics the internal consistency reability was similar to the original scale (0.74-0.86). The MFIS-BR showed be able to identify the different groups. Concerning the reliability the interclass correlation coefficient showed an excellent agreement (0.264-1.0). CONCLUSION: The MFIS-BR fills the criteria of applicability, sensibility witch are similar of the original version.

A esclerose múltipla (EM) é doença desmielinizante, inflamatória, que acomete a substância branca do sistema nervoso central, e sensações vestibulares anormais (vertigem, desequilíbrio) são freqüentes. A reabilitação vestibular (RV) é determinada por mecanismos de adaptações, substituições e compensações neurais. Este estudo avaliou a melhora da vertigem central ou periférica em pacientes com EM remitente-recorrente submetidos à RV (exercícios de Cawthorne-Cooksey), através da escala de Berg e Dizziness Handicap Inventory (DHI). Nesta amostra de 4 casos a RV, realizada em um período de 2 meses, demonstrou a melhora em 3 pacientes avaliados pela escala de Berg e em 2 pacientes quando avaliados pela DHI.Multiple sclerosis (MS) is a demyelinating, inflammatory illness, that attack the white matter of the central nervous system, and abnormal vestibular sensations (vertigo, disequilibrium) are frequent. The vestibular rehabilitation (VR) is determined by mechanisms of adaptations, neural substitutions and compensations. This study evaluated the improvement of the central or peripheral vertigo in patients with relapsing-remitting MS submitted to the VR (exercises of Cawthorne-Cooksey), through the scale of Berg and Dizziness Handicap Inventory (DHI). In this sample of 4 cases the VR, carried through in a period of 2 months, demonstrated the improvement in 3 patients according to the Berg scale and in 2 patients considering that of the DHI.

Neuropsychological studies have consistently reported cognitive dysfunctions associated with multiple sclerosis. One-hundred fifteen subjects with relapsing-remitting multiple sclerosis (RRMS) were compared with forty health controls according to a neuropsychological test battery, which included digit span, trail making, cancellation and stroop test. Both groups were matched for age, sex and educational level. Subjects with RRMS had a worse performance the speed of response. Subjects with RRMS spent more time to complete the test in either sections A (p=0.001) or B (p=0.001), although there was no significant difference in terms of number of errors. The total time required to finish the Stroop test was higher for subjects with RRMS (pEstudos neuropsicológicos demonstram alterações cognitivas associadas à esclerose múltipla. Foram avaliados, através de uma bateria neuropsicológica, 115 pacientes com esclerose múltipla remitente-recorrente (EMRR), comparada a um grupo controle com 40 indivíduos saudáveis. A bateria inclui os testes, span de dígitos, trilhas, teste de cancelamento e stroop. Os grupos foram pareados por sexo, idade e escolaridade.Os pacientes com EMRR tiveram um pior desempenho na rapidez de resposta (p=0,001), os pacientes gastaram um tempo maior para realizar o trilhas A (p=0,001) e o trilhas B (p=0,0001), não havendo diferenças significativas no número de erros. O tempo total no teste stroop foi maior dos sujeitos EMRR (p

A fadiga é um dos mais freqüentes sintomas e incapacitantes na esclerose múltipla (EM). O objetivo do presente estudo foi avaliar a fatigabilidade em pacientes com EM pela aplicação de exercícios isotônicos e isométricos com dinamômetro manual. Como resultados, a fatigabilidade, a força e o tempo máximo de isometria são semelhantes estatisticamente entre o grupo controle e o grupo de EM. Conclui-se que embora a queixa subjetiva de fadiga seja freqüente na EM, a fatigabilidade e a recuperação após o exercício demonstraram ser normais.Fatigue is one of the most commom disabling symptoms in multiple sclerosis (MS). The aim of this study was to evaluate the fatigability on patients with MS by the aplication of hand grip isotonic and isometric exercises with dynamometer. As results the fatigability, the isometric strenght and time were statistically similar in the control group and in MS. We conclude that although fatigue is a frequent subjective complaint on MS, the fatigability and the recover after exercises seems to be normal.

Since 1993 the Federal Drug Administration approved the use of immunomodulatory therapy in multiple sclerosis (MS), modifying the natural course of disease, as demonstrate our experience in treatment of MS patients at the MS Treatment Center (CATEM). OBJECTIVE: To evaluate patient behavior using immunomodulatory therapy for a period of five years treatment. METHOD: We selected 390 patients in CATEM with relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) with relapses. RESULTS: At initial treatment 292 (61.5%) patients presented RRMS, 98 (20.6%) SPMS with relapses, 27 SPMS (5.6%) and 58 (12.1%) primary progressive MS (PPMS). In RRMS 182 (62.5%) used the interferon beta 1a SC, 15 (5.2%) interferon beta 1a IM, 85 (29%) interferon beta 1b and 10 (3.3%) glatiramer acetate. In SPMS 63 (64.3%) used interferon beta 1a SC, 4 (4.1%) interferon beta 1a IM and 31 (31.4%) interferon beta 1b. We observed that in this period 195 (50%) migrated between drugs, 35 (9%) gave up therapy and 160 (41%) continued the initial therapy. CONCLUSION: Stopping the immunomodulatory therapy emerges as a problem in the second year of treatment and it can be a subset of interferon non responsive or development of neutralizing antibodies.

A Multiple Sclerosis Functional Composite Measure (MSFC) é escala para avaliação dos pacientes portadores de esclerose múltipla, desenvolvida pela National Multiple Sclerosis Society dos EUA em 1994, que envolve uma composição de três testes - 9-Hole Peg Test, Timed 25-Foot Walk e PASAT - abrangendo de maneira multidimensional as principais funções neurológicas comprometidas nestes pacientes. A MSFC foi aplicada em 91 indivíduos sadios com o objetivo de padronizá-la na população brasileira para posterior uso nos diversos centros de tratamento e pesquisa no Brasil.The Multiple Sclerosis Functional Composite Measure (MSFC) is an outcome measure in multiple sclerosis developed by USA National Multiple Sclerosis Society (1994), a three-part composite clinical measure - 9-Hole Peg Test, Timed 25-Foot Walk and PASAT. It should be multidimensional in order to reflect the principal ways MS affects an individual. The MSFC was applied in 91 Brazilian subjects and standardized to be use in MS centers.

Objective Natalizumab is a new and efficient treatment for multiple sclerosis (MS). The risk of developing progressive multifocal leukoencephalopathy (PML) during the use of this drug has created the need for better comprehension of JC virus (JCV) infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. Method Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR). Results In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2%) patients. Discussion Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab.

O objetivo deste estudo é traduzir para o português, realizar a equivalência cultural e validar a Escala de Determinação Funcional de Qualidade de Vida (DEFU). Foi realizado estudo longitudinal, com 143 pacientes com esclerose multipla (EM) clinicamente definida. A validação da escala foi determinada pela correlação dos escores do DEFU com a Escala de Incapacidade Funcional Expandida (EDSS) e a Escala Ambulatorial (EAN). A consistência interna (alfa) foi semelhante à observada originalmente. Observamos haver correlação entre as subescalas (0,35-0,71) e destas com o EDSS e o EAN. O coeficiente Kendall Tau evidenciou haver associação significante entre a visita inicial e a de três meses. A sensibilidade da escala foi testada considerando dois grupos de pacientes: com EDSS < 3,5 e com EDSS > 3,5. Observamos escores maiores nos pacientes com EDSS mais baixo, quando comparados com aqueles com comprometimento moderado. Baseados neste estudo, concluímos que esta versão do questionário DEFU traduzido para a língua portuguesa preenche os critérios de confiabilidade, sensibilidade e validade.The objective of the present study was to translate, to do cultural equivalence and validation of the Functional Assessment of Multiple Sclerosis quality of life instrument (FAMS) to Portuguese. The database analyzed is longitudinal, with 143 patients with clinically defined multiple sclerosis (MS). The validity of the scale was established by correlating total FAMS scores and sub-scales scores to EDSS and EAN. The internal consistency reliability were similar to those of the original FAMS. All sub-scales correlated with each other (0.35 to 0.71). Total FAMS score correlated significantly with EDSS, and EAN. All sub-scales correlated to EDSS. Kendall's Tau coefficient, showed significant associations between basal and first visit. Responsiveness was investigated considering two groups: patients with EDSS < 3.5 and with EDSS > 3.5. There was significantly higher score in the group with light EDSS when compared to the group of patients with moderate EDSS. One can conclude, based on this retrospective study that FAMS instrument translated to Brazilian Portuguese can be considered reliable, responsive and content valid.

A possibilidade de correlação entre depressão e esclerose múltipla (EM) é conhecida há muitos anos, porém os estudos de prevalência não são conclusivos. No nosso meio a prevalência deste sintoma na EM permanece desconhecida. O objetivo deste estudo é verificar a prevalência da depressão em pacientes com EM, estudando a sua correlação com a incapacidade funcional, o sexo, a idade e o tempo de doença. Foram avaliados 84 pacientes com EM remitente-recorrente (EMRR). A depressão foi avaliada através da Escala de Beck e da Escala para Ansiedade e Depressão (HAD), e a incapacidade funcional pela Escala de Incapacidade Funcional Expandida (EDSS). A depressão estava presente em 17,9% e a ansiedade em 34,5% dos pacientes com EMRR. Os maiores escores das escalas de depressão correlacionaram-se com maior incapacidade funcional (p=0,0002), porém não estão associados ao tempo de doença, ao sexo ou a idade dos pacientes. Nossos dados indicam que a depressão é frequente nos pacientes com EM e sugerem haver correlação entre a depressão e a incapacidade funcional.

Recentemente foram introduzidos novos medicamentos no tratamento da esclerose múltipla (EM) capazes de modificar a história natural da doença. Nos estudos clínicos que avaliam estas drogas utiliza-se com frequência a escala de incapacidade expandida (EDSS) como instrumento para avaliar as disfunções e incapacidades neurológicas durante estes ensaios. Há inúmeras limitações no uso desta escala, predominantemente pelo fato desta ser uma escala que privilegia em demasia a capacidade de marcha dos pacientes. Neste estudo, apresentamos nossos resultados na aplicação do teste de destreza manual da caixa e blocos em indivíduos normais e em portadores de EM. Observamos que 64,8% das mulheres e 80,7% dos homens apresentaram alterações estatisticamente significantes no escore deste teste quando comparados com indivíduos normais. Por sua facilidade de aplicação e sensibilidade em detectar alterações das habilidades motoras em membros superiores, os autores recomendam o emprego deste teste na avaliação do efeito destes medicamentos em pacientes com EM.

Após breves considerações a respeito da evolução clínica e diagnóstico na esclerose múltipla, os membros do BCTRIMS fazem algumas recomendações no uso de drogas imunomoduladoras no tratamento desta doença.After brief considerations about clinical course and diagnosis in multiple sclerosis, the members of the BCTRIMS present some recommendations for the use of the immunomodulatory drugs in the treatment of this disease.

Muitas escalas neurológicas têm sido utilizadas para avaliar evolutivamente portadores da esclerose múltipla. O Expanded Disability Status Scale (EDSS) de Kurtzke ainda é a mais utilizada. Analisamos comparativamente a aplicação do EDSS e Neurologic Rating Scale (NRS), de Sipe e col. em 302 pacientes com forma definida de esclerose múltipla. Os resultados demonstram que o NRS foi mais sensível que o EDSS na detecção de alterações clínicas em 22,1% dos casos, sendo possivelmente mais sensível na caracterização de um novo surto. As variações do EDSS ocorrereram mais nos pacientes com EDSS de 36,0 e 3,5. Fazemos considerações sobre estes achados, sugerindo a aplicação de mais de uma escala clínica para avaliação dos pacientes nos estudos com novas drogas para tratamento da doença.

A esclerose múltipla é uma das causas mais comuns de incapacidade neurológica crônica em adultos jovens. Avaliamos, através de estudo retrospectivo, características epidemiológicas, formas de apresentação, manifestações clínicas, evolução e o grau de incapacitação física da esclerose múltipla em 302 pacientes. A média da idade dos pacientes foi 37,7 anos e a relação entre os gêneros foi 3,13F:1M. A média da idade no início da doença foi 29,6 anos. Duzentos e oitenta e três pacientes eram brancos (94%), 15 negros (5%) e 4 amarelos (1%). Duzentos e vinte pacientes (72%) apresentaram forma clínica tipo remitente-recorrente. Oitenta e dois pacientes (28%) apresentaram a forma progressiva (50% forma secundária e 50% forma primariamente progressiva). Os sintomas iniciais mais comuns foram sensitivos (31,7%) e ópticos (26,8%).Em relação aos sintomas evolutivos predominavam os sintomas piramidais (72,5%) e os medulares (64,9%). A média do escore do EDSS final foi 3,37 e a do NRS foi 85,17. O índice anual de surtos foi 0,45. Nossos achados coincidem com os da literatura mundial, e ressaltam que 60 pacientes (19,8%) apresentavam esclerose múltipla de forma benigna de valor prognóstico.

Fadiga é um sintoma incapacitante, frequentemente observado nos pacientes com esclerose múltipla, porém pouco compreendido. Escalas de auto-avaliação são utilizadas para melhor estudar este sintoma subjetivo. Foram aplicadas três escalas de avaliação de fadiga em 15 pacientes com diagnóstico de esclerose múltipla, em 9 dos quais havia a referência de fadiga. Nestes os escores apresentavam-se elevados, o que significa fadiga acentuada. As escalas aplicadas demonstraram ser complementares na avaliação da fadiga, a qual se mostrou um sintoma importante nos pacientes avaliados.

Foram avaliados 95 pacientes com forma remitente-recorrente da esclerose múltipla quanto à presença de fadiga. A Escala de Severidade de Fadiga foi aplicada em todos os pacientes. Em 64 pacientes (67,4%) a fadiga foi encontrada. Não observamos diferenças clínicas quanto ao gênero, idade, grau de incapacidade funcional e depressão, nos pacientes com e sem fadiga. Foi encontrada correlação entre ansiedade e tempo de doença com a presença de fadiga. Ao analisarmos estas variáveis quanto à intensidade da fadiga, observamos haver associação entre fadiga grave e maior incapacidade funcional.In 95 patients with the remitting-relapsing form of multiple sclerosis we investigated fatigue. All of them were evaluated with the Fatigue Severity Scale and we found it in 64 patients (67.4%). Gender, age, depression and fuctional incapacity was not predictive of fatigue occurrence, while anxiety and time of disease seems to be correlated with it. When we analysed the fatigue severity, a correlation between the EDSS and the increasing fatigue severity was found.

Chorea is a clinical syndrome characterized by abnormal involuntary arrhythmic movements, randomly distributed in time, affecting mainly the distal parts of the limbs. There are many diseases associated with chorea but the distribution of the etiologies vary too much in different parts of the world. We intended to study the etiologies of chorea in a Movement Disorders Unit of a university hospital-based outpatient clinic in Brazil. We studied the records of 119 patients with chorea based in the diagnostic criteria of the World Federation of Neurology. Sydenham's chorea (SC) was the most frequent cause of chorea (51.3%) of our sample. Other common causes were Huntington's chorea (18.5%) and chorea post-stroke (9.2%). SC is not commonly seen in developed countries nowadays but is not rare in Brazil. SC patients generally have the clinical manifestation of it in the first 20 years of age and girls are more affected than boys and this feature was observed in our sample. Based on our own experience and in the review of the literature we propose an etiological classification of chorea.Coréia é uma síndrome caracterizada por movimentos involuntários arrítmicos, rápidos, abruptos, não repetitivos no tempo e com distribuição variável, preferentemente distal. O número de entidades clínicas reconhecidamente associadas a movimentos coréicos tem se tornado cada vez maior com o passar do tempo. Propusemo-nos estudar a frequência e algumas características epidemiológicas das coréias atendidas em um ambulatório especializado em distúrbios do movimento. Foram estudados os prontuários de 119 pacientes com o diagnóstico sindrômico de coréia. O predomínio absoluto foi de coréia de Sydenham (CS) com 51,3% do total da amostra. Outras causas frequentes foram doença de Huntington (DH) presente em 18,5% e a coréia secundária a doença cerebrovascular em 9,2% dos pacientes. O sexo feminino predominou em todas as faixas etárias, mas principalmente nos pacientes mais jovens, em função da CS predominar e desta ser mais comum nas meninas. Também, a coréia secundária ao uso de anovulatórios e a gravidez contribuiu para este predomínio. Baseados na experiência do nosso serviço e na revisão da literatura, propomos uma classificação para as coréias.

ABSTRACT Multiple sclerosis has become an ever-increasing challenge to neurologists. With the release of the latest medications on the market, Brazilian neurologists feel divided between following their patients’ evolution in accordance with the strict rules established by the Brazilian Ministry of Health regarding drug distribution, or following disease progression and worsening in accordance with the evidence in the literature. Therefore, a systematic review of the main published treatment guidelines was conducted and an escalating therapy proposed for guiding multiple sclerosis patient treatment in Brazil.

ABSTRACT Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV). Objective: To identify the serologic profile of JCV in patients with MS. Methods: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program. Results: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months. Conclusion: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.

ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.

ABSTRACT 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.

ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

ABSTRACT Objectives: To report on four new cases of severe cognitive impairment in the early stages of multiple sclerosis (MS) and to review data on the subject since few cases have been reported worldwide. Methods: Retrospective evaluation of medical records of patients with severe cognitive impairment within the first five years of MS diagnosis. Results on neuropsychological tests and magnetic resonance imaging (MRI) were disclosed. Results: Four patients from different Brazilian neurological departments in Brazil were evaluated, all presenting with severe cognitive dysfunction classified as rapidly developing dementia. MRI images showed severe brain atrophy and basal ganglia lesions in all patients. Conclusions: Although rare, severe cognitive impairment in MS represents an important disability and may ultimately constitute another form of the disease.