Publications by authors named "Sidney Gomes"

37 Publications

Clinical Features of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorders.

Neurol Neuroimmunol Neuroinflamm 2021 11 26;8(6). Epub 2021 Aug 26.

From the Hospital das Clínicas (S.L.A., M.B., G.D.S., L.B., C.C.D.D., D.C.), FM-USP, São Paulo; Universidade Federal de Sergipe and Univ. Tiradentes (L.C.F.), Aracaju; Hospital Univ. Getúlio Vargas (N.A.d.C.S.), Manaus; Hospital Geral de Fortaleza (G.J.M., J.A.d.A., M.S.P., L.S.M.); Universidade Federal da Bahia/Ebserh (T.F.), Salvador; Hospital Ophir Loyola (H.L.S., L.C.R.), Belém; FUNAD (B.E.S.), João Pessoa; UNICAMP (C.R.A.), Campinas; Universidade Federal de São Paulo (E.M.L., L.d.S.A.), UNIFESP; Universidade Metropolitana de Santos (A.A.F.d.C., Y.D.F.); Santa Casa (A.P.G.), Belo Horizonte; Hospital da Restauração (M.I.d.M., A.J.P.), Recife; Santa Casa (R.P.C., M.F.M.), São Paulo; Hospital de Base do Distrito Federal (R.M.D.), Brasília; Hospital Santa Marcelina (A.C.P.), São Paulo; Private Service (A.K.), Cuiabá; Clínica AMO (A.M.), Salvador; Hospital Universitário Gaffree e Guinle (C.C.F.V.), Rio de Janeiro; Santa Casa (D.R.K.M.), Londrina; Universidade Federal de Goiás (D.S.D.), Goiânia; Private Service (E.R.C.-F.), Belo Horizonte; Faculdade de Medicina de Botucatu (F.C.G.D.R, D.G.B.), UNESP; Santa Casa and ABEM-Assoc. Brasileira de Esclerose Múltipla (G.S.d.O.), São Paulo; Universidade Estácio de Sá and Universidade Federal Fluminenses (G.A.C.), Rio de Janeiro; Universidade Federal Fluminense (H.H.R.), Campinas; Universidade Federal do Mato Grosso (H.H.S., J.A.F., L.S.), Cuiabá; Private Service (H.K.S.), Curitiba; IAMSPE (H.R.S.N.), São Paulo; Private Service (L.C.C.), São Paulo; Faculdade de Medicina de Marília (L.D.M.); Univ. da Região de Joinville (Univille) (M.V.M.G.); Santa Casa (M.L.V.P.), Rio de Janeiro; Univ. Federal R G Norte (M.E.T.D.), Natal; Univ. Federal Ciências da Saúde de Porto Alegre (M.d.C.R.); PUC (P.D.d.G.), Sorocaba; Hospital Israelita Albert Einstein (R.B.T.), São Paulo; Univ. Federal de Uberlândia (R.d.R.M.); Hospital Beneficência Portuguesa (S.G.), São Paulo; Hospital Memorial São José (S.S.), rede D'OR, Recife; Univ. Federal do Rio de Janeiro (S.N.M., V.C.S.R.P.); Private Service (S.N.M.), Florianópolis; Univ. Federal de Goiás (T.A.G.J.R.), Goiânia; Hospital Neurológico de Goiânia (V.M.C.); Pontifícia Universidade Católica de Campinas (M.M.d.M.P.); Hospital Universitário da Universidade Federal de Santa Catarina (A.W.d.N.J.), Florianópolis; Faculdade de Medicina de Ribeirão Preto (E.A.D.), USP; Hospital Sírio-Libanês (T.A.), São Paulo; and Faculty of Medicine (F.v.G.), University of Brasilia, Brazil.

Background And Objectives: To describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD).

Methods: The Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described.

Results: Among the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8-77), with disease onset at 31 years (range 4-69) and disease duration of 6 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection.

Discussion: Most NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.
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http://dx.doi.org/10.1212/NXI.0000000000001060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404206PMC
November 2021

Coronavirus disease 2019 in Latin American patients with multiple sclerosis.

Mult Scler Relat Disord 2021 Jul 25;55:103173. Epub 2021 Jul 25.

Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Patients with multiple sclerosis (MS) who present coronavirus disease 2019 (COVID-19) are of particular interest to neurologists. These patients have a neuroimmune disease and receive immunomodulatory or immunosuppressive therapies in the long-term. We present here data from 73 patients with MS and a confirmed diagnosis of COVID-19 from five Latin American countries. Fifteen patients (20.5%) were hospitalized and two patients died. The use of anti-CD20 therapies was the only risk factor associated to hospitalization and death. Despite the small sample size, this study highlights the awareness regarding therapeutic options for MS during the pandemic.
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http://dx.doi.org/10.1016/j.msard.2021.103173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310568PMC
July 2021

Migraine in 746 patients with multiple sclerosis.

Arq Neuropsiquiatr 2019 23;77(9):617-621. Epub 2019 Sep 23.

Universidade Positivo, Curitiba PR, Brazil.

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.
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http://dx.doi.org/10.1590/0004-282X20190100DOI Listing
April 2020

Late Onset of Neuromyelitis Optica Spectrum Disorders.

Neurol Ther 2019 Dec 2;8(2):477-482. Epub 2019 Jul 2.

Department of Neurology, Universidade Estacio de Sa, Rio de Janeiro, RJ, Brazil.

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a "late onset" (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD.

Methods: Retrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units.

Results: The ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals).

Conclusion: This series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.
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http://dx.doi.org/10.1007/s40120-019-0143-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858916PMC
December 2019

Severe Exacerbation of Multiple Sclerosis Following Withdrawal of Fingolimod.

Clin Drug Investig 2019 Sep;39(9):909-913

Universidade Federal Fluminense, Niteroi, RJ, Brazil.

Background: Fingolimod is an effective therapy for multiple sclerosis (MS). Isolated reports of very aggressive MS rebound after discontinuation of fingolimod are drawing neurologists' attention to this potentially severe complication of the drug.

Objective: Our objective was to collect literature data on cases of MS rebound following fingolimod withdrawal. In addition, we report six new cases of this adverse event in Brazil.

Methods: We carried out a systematic review of published data on cases of MS rebound after fingolimod was discontinued. In addition, the study reports a retrospective data series of Brazilian patients presenting this rebound reaction.

Results: Twenty papers have been published reporting on 52 patients with severe MS rebound after fingolimod withdrawal. Six new patients are included in the present paper, all of them with aggressive rebound and accumulated disability sequelae.

Conclusion: We recommend gradual discontinuation of fingolimod with replacement by other treatment. The washout period should not exceed 4 weeks.
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http://dx.doi.org/10.1007/s40261-019-00804-6DOI Listing
September 2019

Clinical Characteristics of Patients With Neuromyelitis Optica Spectrum Disorders With Early Onset.

J Child Neurol 2019 08 23;34(9):487-490. Epub 2019 Apr 23.

2 Department of Neurology, University Hospital Getulio Vargas, Manaus, AM, Brazil.

Neuromyelitis optica spectrum disorder is a severe and disabling disease that manifests with severe relapses of optic neuritis, longitudinally extensive myelitis, and/or brainstem syndromes. The disease is complex and, although onset typically occurs in middle age, children and adolescents may be affected. The present study adds to the literature through detailed clinical data from 36 Brazilian patients with neuromyelitis optica spectrum disorder starting before age 21. This was a retrospective assessment of medical records from 14 specialized units in Brazil. The results showed that the course of neuromyelitis optica spectrum disorder was worse in patients with disease onset before the age of 12 years. Gender and ethnic background did not influence disability accumulation. Over a median period of 8 years, 14% of the patients who presented the initial symptoms of neuromyelitis optica spectrum disorder before the age of 21 years died. In conclusion, the present study adds to the reports from other authors examining the severity of early-onset neuromyelitis optica spectrum disorder.
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http://dx.doi.org/10.1177/0883073819842421DOI Listing
August 2019

Clinical characteristics of 153 Brazilian patients with neuromyelitis optica spectrum disorder (NMOSD).

Mult Scler Relat Disord 2019 Jan 28;27:392-396. Epub 2018 Nov 28.

Department of Neurology, New York University, New York, NY, USA.

Background: The 2015 criteria for diagnosing neuromyelitis optica spectrum disorder (NMOSD) have encouraged several groups across the world to report on their patients using these criteria. The disease typically manifests with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndromes, often leading to severe disability. Some patients are seropositive for antibodies against aquaporin-4 (AQP4), others are positive for anti-myelin oligodendrocyte glycoprotein (MOG), while a few are negative for both biomarkers. The disease is complex, and only now are specific therapeutic clinical trials being carried out. The present study adds to the literature through detailed clinical data from 153 medical records of Brazilian patients.

Methods: Retrospective assessment of medical records from nine specialized units in Brazil.

Results: NMOSD was more prevalent in females (4.1:1), who had significantly fewer relapses than males (p = 0.007) but presented similar levels of disability over time. African ancestry was associated with higher levels of disability throughout the disease course (p < 0.001), although the number of relapses was similar to that observed in white patients. Concomitant autoimmune diseases were relatively rare in this population (6.5%). Positivity for anti-AQP4 antibodies was identified in 62% of the patients tested, while 3% presented anti-MOG antibodies. Anti-AQP4 antibodies were not associated to worse disease course. The last medical record showed that six patients had died and 13 were wheelchair-bound. Seventy percent of the patients did not respond to first-line therapy (azathioprine and/or corticosteroids), and five patients continued to relapse even after four different courses of treatment.

Conclusion: The present study adds to the reports from other countries presenting original data on Brazilian patients diagnosed with NMOSD according to the 2015 criteria.
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http://dx.doi.org/10.1016/j.msard.2018.11.031DOI Listing
January 2019

Seroconversion of JCV antibodies is strongly associated to natalizumab therapy.

J Clin Neurosci 2019 Mar 3;61:112-113. Epub 2018 Nov 3.

Hospital Universitario Getulio Vargas, Manaus, AM, Brazil.

Previous infection with John Cunningham virus (JCV) increases the risk of progressive multifocal leukoencephalopathy in patients with multiple sclerosis (MS) undergoing treatment with natalizumab. Patients who test negative for JCV antibodies must be assessed every six months due to the risk of seroconversion. Data from the United States of America, Portugal, Holland, France, United Kingdom and Sweden have shown a strong correlation between the use of natalizumab and JCV seroconversion. The authors present now data on patients from Brazil, as there are no data from Latin American countries published on this subject yet. A group of 86 patients with MS with negative results for antibodies against JCV were included in this analyses with at least two JCV antibodies testing. Twenty-five patients (29% of the total group) did not use natalizumab at any time, while the remaining 71% used natalizumab for a median period of 800 days (equivalent to 28 monthly infusions). Seroconversion was observed in 19 patients (22.1%). There was no association of seroconversion with gender, age, previous pulses of corticosteroid or specific MS-modifying drugs. The use of natalizumab was strongly associated to seroconversion (p < 0.0001). The present results confirm the influence of natalizumab therapy on JCV antibodies in several countries and continents.
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http://dx.doi.org/10.1016/j.jocn.2018.10.128DOI Listing
March 2019

Serological profile of John Cunningham virus (JCV) in patients with multiple sclerosis.

Arq Neuropsiquiatr 2018 09;76(9):588-591

Universidade Metropolitana de Santos, Departamento de Neurologia, São Paulo SP, Brasil.

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.
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http://dx.doi.org/10.1590/0004-282X20180083DOI Listing
September 2018

High levels of alexithymia in patients with multiple sclerosis.

Dement Neuropsychol 2018 Apr-Jun;12(2):212-215

Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil.

Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce.

Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS.

Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used.

Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia.

Conclusion: Alexithymia was a relevant finding in patients with MS.
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http://dx.doi.org/10.1590/1980-57642018dn12-020015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022982PMC
July 2018

Superficial siderosis of the central nervous system is a rare and possibly underdiagnosed disorder.

Arq Neuropsiquiatr 2017 Feb;75(2):92-95

IdHera, Departamento de Neurorradiologia, Joinville SC, Brasil.

Methods: Series of cases collected from Brazilian centers.

Results: We studied 13 cases of patients presenting with progressive histories of neurological dysfunction caused by SS-CNS. The most frequent clinical findings in these patients were progressive gait ataxia, hearing loss, hyperreflexia and cognitive dysfunction. The diagnoses of SS-CNS were made seven months to 30 years after the disease onset.

Conclusion: SS-CNS is a rare disease that may remain undiagnosed for long periods. Awareness of this condition is essential for the clinician.
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http://dx.doi.org/10.1590/0004-282X20170001DOI Listing
February 2017

Dengue fever in patients with multiple sclerosis taking fingolimod or natalizumab.

Mult Scler Relat Disord 2016 Mar 28;6:64-65. Epub 2016 Jan 28.

Department of Neurology, Private Clinic Campinas, Campinas, SP, Brazil.

Dengue fever is the most prevalent mosquito-borne viral illness in humans. There may be different clinical manifestations of the disease, from mild symptoms to hemorrhagic forms of dengue fever and even neurological complications of this viral infection. Blood cells are usually affected, and thrombocytopenia is the hallmark of the disease. This paper presents 15 cases of dengue fever in patients with multiple sclerosis (MS) taking fingolimod or natalizumab. There were no complications of dengue fever or worse outcomes of MS in these patients, and only four of them needed short-term treatment withdrawal due to lymphopenia.
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http://dx.doi.org/10.1016/j.msard.2016.01.005DOI Listing
March 2016

Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis.

Expert Rev Clin Pharmacol 2016 Apr 21;9(4):541-546. Epub 2016 Feb 21.

v Department of Neurology , Universidade Federal do Espirito Santo , Vitoria , Brazil.

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.
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http://dx.doi.org/10.1586/17512433.2016.1145053DOI Listing
April 2016

Cerebrum-cervical arterial dissection in adults during sports and recreation.

Arq Neuropsiquiatr 2016 Apr 6;74(4):275-9. Epub 2015 Oct 6.

Universidade Regional de Blumenau, Blumenau, SC, Brazil.

Unlabelled: Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities.

Methods: Retrospective data on patients with arterial dissection related to sports and recreation.

Results: Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature.

Conclusion: Arterial dissection may be a complication from practicing sports.
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http://dx.doi.org/10.1590/0004-282X20150150DOI Listing
April 2016

Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population.

Arq Neuropsiquiatr 2015 Oct 18;73(10):828-33. Epub 2015 Aug 18.

University of Aberdeen, Aberdeen, GB.

Purpose Recent papers suggest that patients with multiple sclerosis (MS) are prone to alcohol misuse. This may be due to the combination of a lifelong and disabling disease with a psychiatric profile typical of MS. The objective of the present study was to assess these findings in a culturally different population of patients with MS.Method The present case-control transversal study assessed 168 patients with MS and 168 control subjects from Brazil.Results There were no evidence that patients with MS drank more alcohol or, smoked more than did controls. In fact, control subjects had a significantly higher alcohol consumption. The only trait associated to higher alcohol consumption was anxiety, both for patients and controls.Conclusion Unlike previous reports in the literature, patients with MS in our study did not drink or smoked more than a control population.
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http://dx.doi.org/10.1590/0004-282X20150117DOI Listing
October 2015

Fingolimod Prescribed for the Treatment of Multiple Sclerosis in Patients Younger Than Age 18 Years.

Pediatr Neurol 2015 Aug 2;53(2):166-8. Epub 2015 Apr 2.

Department of Neurology and MS Unit, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.

Background: There have been no clinical trials for approval of medications for treating multiple sclerosis in patients younger than age 18 years. All treatments are based on personal experience and data from open observational studies. Fingolimod is an oral drug for multiple sclerosis that has been shown to be efficient and safe in adults. The aim of our study is to describe patients with multiple sclerosis who started treatment with fingolimod before the age of 18 years.

Participants And Methods: Seventeen patients treated with fingolimod were identified in the Brazilian database of children and adolescents with multiple sclerosis. The average time of use of the drug was 8.6 months.

Results: Fingolimod showed a good safety and efficacy profile in these patients, all of whom had very active multiple sclerosis. After starting treatment with fingolimod, only one patient had a relapse and a new lesion on magnetic resonance imaging. The patients' degree of disability did not progress. No major adverse events were reported in relation to the first dose of the drug, nor in the short- and medium-term treatment. No patient has been followed for longer than 18 months, thus limiting long-term conclusions.

Conclusions: Off-label use of fingolimod in patients younger than age 18 years may be a good therapeutic option for multiple sclerosis control.
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http://dx.doi.org/10.1016/j.pediatrneurol.2015.03.024DOI Listing
August 2015

A 77-year-old man with nocturnal epilepsy.

Ann Am Thorac Soc 2014 Oct;11(8):1332-4

1 Pulmonary Division, Heart Institute (InCor)/Hospital das Clínicas, University of São Paulo School of Medicine, and.

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http://dx.doi.org/10.1513/AnnalsATS.201312-449CCDOI Listing
October 2014

The real-life experience with cardiovascular complications in the first dose of fingolimod for multiple sclerosis.

Arq Neuropsiquiatr 2014 Sep;72(9):712-4

Departamento de Neurologia, Hospital de Base do Distrito Federal, Brasília, DF, Brazil.

Fingolimod is a new and efficient treatment for multiple sclerosis (MS). The drug administration requires special attention to the first dose, since cardiovascular adverse events can be observed during the initial six hours of fingolimod ingestion. The present study consisted of a review of cardiovascular data on 180 patients with MS receiving the first dose of fingolimod. The rate of bradycardia in these patients was higher than that observed in clinical trials with very strict inclusion criteria for patients. There were less than 10% of cases requiring special attention, but no fatal cases. All but one patient continued the treatment after this initial dose. This is the first report on real-life administration of fingolimod to Brazilian patients with MS, and one of the few studies with these characteristics in the world.
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http://dx.doi.org/10.1590/0004-282x20140102DOI Listing
September 2014

Postpartum Treatment With Immunoglobulin Does Not Prevent Relapses of Multiple Sclerosis in the Mother.

Health Care Women Int 2015 30;36(10):1072-80. Epub 2014 Oct 30.

ab Department of Neurology, Hospital de Base do Distrito Federal , Brasilia , Brazil.

Multiple sclerosis (MS) is a chronic, neurological, immune-mediated disease that can worsen in the postpartum period. There is no consensus on the use of immunoglobulin for prevention of disease relapses after delivery. We have shown that the controversial beneficial effect of immunoglobulin given immediately after birth could not be observed in patients with MS.
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http://dx.doi.org/10.1080/07399332.2014.948627DOI Listing
January 2016

We know how to prescribe natalizumab for multiple sclerosis, but do we know how to withdraw it?

Expert Rev Neurother 2014 Feb 13;14(2):127-30. Epub 2014 Jan 13.

MS Reference Center, Medical School, Universidade Metropolitana de Santos, Santos, SP, Brazil.

Natalizumab is a potent immunosuppressive monoclonal antibody used for the treatment of multiple sclerosis (MS). While definite guidelines for the safety of natalizumab prescriptions are available in all countries, there are no specific recommendations on how to withdraw the drug if the need arises. There are reports describing MS complications after natalizumab infusions were stopped. Most neurologists seem to stop natalizumab treatment according to their idea on how to best carry out the withdrawal. The present study shows the very different manners in which expert neurologists from 14 MS units in Brazil stopped natalizumab in their patients. The authors concluded that pharmacovigilance on natalizumab must persist after the drug is withdrawn in order to have enough data for adequate recommendations.
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http://dx.doi.org/10.1586/14737175.2014.874947DOI Listing
February 2014

Multiple sclerosis starting before the age of 18 years: the Brazilian experience.

Arq Neuropsiquiatr 2013 Oct;71(10):783-7

Universidade Metropolitana de Santos, SantosSP, Brazil.

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.
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http://dx.doi.org/10.1590/0004-282X20130122DOI Listing
October 2013

Nearly one-half of Brazilian patients with multiple sclerosis using natalizumab are DNA-JC virus positive.

Arq Neuropsiquiatr 2013 Oct;71(10):780-2

Universidade Metropolitana de Santos, SantosSP, Brasil.

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.
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http://dx.doi.org/10.1590/0004-282X20130121DOI Listing
October 2013

Multiple sclerosis in South America: month of birth in different latitudes does not seem to interfere with the prevalence or progression of the disease.

Arq Neuropsiquiatr 2013 Sep;71(9A):573-9

Department of Neurology, Universidade Metropolitana de Santos, SantosSP, Brazil.

Objective: To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life.

Methods: Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression.

Results: Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0-10; 11-20; 21-30; and 31-40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band.

Conclusion: The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.
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http://dx.doi.org/10.1590/0004-282X20130098DOI Listing
September 2013

Neuromyelitis optica with onset in childhood and adolescence.

Pediatr Neurol 2014 Jan 13;50(1):66-8. Epub 2013 Oct 13.

Universidade Federal de Santa Catarina, Florianopolis, Brazil.

Background: Neuromyelitis optica with onset before the age of 18 years is a relatively rare, yet potentially devastating condition. The objective of the present study was to contribute to the study of early-onset neuromyelitis optica with a case series.

Patients: Data were collected from medical records of Brazilian neurologists caring for patients with neuromyelitis optica occurring in childhood and adolescence.

Results: Twenty-nine patients with neuromyelitis optica occurring before the age of 18 years and fulfilling the diagnostic criteria were identified. The average age at disease onset was 13 years and the patients had had an average disease duration of 6 years. The expanded disability scale score at the latest consultation was, on average, 4.7, and one patient had died from the disease. The 29 patients had had an average 4.5 relapses during the disease, accounting for 0.75 relapses per year, irrespective of the medication used. All patients were using one or more of the following medications: azathioprine, prednisone, immunoglobulin, and glatiramer acetate.

Conclusions: Neuromyelitis optica with onset in childhood and adolescence is a poorly understood condition that is often disabling and difficult to manage.
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http://dx.doi.org/10.1016/j.pediatrneurol.2013.07.003DOI Listing
January 2014

Long-term effects of exposure to disease-modifying drugs in the offspring of mothers with multiple sclerosis: a retrospective chart review.

CNS Drugs 2013 Nov;27(11):955-61

Department of Neurology, Medical School, Universidade Metropolitana de Santos (UNIMES), Rua da Constituicao 374, CEP 11015-470, Santos, SP, Brazil,

Introduction: Multiple sclerosis (MS) mainly affects women of fertile age. To date, the only recommendation for women with MS intending to become pregnant is to stop all treatment. This recommendation reflects the concerns about the effects of disease-modifying drugs (DMDs) on the offspring. The objective of the present study was to assess the potential long-term effects of maternal exposure to DMDs on the offspring.

Method: This was a retrospective study revising medical data on the offspring of women with MS. These women now have children aged at least 1 year and include a group of patients that were not exposed to any DMDs for at least 3 months prior to pregnancy and during the whole gestation (control group). Another group of patients had at least 2 weeks of exposure to DMDs, mainly to interferon beta or glatiramer acetate

Results: The women with MS participating in this study have children currently aged, on average, 6.6 years (range 1-39 years). There was no pattern of drug-related adverse events or complications in the children whose mothers were exposed to DMDs. No specific long-term adverse events were observed in the offspring of women with MS who were exposed to drugs during pregnancy. The profile of relevant diagnoses in their children was similar to that of children whose mothers had not been exposed to DMDs.

Conclusions: The present retrospective study did not show a specific profile of long-term deleterious drug effects on children born from mothers who were exposed to drugs for MS treatment.
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http://dx.doi.org/10.1007/s40263-013-0113-7DOI Listing
November 2013

Natalizumab adverse events are rare in patients with multiple sclerosis.

Arq Neuropsiquiatr 2013 Mar;71(3):137-41

Universidade Metropolitana de Santos (UNIMES), Santos SP, 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.
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http://dx.doi.org/10.1590/s0004-282x2013000300002DOI Listing
March 2013
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