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El estudio tiene como propósito comprobar los efectos del programa de aprendizaje colaborativo en los niveles de inclusión entre estudiantes universitarios en entornos B-Learning del curso Seminario de Investigación del ciclo académico 2021-2 de una universidad de Lima Metropolitana, así como analizar la percepción de los docentes sobre los efectos de este. El diseño utilizado es explicativo secuencial. Se considera como participantes para el estudio a 80 estudiantes y 12 docentes del curso. Referido a los primeros se les aplica un test con 20 ítems basados en la primera dimensión del “Index for inclusión” referida a crear culturas inclusivas y a los segundos se le realiza una entrevista semiestructurada. A nivel cuantitativo se analizaron los resultados del pretest y postest mediante el programa SPSS y a nivel cualitativo se analizaron los resultados de las entrevistas mediante del software IRaMuTeQ. Las derivaciones de la prueba t de Student confirman la hipótesis, ya que el valor de probabilidad de error (p) es igual a 0.008 inferior al nivel de significancia (0.05). Por otro lado, la percepción de los docentes coincide que con el programa instruccional aplicado los estudiantes son el centro del proceso educativo, logrando favorecer los niveles de inclusión con la participación de todos ellos. Con los resultados del estudio se comprueba que el programa de aprendizaje colaborativo mejora los niveles de inclusión entre estudiantes universitarios. En ese sentido, laborar de manera colaborativa promueve la inclusión en las clases y es la esencia para una enseñanza de calidad.&nbsp

La PNL se proyecta como una herramienta de perfeccionamiento colectivo e individual en el marco de la excelencia, que favorece la humanización y sensibilidad de este mundo neurotizado por las diferentes barreras comunicacionales y paradigmas culturales y sociales; con el objetivo de optimizar nuestras esferas de actuación. La finalidad del presente artículo fue analizar el conocimiento acerca de la Programación Neurolingüística que posee el personal directivo de las escuelas de Educación Básica del distritolos olivos de la provincia de lima, Perú en los actuales tiempos de pandemia. El estudio se fundamentó con los planteamientos teóricos de Douat (2017), Deminco (2019), Muñoz (2019), Redford (2017), Romero et al. (2015), entre otros. Se utilizó una metodología descriptiva con diseño no experimental. La muestra estuvo constituida por 58 sujetos, a los cuales se les aplicó un cuestionario. Los resultados muestran que los directivos poseen un mediano conocimiento de la PNL y con respecto a la comunicación, la media aritmética es de 0,188 categorizándose en muy baja, según el baremo establecido, lo cual indica que el personal directivo de los colegios nacionales de educación primaria del distrito Los Olivos de la provincia de Lima, poseen muy bajo conocimiento acerca de la comunicación, resultando un aspecto negativo en cuanto al desenvolvimiento gerencial del personal referido, ya que no conocen en su totalidad esta característica fundamental para el desarrollo de la PNL. en todos los ámbitos. Por ello se propone, el uso de la PNL, para que posibilite el desarrollo de habilidades con las que se puedan concebir resultados que optimicen la comunicación del personal directivo de los colegios referidos en los actuales tiempos de pandemia. NLP is projected as a tool for collective and individual improvement within the framework of excellence, which favors the humanization and sensitivity of this world neurotized by the different communicational barriers and cultural and social paradigms, aiming to optimize our spheres of action. The purpose of this article was to analyze the knowledge about Neurolinguistic Programming possessed by the management staff of Basic Education schools in the district of Los Olivos in the province of Lima, Peru, in the current times of pandemic. The study was based on the theoretical approaches of Douat (2017), Deminco (2019), Muñoz (2019), Redford (2017), Romero et al. (2015), among others. A descriptive methodology with a non-experimental design was used. The sample consisted of 58 subjects to whom a questionnaire was applied. The results show that managers have a medium knowledge of NLP and with respect to communication, the arithmetic mean is 0.188, categorized as very low, according to the established scale, which indicates that the management staff of the national primary schools ofthe Los Olivos district of the province of Lima, have very low knowledge about communication, resulting in a negative aspect regarding the managerial development of the referred staff since they do not know in full this fundamental characteristic for the development of NLP in all areas. Therefore, NLP is proposed to enable the development of skills with which results can be conceived to optimize the communication of the management staff of the referred schools in the current times of pandemics. Campus Lima Centro

The use of telemedicine has quickly increased during of the COVID-19 pandemic. Given that unmet needs and barriers to multiple sclerosis (MS) care have been reported, telemedicine has become an interesting option to the care of these patients. The objective of these consensus recommendations was to elaborate a guideline for the management of people with MS using telemedicine in order to contribute to an effective and high-quality healthcare.A panel of Argentinean neurologist's experts in neuroimmunological diseases and dedicated to the diagnosis, management,and care of MS patients gathered virtually during 2021 and 2022 to conduct a consensus recommendation on the use of telemedicine in clinical practice in adult people with MS. To reach consensus, the methodology of "formal consensus RAND/UCLA Appropriateness method" was used.Recommendations were established based on relevant published evidence and expert opinion focusing on definitions, general characteristics and ethical standards, diagnosis of MS, follow-up (evaluation of disability and relapses of MS), identification and treatment of relapses, and finally disease-modifying treatments using telemedicine.The recommendations of this consensus would provide a useful guide for the proper use of telemedicine for the assessment, follow-up, management, and treatment of people with MS. We suggest the use of these guidelines to all the Argentine neurologists committed to the care of people with MS.

The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177).The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset.A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively).3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.

El actual artículo se desarrolla con la finalidad de analizar los efectos de la gestión de servicio basada en la programación neurolingüística en la atención de los clientes en tiempos de pandemia. La investigación se fundamenta en método y técnicas experimentales, desarrollando un diseño pre-experimental. Las muestras están representadas por 24 empleados y 369 suscriptores de la empresa Electricidad del Perú (Electroperú) del distrito de San Juan de Miraflores del Perú. Con relación al procedimiento estadístico, se empleó laPresentación SPSS, efectuando el estudio de forma inferencial, identificándose las medias aritméticas, además se empleó la T de Student para precisar el grado de significancia, con las derivaciones que se obtengan del pre - test y post – test. Se diseñó y ejecutó un cuestionario, para determinar la confiabilidad del instrumento se logró con el coeficiente alfa Cronbach de 0,86. Los resultados en la estructura de los indicadores de la gestión de servicio antes y después del tratamiento, indican diferencias altamente significativas entre ellos, debido a que los valores de T computados presentan niveles de significancia por debajo de 0,01.

Resumen Introduccion La esclerosis multiple es una enfermedad con componente autoinmune, y un numero significativo de pacientes se encuentra bajo tratamiento inmunomodulador e inmunosupresor. Frecuentemente los medicos tratantes se preguntan si la vacunacion podra tener un impacto en el desarrollo de la enfermedad, y si existen indicaciones o contraindicaciones para la vacunacion de acuerdo a las terapias indicadas. Objetivo Elaborar una guia de referencia sobre indicaciones y contraindicaciones de vacunacion para neurologos que participan en el manejo de pacientes con esclerosis multiple con o sin terapias modificadoras de la enfermedad. Desarrollo Se conformo un equipo de elaboracion de las guias entre los miembros del Grupo de Trabajo de Enfermedades Desmielinizantes de la Sociedad Neurologica Argentina (SNA). La metodologia implementada fue de acuerdo a recomendaciones establecidas por la SNA, basadas en evidencia, con clasificacion de la misma y elaboracion de las recomendaciones segun el formato GRADE. Conclusiones Se detallan las vacunas disponibles en Argentina, el impacto potencial que podrian tener en el curso de la enfermedad, las indicaciones de vacunacion previas al inicio de cada tratamiento y las contraindicaciones para cada vacuna de acuerdo a la terapia indicada.

The objective was to evaluate time to reach an EDSS of 4, 6, and 7 in NMOSD and MOGAD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03,375,177).NMOSD patients diagnosed according to 2015 criteria and with MOGAD were identified. Patients with at least 3 years of follow-up and periodic clinical evaluations with EDSS outcomes were included. AQP4-antibody and MOG-antibody status was recorded, and patients were stratified as seropositive and seronegative for AQP4-antibody. EDSS of 4, 6, and 7 were defined as dependent variables. Log rank test was used to identify differences between groups.Registry data was provided for a total of 137 patients. Of these, seventy-five presented AQP4-ab-positive NMOSD, 45 AQP4-ab-negative NMOSD, and 11 MOGAD. AQP4-ab status was determined by cell-based assay (CBA) in 72% of NMOSD patients. MOG-ab status was tested by CBA in all cases. Mean time to EDSS of 4 was 53.6 ± 24.5 vs. 63.1 ± 32.2 vs. 44.7 ± 32 months in seropositive, seronegative NMOSD, and MOGAD, respectively (p = 0.76). Mean time to EDSS of 6 was 79.2 ± 44.3 vs. 75.7 ± 48.6 vs. 54.7 ± 50 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.23), while mean time to EDSS of 7 was 86.8 ± 54 vs. 80.4 ± 51 vs. 58.5 ± 47 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.39).No differences were observed between NMOSD (seropositive and seronegative) and MOGAD in survival curves.

The objective of this study was to describe and compare the baseline epidemiological data of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients included in RelevarEM (Clinical Trials registry number NCT03375177). RelevarEM is a longitudinal, strictly observational MS and NMOSD registry in Argentina. Epidemiological and comorbidity data from MS and NMOSD patients were described and compared. For comorbidities, the Charlson comorbidity index (CCI) was used to calculate the burden at entry. CCI was stratified in 0 and ≥ 1 and described for the entire cohort. A total of 1588 and 75 MS and NMOSD patients (respectively) were included. For MS patients, the mean age was 42 ± 7 years, female sex 65.3%, mean EDSS 2, and mean disease duration 8 ± 6 years. In NMOSD, the mean age was 40 ± 7 years, female sex 78.7%, mean disease duration 5 ± 3.5 years, and mean EDSS 2.5. The most frequent MS phenotype was RRMS in 82.4%. In MS, the CCI was 0 in 85.8.2% while ≥ 1 was in 14.2% of patients. Regarding phenotype stratification, CCI ≥ 1 was 3.9% in CIS, 13.5% in RRMS, 28.7% in SPMS, and 17.4% in PPMS (p

Neuromyelitis optica spectrum disorder (NMOSD) is a rare but severe neuroimmunological condition associated with a significant financial burden. NMOSD is also associated with increased health care utilization, including neurology outpatient visits, magnetic resonance imaging (MRI) use, long-term medication, among others. We aimed to evaluate real-world patient experiences in access to care and NMOSD burden in an Argentinean cohort.This cross-sectional study used a self-administered survey and was conducted in Argentina (2022). Patients with NMOSD were divided into three groups: private health insurance (PHI), social health insurance (SHI), and public health insurance (PHI, Ministry of Public Health). Differences in access and health care barriers were assessed.One hundred patients with NMOSD (74 women) with a mean age at diagnosis of 38.7 years were included. Their EDSS was 2.8 and they were followed for 5.2 years. Of them, 51%, 11%, and 13% were employed (full-time: 57.5%), currently unemployed and retired by NMOSD, respectively. 55% of them visited between 2-3 specialists before NMOSD diagnosis. Aquaporin-4-antibody and/or myelin oligodendrocyte glycoprotein-antibody testing was requested in 91% (health insurance covered this partially in 15.3% and 32.9% of the time the test was entirely paid by patient/family). Patients with NMOSD receiving private medical care reported greater access to MRI, outpatient visits, and fewer issues to obtain NMOSD medications compared to those treated at public institutions. A longer mean time to MRI and neurology visit was found in the PHI group when compared with the other two subgroups. Regression analysis showed that private insurance (OR=3.84, p=0.01) was the only independent factor associated with appropriate access to NMOSD medications in Argentina.These findings suggest that barriers to access and utilization of NMOSD care services in Argentina are common. NMOSD patients experienced problems to receive NMOSD medication properly, especially those from the public sector.

Background PPMS (primary progressive multiple sclerosis) patients represent less than 10% of MS patients in Argentina, men and women were similarly affected and most of them had a severe functional impairment. More rapid progression has been reported in males, but this is not the case in all datasets. The main objective of our study was to determine the time to EDSS (Expanded disability Status Scale) 4, 6 and 7 in PPMS patients. We also compared the times to reach these EDSS in men and women and aimed to identify factors associated with the disability progression. Method This cohort of patients with diagnosis of PPMS (n = 253) was selected from follow-up recorded in the RelevarEM registry database. Result The median times to EDSS 4, 6 and 7 were 24 (IQR 12-48), 72 (IQR 36-96) and 96 (IQR 60-120) months, respectively. Comparison of the survival curves to EDSS 4, 6 and 7 according to gender did not show significant differences (p = 0.33, p = 0.55 and p = 0.59). There is no evidence of an association between the clinical adjustment variables (sex, age40 years at diagnosis, EDSS3 at onset and multifocal MS symptoms at disease onset) and the time of arrival at the EDSS 4, 6 and 7. Conclusion Severe disability was observed six years after the onset of symptoms. No association was found between the studied factors and the time to arrival to severe disability.

Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders.A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference.A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS.Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.

We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177). RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan–Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified. A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29–10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09–7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4–8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4–22, p

Despite that different registries already exist in various countries in Europe and North America, no ongoing nationwide registry exists in Latin America (LATAM), a region where the disease behaves differently than in other regions. The objective of this document is to describe the methodology behind RelevarEM, the first nationwide MS registry in Argentina and LATAM. METHODS: In this article, we described the creation, implementation and data management of the nationwide MS registry in Argentina. The registry contains information on the structure, ethical aspects, implementation and variables of the registry (Clinical Trials registry number NCT NCT03375177). CONCLUSION: RelevarEM is the first MS nationwide registry in Argentina, as well as in LATAM, with the objective of providing reliable real-world data of MS in the country.

Background There has been an increase in the number of reports of multiple sclerosis (MS) rebound activity (RA), which is usually defined as a severe disease reactivation after natalizumab or fingolimod withdrawal that exceeds pre-treatment baseline inflammatory activity. The frequency and risk factors that could predict RA remain unknown. Fingolimod is currently the most frequently prescribed disease modifying therapy for MS in Argentina, so that there is a need to determine possible predictors of RA. Objectives To identify risk factors for developing RA after fingolimod cessation; to describe RA characteristics, management and evolution. Methods The study was a multicenter, retrospective, case-control study of patients with MS who had discontinued fingolimod and were followed up to nine months after discontinuation. Demographic, clinical and paraclinical data was extracted, including age, gender, MS phenotype, reason for discontinuation, number of relapses during the year prior to suspension, time treated with fingolimod, EDSS before, during and after rebound, MRI findings. Results 26 cases of RA were matched 1:1 with patients without RA. The median time elapsed to RA was 50 days. 68% showed worsening of the EDSS in the evaluation at 3 months of RA. When compared with the control group, no difference was found in terms of age, gender, phenotype, EDSS at the moment of suspension, reason for discontinuation, number of relapses in the previous year, and time on therapy. Conclusion In this case-controlled study, no risk factors could be identified to predict RA after fingolimod cessation. Further controlled, prospective, better powered studies are needed to confirm these findings.

BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an increasing diagnostic and therapeutic challenge in Latin America (LATAM). Despite the heterogeneity of this population, ethnic and socioeconomic commonalities exist, and epidemiologic studies from the region have had a limited geographic and population outreach. Identification of some aspects from the entire region are lacking. OBJECTIVES To determine ethnic, clinical characteristics, and utilization of diagnostic tools and types of therapy for patients with NMOSD in the entire Latin American region. METHODS The Latin American Committee for Treatment and Research in MS (LACTRIMS) created an exploratory investigational survey addressed by Invitation to NMOSD Latin American experts identified through diverse sources. Data input closed after 30 days from the initial invitation. The questionnaire allowed use of absolute numbers or percentages. Multiple option responses covering 25 themes included definition of type of practice; number of NMOSD cases; ethnicity; utilization of the 2015 International Panel criteria for the diagnosis of Neuromyelitis optica (IPDN); clinical phenotypes; methodology utilized for determination of anti-Aquaporin-4 (anti- AQP4) antibodies serological testing, and if this was performed locally or processed abroad; treatment of relapses, and long-term management were surveyed. RESULTS We identified 62 investigators from 21 countries reporting information from 2154 patients (utilizing the IPDN criteria in 93.9% of cases), which were categorized in two geographical regions: North-Central, including the Caribbean (NCC), and South America (SA). Ethnic identification disclosed Mestizos 61.4% as the main group. The most common presenting symptoms were concomitant presence of optic neuritis and transverse myelitis in 31.8% (p=0.95); only optic neuritis in 31.4% (more common in SA), p

Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.

Maple syrup disease is an autosomal recessive entity caused by a congenital error in the metabolism of three essential branchedchain amino acids: valine, leucine and isoleucine. The neonatal form of this disease is expressed by a severe and progressive neurological compromise, associated with a peculiar smell of urine, a consequence of the elimination of the excess of these amino acids. This smell of burnt sugar mimics the molasses obtained from maples, which gives its name to this disease. The best method to eliminate these toxins is hemodiafiltration, but in centers where this practice is not possible, peritoneal dialysis is an alternative. We present a newborn with leukinosis with severe central nervous system involvement in whom peritoneal dialysis was useful to overcome metabolic decompensation.

Background : In multiple sclerosis demographics there is a well-known female prevalence and male patients have been less specifically evaluated in clinical studies, though some clinical differences have been reported between sexes. Objective : The objective of this study was to assess clinical and demographic differences between male and female patients included in the national Argentine MS Registry – RelevarEM. Material and methods : This study was observational, retrospective, and was based on the data of 3,099 MS patients included as of 04 April 2021. The statistical analysis plan included bivariate analyses with the crude data and also after adjustment for the MS phenotype, further categorized as progressive-onset MS or relapsing-onset MS. In the adjusted analysis, the Mantel-Haenszel odds ratio was compared to the crude odds ratio, to account for the phenotype as a confounder. Results : The data from 1,074 (34.7%) men and 2,025 (65.3%) women with MS diagnosis were analysed. Males presented primary progressive disease two times more often than women (11% and 5%, respectively). In the crude analyses by sex, the presence of exclusively infratentorial lesions in the magnetic resonance imaging studies was more frequent in males than in females, but after adjustment by MS onset phenotype, such difference was only present in males with relapsing-onset MS (p = 0.00006). Similarly, worse Expanded Disability Status Scale scores were confirmed only in men with relapsing-onset disease after phenotype adjustment (p = 0.02). Conclusion : We did not find any statistically significant clinical or demographic difference between sexes when the progressive or remitting MS phenotype was specifically considered. However, the differences we found between the clinical phenotypes are in line with the literature and highlight the importance of stratifying the analyses by sex and phenotype when designing MS studies.

We aimed to examine treatment interventions implemented in patients experiencing neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and response). Methods Retrospective study. Data on patient demographic, clinical and radiological findings, and administered treatments were collected. Remission status (complete [CR], partial [PR], no remission [NR]), based on changes in the EDSS score was evaluated before treatment, during attack, and at 6 months. CR was analyzed with a generalized estimating equations (GEEs) model. Results A total of 131 patients (120 NMOSD and 11 myelin oligodendrocyte glycoprotein-antibody-associated diseases [MOGAD]), experiencing 262 NMOSD-related attacks and receiving 270 treatments were included. High-dose steroids (81.4%) was the most frequent treatment followed by plasmapheresis (15.5%). CR from attacks was observed in 47% (105/223) of all treated patients. During the first attack, we observed CR:71.2%, PR:16.3% and NR:12.5% after the first course of treatment. For second, third, fourth, and fifth attacks, CR was observed in 31.1%, 10.7%, 27.3%, and 33.3%, respectively. Remission rates were higher for optic neuritis vs. myelitis (p Conclusions This study suggests individualization of treatment according to age and attack manifestation. The outcome of attacks was generally poor.

Introduction During the last 20 years, multiple sclerosis (MS) disease has seen major changes with new diagnostic criteria, a better identification of disease phenotypes, individualization of disease prognosis and the appearance of new therapeutic options in relapsing remitting as well as progressive MS. As a result, the management of MS patients has become more complex and challenging. The objective of these consensus recommendations was to review how the disease should be managed in Argentina to improve long-term outcomes in MS patients. Methods A panel of 36 experts in neurology from Argentina, dedicated to the diagnosis and care of MS patients, gathered both virtually and in person during 2018 and 2019 to carry out a consensus recommendation on the management of MS patients in Argentina. To achieve consensus, the methodology of “formal consensus-RAND/UCLA method” was used. Results Recommendations focused on diagnosis, disease prognosis, tailored treatment, treatment failure identification and pharmacovigilance process. Conclusions The recommendations of these consensus guidelines attempt to optimize the health care and management of patients with MS in Argentina.

Maple syrup disease is an autosomal recessive entity caused by a congenital error in the metabolism of three essential branchedchain amino acids: valine, leucine and isoleucine. The neonatal form of this disease is expressed by a severe and progressive neurological compromise, associated with a peculiar smell of urine, a consequence of the elimination of the excess of these amino acids. This smell of burnt sugar mimics the molasses obtained from maples, which gives its name to this disease. The best method to eliminate these toxins is hemodiafiltration, but in centers where this practice is not possible, peritoneal dialysis is an alternative. We present a newborn with leukinosis with severe central nervous system involvement in whom peritoneal dialysis was useful to overcome metabolic decompensation.La enfermedad de jarabe de arce es una entidad autosómica recesiva producida por un error congénito en el metabolismo de tres aminoácidos esenciales de cadena ramificada: valina, leucina e isoleucina. La forma neonatal de esta enfermedad se manifiesta por un cuadro de compromiso neurológico grave y progresivo, asociado a un olor peculiar de la orina, consecuencia de la eliminación del exceso de estos aminoácidos. Este olor a azúcar quemada remeda a la melaza obtenida de los arces, lo que da nombre a esta enfermedad. El mejor método para eliminar estos tóxicos es la hemodiafiltración, pero, en los centros en los que esta práctica no es posible, la diálisis peritoneal constituye una alternativa. Se presenta a un recién nacido con leucinosis, con compromiso grave del sistema nervioso central, en quien la diálisis peritoneal fue de utilidad para superar la descompensación metabólica.

Background Myelin oligodendrocyte glycoprotein antibodies (MOG-ab) have been described in aquaporin-4-antibodies(AQP4-ab)-negative neuromyelitis optica spectrum disorder (NMOSD) patients. We aimed to evaluate the percentage of AQP4-ab-negative NMOSD patients who are positive for MOG-ab in a cohort of Argentinean patients included in RelevarEM (Clinical Trials registry number NCT03375177). Methods RelevarEM is a longitudinal, strictly observational multiple sclerosis (MS) and NMOSD registry in Argentina. Of 3031 consecutive patients (until March 2020), 165 patients with phenotype of suspected NMOSD, whose relevant data for the purpose of this study were available, were included. Data on demographic, clinical, paraclinical and treatment in AQP4-ab (positive, negative and unknown) and MOG-ab (positive and negative) patients were evaluated. Results A total of 165 patients (79 AQP4-Ab positive, 67 AQP4-Ab negative and 19 unknown) were included. Of these, 155 patients fulfilled the 2015 NMOSD diagnostic criteria. Of 67 AQP4-Ab-negative patients, 36 (53.7%) were tested for MOG-Ab and 10 of them (27.7%) tested positive. Serum AQP4-ab levels were tested by means of cell-based assay (CBA) in 48 (35.2%), based on tissue-based indirect immunofluorescence assays in 58 (42.6%) and enzyme-linked immunosorbent assay in 4 (2.9%). All MOG-ab were tested by CBA. Optic neuritis (90%) was the most frequent symptom at presentation and optic nerve lesions the most frequent finding (80%) in neuroimaging of MOG-ab-associated disease. Of these, six (60%) patients were under immunosuppressant treatments at latest follow-up. Conclusion We observed that 27.7% (10/36) of the AQP4-ab-negative patients tested for MOG-ab were positive for this antibody, in line with results from other world regions.

Introduccion. Existen diferencias significativas en el diagnostico, la identificacion y el seguimiento de pacientes con esclerosis multiple secundaria progresiva (EMSP) entre los profesionales de la salud a cargo de su tratamiento. Objetivo. Proveer recomendaciones sobre el tratamiento de los pacientes con EMSP en Argentina con el fin de optimizar su cuidado. Desarrollo. Un grupo de neurologos expertos en esclerosis multiple de Argentina elaboro un consenso para el tratamiento de pacientes con EMSP en la region mediante metodologia de ronda de encuestas a distancia y reuniones presenciales. Se establecieron 33 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el diagnostico y el seguimiento de los pacientes con EMSP. Conclusion. Las recomendaciones establecidas en el presente consenso permitirian optimizar el cuidado y el seguimiento de los pacientes con EMSP en Argentina.

Resumen El uso racional de medicamentos (URM) implica tener un conocimiento actualizado de los tratamientos, asi como de las normativas dadas por las agencias regulatorias nacionales. Mediante la educacion medica y la actualizacion de los conocimientos, es posible modificar de manera gradual conductas prescriptivas que no resultan optimas para el manejo clinico del paciente ni para la correcta administracion de recursos de los sistemas de salud. Con este objetivo, el Grupo de Trabajo de Neurofarmacologia de la Sociedad Neurologica Argentina presenta esta revision sobre URM para su aplicacion en nuestro medio y, eventualmente, en el resto de los paises hispanoparlantes del Cono Sur. Para la revision que hoy publicamos se tuvieron en cuenta los conocimientos de regulacion de medicamentos, investigacion clinica, medicina basada en evidencia y experiencia clinica neurologica. Provee a los profesionales los estandares necesarios para una adecuada prescripcion racional de medicamentos.

Background Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients. Methods A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the “formal consensus-RAND/UCLA method” was used. Results Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues. Conclusion The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.

Resumen Objetivo Realizar una actualizacion del estado de la Neurologia argentina a traves de un relevamiento nacional mediante encuesta a los delegados distritales de la Sociedad Neurologica Argentina (SNA). Material y metodos Se realizo en el primer trimestre del ano 2014 una encuesta semiestructurada entre todos los delegados distritales que cuenta la SNA. Resultados El presente estudio determina una tasa neurologo/poblacion de 1/21.495 (4,6/100.000 habitantes) para los adultos y de 1/32.443 neuropediatra (3,1/100.000) para la poblacion menor de 18 anos. Ademas, se registran en el pais 138 servicios de Neurologia clinica, equivalente a 1/290.704 habitantes (rango 0 a 1/60.211), con 45 residencias y 46 concurrencias de capacitacion neurologica de posgrado. La mayoria de los distritos mostraron una aceptable presencia cualitativa de recursos tecnologicos en el area de las neuroimagenes estructurales, la neurofisiologia basica y la neuropsicologia. Las principales carencias fueron ausencia de accesibilidad a fibra unica en electromiografia, neuropatologia especializada, estudio de bandas oligoclonales en liquido cefalorraquideo y estudios de neuroimagenes funcionales. Conclusion Existe una gran variabilidad territorial (interdistrital) de los recursos humanos, academicos y en menor medida tecnologicos. Hay una gran tendencia a la acumulacion desproporcionada de los mismos en la Ciudad Autonoma de Buenos Aires, Cordoba, Santa Fe y algunas partes de provincia de Buenos Aires. Se hace imprescindible mantener, reforzar y mejorar en lo posible los sistemas de formacion de posgrado, la actualizacion neurologica continua y estimular la formacion de mas servicios de Neurologia adecuadamente dotados desde lo tecnologico. Todo con una mejor distribucion territorial acorde a las necesidades de cada region de Argentina.

Resumen Introduccion El accidente cerebro vascular (ACV) es una patologia de alta incidencia y morbimortalidad en la mayoria de los paises del mundo. Entre las medidas terapeuticas para el evento isquemico agudo se encuentran las sustancias tromboliticas que, usadas en forma precoz y regladamente, resultan ser muy eficaces en casos seleccionados. Objetivo Realizar un relevamiento epidemiologico nacional para determinar la disponibilidad de centro de tratamientos tromboliticos (CTT) en la Argentina mediante una encuesta destinada a los delegados distritales de la Sociedad Neurologica Argentina. Resultados Como resultado de la misma se definio que este relevamiento, a pesar de sus limitaciones, evidencia que muchas regiones del pais no cuentan, al parecer, con CTT y en donde existen, podrian no ser suficientes en numero para cubrir las necesidades en su area de influencia de acuerdo a la densidad poblacional. Conclusion De acuerdo con todo lo antes expresado, se hace necesario un relevamiento nacional objetivo (p. ej., un censo nacional tipo centro por centro) para definir la verdadera disponibilidad y funcionalidad de los CTT que permiten acceder a trombolisis cerebral en Argentina.

One of the biggest challenges in multiple sclerosis (MS) is the definition of treatment response/failure in order to optimize treatment decisions in affected patients. The objective of this consensus was to review how disease activity should be assessed and to propose recommendations on the identification of treatment failure in RRMS patients in Argentina. Methods A panel of experts in neurology from Argentina, dedicated to the diagnosis and care of MS patients, gathered both virtually and in person during 2016 and 2017 to carry out a consensus recommendation on the identification of treatment failure in RRMS patients. To achieve consensus, the methodology of “formal consensus-RAND/UCLA method” was used. Results Recommendations were established based on published evidence and the expert opinion. Recommendations focused on disease management, disease activity markers and treatment failure identification were determined. Main consensus were: ≥ 2 relapses during the first year of treatment and/or ≥ 3 new or enlarged T2 or T1 GAD + lesions and/or sustained increase of ≥ 2 points in EDSS or ≥ 100% in T25FW defines treatment failure in RRMS patients. Conclusions The recommendations of this consensus guidelines attempts to optimize the health care and management of patients with MS in Argentina.

Resumen Se presenta una propuesta para la unificacion de criterios metodologicos en la elaboracion de guias de practica clinica por parte de la Sociedad Neurologica Argentina (SNA). Se presentan los pasos necesarios para su correcta elaboracion. La metodologia preferida es la de guias basadas en evidencia, con utilizacion de metodos explicitos, con niveles de evidencia y grados de recomendacion de acuerdo al sistema GRADE, y plausibles de ser validadas por el instrumento AGREE. Esto dara a la SNA la posibilidad de publicar guias confeccionadas de acuerdo a los mas altos estandares validados por la Academia Argentina de Medicina y aceptados a nivel internacional.

The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective.Method:Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and 3 and 3 y 3 y

Nora Fernandez Liguori a,∗, Juan Ignacio Rojas b, Mario Bana c,d, Andres Barboza e, Adriana Carra f, Jorge Correale g, Edgardo Cristiano b, Norma Deri h, Marcela Fiol g, Orlando Garcea i, Alejandra Martinez j, Cristina Martinez c, Daniel Munoz h,k, Marcela Parada Marcilla l, Liliana Patrucco b, Walter Perez m, Lucas Martin Romano n, Marina Romano o, Roberto Rotta Escalante p, Vladimiro Sinay q,r, Adriana Tarulla d,s, Silvia Tenembaum t, Andres Villa u, Maria Celica Ysrraelit g y por el Grupo de trabajo de enfermedades desmielinizantes y el Grupo de trabajo de neurofarmacologia de la Sociedad Neurologica Argentina

Like MS prevalence, oligoclonal bands (OCB) frequency seems to follow a latitudinal gradient. Argentina is extensive, latitude-wise, and previous studies have not found an MS prevalence latitudinal gradient. Our aim is to describe OCB prevalence in MS, clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) patients included in the Argentinean MS and NMOSD registry (RelevarEM) and to investigate if it follows a latitudinal gradient.For each province, an average latitude was calculated, and OCB frequency was investigated. Multivariate logistical regression analysis and linear correlation were performed. Statistical analysis was repeated after excluding patients from centers using isoelectric focusing (IEF) in less than 95% of patients (CwIEF95).We included 2866 patients. OCB where positive in 73.9% of patients. No association or correlation were found between OCB and latitude of residence, even after excluding patients from (CwIEF95).OCB positivity does not follow a latitudinal gradient in Argentina. Also, OCB positivity is lower than described in other world regions.