Publications by authors named "Yara Dadalti Fragoso"

127 Publications

Multiple Sclerosis does not affect the muscular strength of the pelvic floor during pregnancy a case control study.

Mult Scler Relat Disord 2021 Jan 10;49:102746. Epub 2021 Jan 10.

Federal University of State of Rio de Janeiro (UNIRIO), Rua Mariz e Barros 775, Tijuca, Rio de Janeiro, RJ, Brazil - ZIP CODE 20270004; Federal University of Rio de Janeiro (UFRJ), Av. Pedro Calmon 550, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil - ZIP CODE 21941-901. Electronic address:

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http://dx.doi.org/10.1016/j.msard.2021.102746DOI Listing
January 2021

Dietary habits in a group of patients with multiple sclerosis are similar to those of healthy control subjects.

Arq Neuropsiquiatr 2020 10;78(10):638-641

Universidade Metropolitanta de Santos, Postgraduate Health and Environment Program, Santos SP, Brazil.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Over time, patients with MS accumulate neurological disabilities. MS typically affects young adults and is associated with an inflammatory profile of cytokines and lymphocytes. If a patient were to consume a potentially inflammatory diet, it is possible that the evolution of MS in that individual would be more aggressive.

Objective: To investigate whether patients with MS living in and around the city of Santos, São Paulo, Brazil, had a profile of inflammatory diet.

Methods: Patients with MS and healthy control subjects were individually interviewed, and the 24-hour Diet Recall and the Bristol Stool Form Scale were applied. Salt intake was calculated using the WebDiet 2.0 software.

Results: There were no remarkable differences in dietary habits between healthy control subjects (n=34) and patients with MS (n=66), except for higher consumption of carbohydrates by patients. Both patients with MS and control subjects had higher protein and lower carbohydrate intake than the World Health Organization's recommended daily amounts. There was no correlation between food intake and neurological disability in patients with MS.

Conclusion: The dietary patterns of patients with MS and healthy controls were similar in the city of Santos, São Paulo, Brazil, and surrounding towns, except for higher intake of carbohydrates by patients. No profile of pro-inflammatory diets was identified among the patients with MS enrolled in this study.
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http://dx.doi.org/10.1590/0004-282X20200065DOI Listing
October 2020

Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis.

Mult Scler 2021 Apr 15;27(5):755-766. Epub 2020 Jun 15.

CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.

Background: Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear.

Objective: The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms.

Methods: This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores.

Results: The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37,  < 0.001) and EDSS (β = 0.16,  < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89,  = 0.01) and EDSS (β = -0.06,  < 0.001). Neither presentation was associated with changes in relapse risk.

Conclusion: Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.
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http://dx.doi.org/10.1177/1352458520926955DOI Listing
April 2021

Cannabis and multiple sclerosis.

Expert Rev Neurother 2020 08 18;20(8):849-854. Epub 2020 Jun 18.

Departamento De Neurociencias Y Doctorado De Farmacologia, CUCS, Universidad De Guadalajara , Mexico.

Introduction: Patients with multiple sclerosis (MS) may suffer from spasticity and pain during their disease course. Baclofen, dantrolene, diazepam and gabapentin have been used as first-line options to treat these conditions, with modest results. Medical use of marijuana smoking has bypassed traditional clinical trials and has been legalized as a therapeutic option for MS-related spasticity and pain in some countries. Cannabis-derived drugs have been tested and approved for medical use.

Areas Covered: With the development of nabiximols by the pharmaceutical industry, more countries have made it possible for patients with MS to have legal access to cannabis-related therapies. The evidence-based data on nabiximols and MS-related spasticity, pain, and urinary symptoms is consistent. There are over 7,500 patients reported in 33 studies (12 from the United Kingdom and 11 from Italy).

Expert Opinion: Nabiximols is safe and effective for patients with MS whose spasticity could not be treated with the first-line oral drugs. At present, legislation, bureaucracy and costs involved in prescribing this drug limit the experience of neurologists from many countries. There is no scientific evidence that smoking marijuana can be beneficial to patients with MS.
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http://dx.doi.org/10.1080/14737175.2020.1776610DOI Listing
August 2020

Effects of photobiomodulation on interleukin-10 and nitrites in individuals with relapsing-remitting multiple sclerosis - Randomized clinical trial.

PLoS One 2020 7;15(4):e0230551. Epub 2020 Apr 7.

Universidade Nove de Julho, UNINOVE, São Paulo, SP, Brazil.

Objective: Investigate the effects of photobiomodulation (PBM) on the expression of IL-10 and nitrites in individuals with Relapsing-Remitting multiple sclerosis (MS), as these biomarkers play a fundamental role in the physiopathology of the disease. The modulation of IL-10 and nitrites through treatment with PBM may be a novel treatment modality for MS.

Methods: A randomized, uncontrolled, clinical trial was conducted involving 14 individuals with a diagnosis of Relapsing-Remitting MS and a score of up to 6.0 on the Expanded Disability Status Scale (EDSS).

The Participants Were Randomized To Two Groups: Group 1 -PBM in the sublingual region; Group 2 -PBM over the radial artery. Irradiation was administered with a wavelength of 808 nm and output power of 100 mW for 360 seconds twice a week, totaling 24 sessions. Peripheral blood was analyzed for the determination of serum levels of IL-10 and nitrites.

Results: After treatment with PBM, the expression of IL-10 increased in both the sublingual group (pre-treatment: 2.8 ± 1.4 pg/ml; post-treatment: 8.3 ± 2.4 pg/ml) and the radial artery group (pre-treatment: 2.7 pg/ml ± 1.4; post-treatment: 11.7 ± 3.8 pg/ml). In contrast, nitrite levels were not modulated in the sublingual group (pre-treatment: 65 ± 50 nmol/mg protein; post-treatment: 51 ± 42 nmol/mg protein) or the radial artery group (pre-treatment: 51 ± 16 nmol/mg protein; post-treatment: 42 ± 7 nmol/mg protein).

Conclusion: Treatment with PBM positively modulated the expression of IL-10 but had no effect on nitrite levels. Further studies should be conducted with a larger sample and a control group, as PBM may be a promising complementary treatment for the management of MS. This trial is registered at ClinicalTrials.gov. Identifier: NCT03360487.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230551PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138327PMC
July 2020

Teaching brainstem anatomy using a sharply-located demyelinating plaque of multiple sclerosis.

Arq Neuropsiquiatr 2019 23;77(9):677. Epub 2019 Sep 23.

Instituto de Pesquisa de Cefaleia e Esclerose Múltipla, Santos SP, Brasil.

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http://dx.doi.org/10.1590/0004-282X20190099DOI Listing
April 2020

Alice in Wonderland syndrome: "Who in the world am I?"

Arq Neuropsiquiatr 2019 23;77(9):672-674. Epub 2019 Sep 23.

Multiple Sclerosis & Headache Research Institute, Santos SP, Brasil.

Alice in Wonderland syndrome (AIWS) is a paroxysmal, perceptual, visual and somesthetic disorder that can be found in patients with migraine, epilepsy, cerebrovascular disease or infections. The condition is relatively rare and unique in its hallucinatory characteristics. OBJECTIVE To discuss the potential pathways involved in AIWS. Interest in this subject arose from a patient seen at our service, in which dysmetropsia of body image was reported by the patient, when she saw it in her son. METHODS We reviewed and discussed the medical literature on reported patients with AIWS, possible anatomical pathways involved and functional imaging studies. RESULTS A complex neural network including the right temporoparietal junction, secondary somatosensory cortex, premotor cortex, right posterior insula, and primary and extrastriate visual cortical regions seem to be involved in AIWS to varying degrees. CONCLUSIONS AIWS is a very complex condition that typically has been described as isolated cases or series of cases.
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http://dx.doi.org/10.1590/0004-282X20190094DOI Listing
April 2020

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

Implementing the 2017 McDonald criteria for the diagnosis of multiple sclerosis.

Nat Rev Neurol 2019 08;15(8):441-445

Department of Neurology, University of California-San Francisco, San Francisco, CA, USA.

The latest revision of the McDonald criteria for the diagnosis of multiple sclerosis (MS) was published online in 2017. New features of the criteria, which were designed to facilitate earlier diagnosis of MS, include the recognition of oligoclonal bands in the cerebrospinal fluid as a possible marker of dissemination of MS pathology in time, the introduction of symptomatic lesions as a parameter to demonstrate spatial or temporal pathology dissemination, and the use of cortical lesions to demonstrate dissemination in space. In this Viewpoint, a panel of world-renowned MS specialists share their personal experiences of the new criteria to date.
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http://dx.doi.org/10.1038/s41582-019-0194-0DOI Listing
August 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

Pharmacogenetics in multiple sclerosis: the long and winding road ahead of us.

Arq Neuropsiquiatr 2018 10;76(10):647-648

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

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http://dx.doi.org/10.1590/0004-282X20180115DOI Listing
October 2018

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

Pediatric acute-onset neuropsychiatric syndrome (PANS) misdiagnosed as autism spectrum disorder.

Immunol Lett 2018 11 15;203:52-53. Epub 2018 Sep 15.

Department of Neurology, Universidade Metropolitana de Santos, UNIMES, Santos, SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.imlet.2018.09.009DOI Listing
November 2018

Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children.

Neurol Ther 2018 Dec 30;7(2):207-232. Epub 2018 Aug 30.

Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.
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http://dx.doi.org/10.1007/s40120-018-0110-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283793PMC
December 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

There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis.

Arq Neuropsiquiatr 2018 Jun;76(6):361-366

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

Objective: Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS.

Methods: The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin".

Results: The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses.

Conclusion: The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.
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http://dx.doi.org/10.1590/0004-282X20180041DOI Listing
June 2018

Normative values of the Brief Repeatable Battery of Neuropsychological Tests in a Brazilian population sample: discrete and regression-based norms.

Arq Neuropsiquiatr 2018 03;76(3):163-169

Departamento de Neurologia, Universidade de Campinas, Campinas, SP, Brasil.

Objective Cognitive dysfunction is common in multiple sclerosis. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was developed to assess cognitive functions most-frequently impaired in multiple sclerosis. However, normative values are lacking in Brazil. Therefore, we aimed to provide continuous and discrete normative values for the BRB-N in a Brazilian population sample. Methods We recruited 285 healthy individuals from the community at 10 Brazilian sites and applied the BRB-N version A in 237 participants and version B in 48 participants. Continuous norms were calculated with multiple-regression analysis. Results Mean raw scores and the 5th percentile for each neuropsychological measure are provided, stratified by age and educational level. Healthy participants' raw scores were converted to scaled scores, which were regressed on age, sex and education, yielding equations that can be used to calculate predicted scores. Conclusion Our normative data allow a more widespread use of the BRB-N in clinical practice and research.
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http://dx.doi.org/10.1590/0004-282x20180006DOI Listing
March 2018

Effect of photobiomodulation treatment in the sublingual, radial artery region, and along the spinal column in individuals with multiple sclerosis: Protocol for a randomized, controlled, double-blind, clinical trial.

Medicine (Baltimore) 2018 May;97(19):e0627

Nove de Julho University (UNINOVE) University Metropolitana de Santos (UNIMES) University, Santos, Brazil.

Background: Multiple sclerosis (MS) is an autoimmune disease, for which the forms of treatment are medication and rehabilitation. However, in vitro and in vivo studies have demonstrated that photobiomodulation can be an effective treatment modality for inflammatory diseases, including MS. Photobiomodulation has a broad range of benefits, such as the avoidance of cell and tissue death, the stimulation of healing and injury repair, reductions in pain, edema and inflammation, cell proliferation, and even apoptosis. The outcomes of photobiomodulation include the regeneration of cells, the stimulation of the growth of Schwann cells, a reduction in spasticity, functional improvements, a reduction in nitric oxide levels, and the upregulation of the cytokine IL10, demonstrating that this therapeutic modality can offer neuroprotection.

Methods: A randomized, controlled, double-blind, clinical trial is proposed. The patients will be divided into 6 groups. Groups 1 and 2 will receive sham and active photobiomodulation in the sublingual region, respectively. Groups 3 and 4 will receive sham and active photobiomodulation along the spinal cord, respectively. Group 5 will receive placebo treatment with photobiomodulation on the skin in the region of the radial artery with a specific bracelet. Group 6 will be treated with photobiomodulation on the skin in the region of the radial artery.

Discussion: Treatment for MS is directed at the immune response and slowing the progression of the disease. This is one of the first clinical trials involving photobiomodulation in the sublingual region and along the spinal cord, which could help establish a promising new form of nonpharmacological treatment for autoimmune diseases. This is one of the first clinical trials with sublingual photobiomodulation and along the spinal cord that could help establish a new form of promising treatment of the disease associated with pharmacological treatment.
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http://dx.doi.org/10.1097/MD.0000000000010627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959421PMC
May 2018

Augusta Marie Déjerine-Klumpke: much more than just Déjerine's wife.

Arq Neuropsiquiatr 2018 Feb;76(2):117-119

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

Augusta Marie Déjerine-Klumpke (1859-1927) was a formidable neurologist, neuroanatomist and researcher in France. One of the first women to be accepted for medical internship, externship and research in Paris, Augusta made her name studying and teaching anatomy, histology and dissection, attending clinical activities in neurology, obstetrics, pediatrics and neurologic trauma, performing necropsies, and writing scientific papers and book chapters. Her main research in neurology awarded her an eponym for the avulsion of the lowest root of the brachial plexus (Klumpke's palsy). Married to her professor, the remarkable Dr. Joseph Jules Déjerine, Augusta continued her career and became the first female president of the French Society of Neurology.
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http://dx.doi.org/10.1590/0004-282X20170185DOI Listing
February 2018

Systematic review of the published data on the worldwide prevalence of John Cunningham virus in patients with multiple sclerosis and neuromyelitis optica.

Epidemiol Health 2018 5;40:e2018001. Epub 2018 Jan 5.

Reference Center for Multiple Sclerosis, Santos, Brazil.

Objectives: John Cunningham virus (JCV) is a polyoma virus that infects humans, mainly in childhood or adolescence, and presents no symptomatic manifestations. JCV can cause progressive multifocal leukoencephalopathy (PML) in immunosuppressed individuals, including those undergoing treatment for multiple sclerosis (MS) and neuromyelitis optica (NMO). PML is a severe and potentially fatal disease of the brain. The prevalence of JCV antibodies in human serum has been reported to be between 50.0 and 90.0%. The aim of the present study was to review worldwide data on populations of patients with MS and NMO in order to establish the rates of JCV seropositivity in these individuals.

Methods: The present review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used the following search terms: "JCV" OR "JC virus" AND "multiple sclerosis" OR "MS" OR "NMO" OR "neuromyelitis optica" AND "prevalence." These terms were searched for both in smaller and in larger clusters of words. The databases searched included PubMed, MEDLINE, SciELO, LILACS, Google Scholar, and Embase.

Results: After the initial selection, 18 papers were included in the review. These articles reported the prevalence of JCV antibodies in the serum of patients with MS or NMO living in 26 countries. The systematic review identified data on 29,319 patients with MS/NMO and found that 57.1% of them (16,730 individuals) were seropositive for the anti-JCV antibody (range, 40.0 to 69.0%).

Conclusions: The median worldwide prevalence of JCV among adults with MS or NMO was found to be 57.1%.
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http://dx.doi.org/10.4178/epih.e2018001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900441PMC
April 2018

Mary Broadfoot Walker: 83 years since a historical discovery.

Arq Neuropsiquiatr 2017 Nov;75(11):825-826

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

Mary Broadfoot Walker was a Scottish physician who, in 1935, described in great detail the effect of an anticholinesterase drug (physostigmine) on the signs and symptoms of myasthenia gravis. An original five-minutes movie is available online and the skepticism of her contemporary British medical doctors is understandable when the drastic effect of the treatment is shown in this movie. What Mary Walker taught us, more than eight decades ago, about myasthenia gravis continues to be the basis of a pharmacological diagnostic test and treatment of this disease.
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http://dx.doi.org/10.1590/0004-282X20170138DOI Listing
November 2017

The relationship between bruxism, sleep quality, and headaches in schoolchildren.

J Phys Ther Sci 2017 Nov 24;29(11):1889-1892. Epub 2017 Nov 24.

University Nove de Julho, São Paulo: Vergueiro Street, 235/249, Liberdade 01504-001, São Paulo, SP, Brazil.

[Purpose] Present study aimed to evaluate the relationship between sleep bruxism and headache in school children. [Subjects and Methods] This study was conducted with 103 children aged 3-6 years. The exclusion criteria were early tooth loss, dental appliance was used, physical or psychological limitations, chronic disease and continuous medication. Sleep bruxism was diagnosed based on an indication by parents of the occurrence of teeth clenching/grinding and incisor/occlusal tooth wear, following the criteria of the American Academy of Sleep Medicine. Sleep quality was evaluated by a questionnarie, detailing the child's sleep characteristics. [Results] Forty-nine children (47.6%) were diagnosed with sleep bruxism. Those with sleep bruxism were 3.25-fold more likely to present headache. Children whose parents were separated had a significantly greater frequency of sleep bruxism and primary headache. The relative risk of exhibiting primary headache was 13.1 among children with sleep bruxism whose parents were separated. [Conclusion] Children with SB demonstrated a greater risk of having primary headache and those whose parents were separated had a greater chance of having headache. Only sleep bruxism was associated with headache, clenching the teeth during waking hours was not correlated with primary headache.
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http://dx.doi.org/10.1589/jpts.29.1889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702807PMC
November 2017

Lymphocyte count in peripheral blood is not associated with the level of clinical response to treatment with fingolimod.

Mult Scler Relat Disord 2018 Jan 22;19:105-108. Epub 2017 Nov 22.

Box Hill Hospital, Eastern Health, Melbourne, Australia.

Background: Fingolimod is an efficient and safe drug for treating relapsing-remitting multiple sclerosis (RRMS). In vivo, fingolimod is phosphorylated and binds to "sphingosine-1-phosphate"(S1P) receptors that are expressed in a wide range of cells, including lymphocytes. Under the effect of fingolimod, lymphocytes are retained in lymphoid tissues through the regulation of S1P receptors. The aim of the present study was to assess whether the degree of lymphopenia was correlated to the positive treatment response of RRMS patients with fingolimod.

Methods: Data was sourced from the MSBase Registry. Patients were divided into two groups, according to the lymphocyte count on peripheral blood examination. Annualized Relapse Rate (ARR), time to first relapse and time to six-month confirmed disability progression were compared between groups.

Results: Group one consisted of 202 patients who reached 750 lymphocytes/mm during treatment while the comparison group two included 101 patients who never reached less than 1000 lymphocytes/mm in peripheral blood during the observation period. There were no differences between groups in ARR, time to first relapse or time to six-month confirmed disability progression.

Conclusion: The degree of lymphopenia in peripheral blood was not associated to the positive treatment response of fingolimod in RRMS patients.
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http://dx.doi.org/10.1016/j.msard.2017.11.018DOI Listing
January 2018

Partial Vogt-Koyanagi-Harada syndrome as a differential diagnosis of optical neuritis.

Mult Scler Relat Disord 2017 10 15;17:128-129. Epub 2017 Jul 15.

NNH-Neurology Neuroscience and Headache, Santos, SP, Brazil; Universidade Metropolitana de Santos, Santos, SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.msard.2017.07.016DOI Listing
October 2017

Critical analysis on the present methods for brain volume measurements in multiple sclerosis.

Arq Neuropsiquiatr 2017 Jul;75(7):464-469

Universidade Metropolitana de Santos, Centro de Referência de Esclerose Múltipla, Departamento de Neurologia, Santos SP, Brasil.

Objective: The treatment of multiple sclerosis (MS) has quickly evolved from a time when controlling clinical relapses would suffice, to the present day, when complete disease control is expected. Measurement of brain volume is still at an early stage to be indicative of therapeutic decisions in MS.

Methods: This paper provides a critical review of potential biases and artifacts in brain measurement in the follow-up of patients with MS.

Results: Clinical conditions (such as hydration or ovulation), time of the day, type of magnetic resonance machine (manufacturer and potency), brain volume artifacts and different platforms for volumetric assessment of the brain can induce variations that exceed the acceptable physiological rate of annual loss of brain volume.

Conclusion: Although potentially extremely valuable, brain volume measurement still has to be regarded with caution in MS.
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http://dx.doi.org/10.1590/0004-282X20170072DOI Listing
July 2017