RESUMEN
BACKGROUND: Fampridine is a broad-spectrum voltage-dependent potassium channel blocker that enhances synaptic transmission. The drug has been shown to be able to ameliorate conduction in demyelinated axons, thereby leading to improved gait in patients with multiple sclerosis (MS). OBJECTIVE: To assess the "real-life" efficacy and safety of fampridine prescribed for gait disorders in MS. This was an observational and prospective study carried out at MS Units participating in the Brazilian Multiple Sclerosis Study Group. METHODS: Patients with MS and gait disorders were prescribed fampridine (10âmg twice a day), irrespectively of the degree of disability determined by MS. Neurological disability determined by MS was assessed with the expanded disability scale score (EDSS). Outcomes for efficacy and safety of the drug were evaluated by the 25 foot-walk test and by the adverse events of fampridine. RESULTS: The time taken to walk 25 feet decreased by 20% or more in 62 patients (70%). Twenty-five patients were considered to be non-responders to this treatment. Improvement in walking speed was independent of improvement of disability. Mild or moderate adverse events were reported in 8% of patients. CONCLUSION: Fampridine is an efficient and safe therapeutic option for patients with MS and gait disorders.
Asunto(s)
4-Aminopiridina/uso terapéutico , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/tratamiento farmacológico , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológico , Bloqueadores de los Canales de Potasio/uso terapéutico , 4-Aminopiridina/farmacología , Adulto , Anciano , Femenino , Trastornos Neurológicos de la Marcha/epidemiología , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/epidemiología , Bloqueadores de los Canales de Potasio/farmacología , Estudios ProspectivosRESUMEN
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.
Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Inmunosupresores/efectos adversos , Esclerosis Múltiple/tratamiento farmacológico , Glicoles de Propileno/efectos adversos , Esfingosina/análogos & derivados , Adulto , Anciano , Bradicardia/inducido químicamente , Femenino , Clorhidrato de Fingolimod , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Inmunosupresores/administración & dosificación , Masculino , Persona de Mediana Edad , Glicoles de Propileno/administración & dosificación , Esfingosina/administración & dosificación , Esfingosina/efectos adversos , Factores de Tiempo , Adulto JovenRESUMEN
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.
Fingolimode é um tratamento novo e eficaz para esclerose múltipla (EM). A administração desta droga requer atenção especial para a primeira dose, uma vez que eventos adversos cardiovasculares podem ser observados nas seis horas iniciais da ingestão de fingolimode. O presente estudo consistiu de uma revisão de dados cardiovasculares de 180 pacientes com EM ao receberem a primeira dose de fingolimode. A taxa de bradicardia nestes pacientes foi maior do que aquele observada em estudos clínicos que tem critérios de inclusão muito rigorosos para seleção de pacientes. Menos de 10% dos casos necessitou de atenção especial, mas não houve casos fatais. Todos os pacientes exceto por um continuaram o tratamento após esta dose inicial. Este é o primeiro relato de dados de administração de fingolimode na vida real de pacientes brasileiros com EM, e um dos poucos trabalhos com estas características no mundo.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enfermedades Cardiovasculares/inducido químicamente , Inmunosupresores/efectos adversos , Esclerosis Múltiple/tratamiento farmacológico , Glicoles de Propileno/efectos adversos , Esfingosina/análogos & derivados , Bradicardia/inducido químicamente , Frecuencia Cardíaca/efectos de los fármacos , Inmunosupresores/administración & dosificación , Glicoles de Propileno/administración & dosificación , Esfingosina/administración & dosificación , Esfingosina/efectos adversos , Factores de TiempoRESUMEN
Multiple sclerosis (MS) is one of the leading causes of neurologic deficits in young adults and can lead to physical, intellectual and emotional problems. Approved treatments are expensive and are among the 10 highest budgets of the Brazilian Health Ministry. Given the diverse prevalence of MS among Brazilian regions, it is important to determine prevalence rates across the country. Seven studies have assessed MS in Brazil and reported rates ranging from 15 cases to 18 cases per 100,000 inhabitants. It has been hypothesized that this rate is even higher in southern Brazil, which has a high proportion of European heritage (mostly German and Italian) immigrants. Here, we report that the prevalence of MS in the city of Santa Maria, Rio Grande do Sul, Brazil, is 27.2 cases/100,000 inhabitants.
Asunto(s)
Esclerosis Múltiple/epidemiología , Brasil/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Población Blanca , Adulto JovenRESUMEN
Multiple sclerosis (MS) is one of the leading causes of neurologic deficits in young adults and can lead to physical, intellectual and emotional problems. Approved treatments are expensive and are among the 10 highest budgets of the Brazilian Health Ministry. Given the diverse prevalence of MS among Brazilian regions, it is important to determine prevalence rates across the country. Seven studies have assessed MS in Brazil and reported rates ranging from 15 cases to 18 cases per 100,000 inhabitants. It has been hypothesized that this rate is even higher in southern Brazil, which has a high proportion of European heritage (mostly German and Italian) immigrants. Here, we report that the prevalence of MS in the city of Santa Maria, Rio Grande do Sul, Brazil, is 27.2 cases/100,000 inhabitants.
Esclerose múltipla (EM) é uma das principais causas de déficit neurológico em adultos jovens, causando problemas físicos, intelectuais e emocionais. Os tratamentos aprovados estão entre os 10 maiores gastos do Ministério da Saúde em nosso país. O conhecimento da prevalência da doença nas diversas regiões brasileiras torna-se essencial. Há sete estudos de prevalência realizados no Brasil, com taxas variando desde 15/100.000 até 18/100.000. Há expectativa de que o sul do Brasil – devido à imigração européia (a maioria alemães e italianos) possa ter taxas até maiores do que 18/100.000. Este estudo mostrou que a prevalência de EM na cidade de Santa Maria, Brasil, é de 27,2/100.000.
Asunto(s)
Femenino , Humanos , Masculino , Adulto Joven , Esclerosis Múltiple/epidemiología , Brasil/epidemiología , Población Blanca , PrevalenciaRESUMEN
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.
Asunto(s)
Esclerosis Múltiple/epidemiología , Adolescente , Distribución por Edad , Edad de Inicio , Brasil/epidemiología , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/terapia , Estudios Retrospectivos , Distribución por Sexo , Factores de TiempoRESUMEN
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. .
Esclerose múltipla (EM) com início na infância e adolescência constitui um desafio para o diagnóstico e manejo da doença. A proposta do presente estudo foi avaliar as características da EM de início precoce em pacientes brasileiros. Métodos Coleta de dados retrospectiva de arquivos de unidades especializadas em atendimento da EM. Resultados A partir de 20 unidades de EM de nove estados brasileiros, foram coletados 117 casos de EM com início antes dos 18 anos de idade. Estes pacientes tinham uma média de 10 anos de duração da doença, de maneira geral apresentavam pouca incapacidade , com um surto a cada dois anos e meio. A média de idade no início da doença era 13,7 anos. Conclusão O presente estudo apresenta uma grande série de casos brasileiros de EM pediátrica. Embora alguns pacientes tenham apresentado forma grave de EM, de maneira geral o grupo de pacientes cuja EM iniciou-se na infância ou adolescência apresentou uma forma relativamente leve da doença no Brasil. .
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Esclerosis Múltiple/epidemiología , Distribución por Edad , Edad de Inicio , Brasil/epidemiología , Progresión de la Enfermedad , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/terapia , Estudios Retrospectivos , Distribución por Sexo , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on medical evidence and may interfere with disease control by immunomodulatory drugs. The present study was designed to help discuss the effect of DMT for MS on pregnancy and on disease course. PATIENTS AND METHODS: Retrospective data from 152 pregnancies of 132 women with MS were collected by the physician in charge of the case. All data were entered into a specific file for qualitative and quantitative statistical analysis. RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of obstetric and neonatal complications was similar in both groups, except for the newborn weight and height which was smaller for mothers receiving medications. Mothers' post-delivery relapse rate and EDSS scores in the follow-up period were significantly higher in the absence of treatment. CONCLUSION: It is possible that, with further such supportive data, international guidelines on MS treatment in young women who intend to get pregnant may need to be revised.