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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.

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 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

The objective of the study was to evaluate the incidence of COVID-19 after complete vaccination in people with multiple sclerosis (PwMS) included in the Argentinean MS and NMOSD registry (RelevarEM, NCT03375177).cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (date, symptoms, need for hospitalization, ventilatory assistance, treatment, and evolution). The contact was made every 30 days during the period of 3 months after the full dose vaccination. A positive COVID-19 case was defined according to the definition established by the Ministry of Health in Argentina. Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density.A total of 576 PwMS were included, mean age 45.2 ± 13 years, 432 (75%) RRMS, 403 (70%) were female. The mean and median time of follow-up after the second dose was 91 ± 17 and 94 ± 21 days respectively. Most frequent first and second dose received was Astra-Zeneca vaccine, followed by Sputnik V vaccine. During follow-up a total of twenty COVID-19 cases were observed for a total exposure time of 39,557 days. The overall cumulative incidence for the observed period was 3.4% (SE 0.4%) with an overall incidence density of 5 × 10.000 patients/day (95%CI 0.7-12). We observed more cases in woman than men with an incidence density of 6 × 10.000 patients/day (95%CI 0.9-9) vs. 3 × 10.000 patients/day (95%CI 0.2-6) respectively, but not significantly different (IRR 1.7 95% CI 0.56-7.37 p = 0.15).we found an incidence density of breakthrough COVID-19 infection of 5 × 10.000 patients/day (95%CI 0.7-12) after vaccination in Argentina.

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 : 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.

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.

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 0.001 between groups). In NMOSD, the CCI was 0 in 64% while ≥ 1 was in 36%. The MS/NMOSD ratio found was 21/1.This is the first analysis of the longitudinal Argentinean registry of MS and NMOSD describing and comparing conditions that contributes to provide reliable real-world data in the country.

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.

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.

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.