RESUMO
BACKGROUND: Patients with Multiple Sclerosis (MS) undergoing treatment with natalizumab (NTZ) are at risk of developing progressive multifocal leukoencephalopathy (PML) due to the reactivation of John Cunningham (JC) virus. A relevant characteristic among PML cases is the development of single nucleotide mutations in the VP1 gene of the causal JC virus. The identification of such mutations in timely manner can provide valuable information for MS management. OBJECTIVE: To identify mutations along the JC virus VP1 gene in MS patients undergoing treatment with NTZ, and correlate them with anti-JC virus antibody index. METHODS: Eighty-eight MS patients, one hundred twenty controls, and six patients with diagnosis of Human Immunodeficiency Virus (HIV) with and without secondary PML were included. JC virus was identified in peripheral blood mononuclear cells and cerebrospinal fluid by PCR. Amplification and sequencing of the entire length of the VP1 gene were performed in all positive clinical samples. RESULTS: In MS cases no mutations were observed in the JC virus VP1 gene, but it was positive in HIV controls with PML. Interestingly, the JC virus VP1 gene sequence derived from the HIV patients exhibited a non-silent substitution in position 186 (G â C), leading to an amino acid change (Lys â Asp). We did not find correlation between anti-JC virus antibody index and DNA viral detection. CONCLUSIONS: . The identification of single nucleotide mutants in the JC virus VP1 gene might be an early predictive marker to PML for efficient patient treatment and follow-up.
Assuntos
Vírus JC , Leucoencefalopatia Multifocal Progressiva , Esclerose Múltipla , Infecções por HIV , Humanos , Vírus JC/genética , Leucócitos Mononucleares , Esclerose Múltipla/complicações , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/genética , Mutação , Natalizumab/uso terapêuticoRESUMO
INTRODUCTION: Recent studies report that patients with neuromyelitis optica (NMO) or seropositive NMO spectra disorders display clinical characteristics that are different from those of patients who are seropositive for the aquaporin-4 (AQP4) antibody. AIM: To analyse the clinical and paraclinical characteristics of patients with NMO according to their serum AQP4 status. PATIENTS AND METHODS: We conducted a retrospective study of 100 patients with NMO who fulfilled the Wingerchuk criteria: 70 were positive for the AQP4 antibody and 30 were seronegative. RESULTS: 70% of the subjects met the criteria for NMO, and 30% met criteria for NMO spectra disorders. The seropositive patients presented greater disability in the scores on the American Spinal Injury Association scale (ASIA) and the Expanded Disability Status Scale (p = 0.034 and 0.004, respectively) compared to seronegatives during the follow-up; in this same group there was greater visual involvement (p = 0.02), a higher number of relapses (p = 0.008) and a greater number of spinal segments involved (p = 0.003). CONCLUSION: This study provides an overview of the clinical and paraclinical characteristics of patients with NMO according to the AQP4 antibody serostatus. Patients who are seropositive for the AQP4 antibody present greater clinical and imaging involvement.
TITLE: Comparacion de los espectros de neuromielitis optica segun el seroestado del anticuerpo AQP4 en un centro de referencia mexicano.Introduccion. Estudios recientes describen que los pacientes con neuromielitis optica (NMO) o trastornos del espectro de NMO seronegativos exhiben caracteristicas clinicas diferentes a los pacientes seropositivos al anticuerpo acuaporina-4 (AQP4). Objetivo. Analizar las caracteristicas clinicas y paraclinicas de pacientes con NMO segun el estado serico del anticuerpo AQP4. Pacientes y metodos. Estudio retrospectivo de 100 pacientes con NMO que cumplian los criterios de Wingerchuk: 70 presentaron positividad al anticuerpo AQP4 y 30 fueron seronegativos. Resultados. Un 70% de los sujetos cumplio los criterios para la NMO, y un 30%, para los trastornos del espectro de NMO. Los pacientes seropositivos presentaron mayor discapacidad en las puntuaciones de la escala de la Asociacion Americana de Lesion de la Medula Espinal (ASIA) y la escala ampliada del estado de discapacidad (p = 0,034 y 0,004, respectivamente) comparados con los seronegativos durante el seguimiento; en este mismo grupo hubo mayor afectacion visual (p = 0,02), mayor numero de recaidas (p = 0,008) y mayor numero de segmentos medulares afectados (p = 0,003). Conclusion. Este estudio proporciona una vision general de las caracteristicas clinicas y paraclinicas de los pacientes con NMO segun el seroestado del anticuerpo AQP4. Los pacientes seropositivos al anticuerpo AQP4 presentan mayor afectacion clinica e imaginologica.
Assuntos
Anticorpos/sangue , Aquaporina 4/imunologia , Neuromielite Óptica/sangue , Neuromielite Óptica/imunologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/diagnóstico , Estudos RetrospectivosRESUMO
INTRODUCTION: El doctor inverosimil (The Improbable Doctor) is a novel by Ramon Gomez de la Serna (1888-1963) in which the reader follows, by means of a series of different clinical cases, the adventures of Doctor Vivar. AIMS: To present and discuss, for the first time, the influence that Spanish neuropsychiatry had on this novel, taking the following short stories as study models: 'Casos cerebrales' ('Brain Cases') and 'La risita' ('The Giggles'). DEVELOPMENT: In these two tales, the improbable doctor embodies the three defining elements of Spanish neuropsychiatry. The repetitions of Alzheimer's disease (or in the way in which progressive general paralysis is referred to) hints at its Germanic orientation. The mixed neuropsychiatric component is exemplified in both his neurological ('La risita') and psychiatric skills ('Casos cerebrales'). Doctor Vivar's affinity to things histopathological is apparent in his wide and timely usage of neurohistological terminology, mainly from Cajal. CONCLUSIONS: It can be deduced that the Spanish neuropsychiatric school had a strong influence on Gomez de la Serna's El doctor inverosimil.
TITLE: Influencia de la neuropsiquiatria española en la medicina inverosimil de Ramon Gomez de la Serna.Introduccion. El doctor inverosimil es una novela de Ramon Gomez de la Serna (1888-1963) donde seguimos, a traves de diversos casos clinicos, las andanzas del doctor Vivar. Objetivo. Presentar y discutir, por primera vez, el influjo que tuvo la neuropsiquiatria española en esta novela, tomando como modelos de estudio los siguientes relatos: 'Casos cerebrales' y 'La risita'. Desarrollo. En este par de relatos, el doctor inverosimil encarna los tres elementos definitorios de la neuropsiquiatria española. En sus repeticiones de la enfermedad de Alzheimer (o en la forma en que se refiere a la paralisis general progresiva) insinua su orientacion germanica. El componente mixto neuropsiquiatrico esta ejemplificado en su destreza tanto neurologica ('La risita') como psiquiatrica ('Casos cerebrales'). La afinidad histopatologica del doctor Vivar es evidente en su amplio y oportuno uso de la terminologia neurohistologica, principalmente la cajaliana. Conclusiones. Es valido deducir que hay una influencia notoria de la escuela neuropsiquiatrica española en El doctor inverosimil de Gomez de la Serna.
Assuntos
Literatura Moderna/história , Medicina na Literatura/história , Neuropsiquiatria/história , História do Século XIX , História do Século XX , Transtornos Mentais/história , Transtornos Mentais/psicologia , Modelos Neurológicos , Modelos Psicológicos , Neuropsiquiatria/tendências , Médicos , EspanhaAssuntos
Cloridrato de Fingolimode/efeitos adversos , Hipotireoidismo/induzido quimicamente , Imunossupressores/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Adulto , Feminino , Cloridrato de Fingolimode/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Adulto JovemRESUMO
The incidence and prevalence of multiple sclerosis (MS) varies geographically as shown through extensive epidemiological studies performed mainly in developed countries. Nonetheless, scant data is available in Latin America and the Caribbean (LAC). The objective of this review is to assess epidemiological data of MS in LAC. We conducted a systematic review of published articles and gray literature from January 1995 to May 2011. Twenty-two studies met the inclusion criteria after full-text review. Incidence data were found in only three studies and ranged from 0.3 to 1.9 annual cases per 100,000 person-years. Prevalence was reported in 10 studies and ranged from 0.83 to 21.5 cases per 100,000 inhabitants. The most prevalent subtype of MS was the relapsing-remitting form (48% to 91% of the series). No data about mortality were found. This study showed low frequency for MS in LAC compared with North American and European countries. The role of environmental and genetic factors should be well studied, providing new insights about its etiology.
Assuntos
Esclerose Múltipla/epidemiologia , Região do Caribe/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , PrevalênciaRESUMO
OBJECTIVES: Human leukocyte antigen (HLA)-DRB1, DQA1, DQB1 allele typing was performed in Mexicans Mestizos with multiple sclerosis (MS) to define the HLA class II alleles associated with the disease in this population. METHODS: Patients (n = 51) diagnosed according to the Poser criteria and a group of 173 unrelated healthy subjects were studied. PCR-SSOP and PCR-SSP were used for genotyping. RESULTS: Fifty five percent of the patients were females. The mean age at disease onset was 27 years. A relapsing-remitting disease was the most frequent type of MS (67%). A significant association of DRB1*0403 (OR = 5.68) with MS was shown. DRB1*0802 was also involved in susceptibility (OR = 2.41). An excess of DRB1*0802 homozygotes was observed in patients (P = 0.005), this genotype being in genetic equilibrium in controls. CONCLUSIONS: Two novel class II associations are described in Mexicans with MS: DRB1*0403 and DRB1*0802. Both alleles share with DRB1*1501, valine-86 and negatively charged amino acids, in the DRB1-anchoring motif of pocket 4.
Assuntos
Alelos , Etnicidade/genética , Antígenos de Histocompatibilidade Classe II/genética , Indígenas Centro-Americanos/genética , Esclerose Múltipla Crônica Progressiva/genética , Esclerose Múltipla Recidivante-Remitente/genética , Adolescente , Adulto , Feminino , Frequência do Gene , Predisposição Genética para Doença/genética , Genótipo , Antígenos HLA-DQ/genética , Cadeias alfa de HLA-DQ , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Homozigoto , Humanos , Masculino , Região do Mediterrâneo/etnologia , México , Pessoa de Meia-IdadeRESUMO
Improving quality of life is the most important goal for patients with epilepsy. To recognize the factors associated with quality of life in patients with epilepsy in Mexico, we performed a cross-sectional survey using the Quality of Life in Epilepsy 31 (QOLIE-31) inventory to assess the quality of life of 401 adult patients with epilepsy at the National Institute of Neurology and Neurosurgery of Mexico. Clinical and demographical data were collected. Multiple regression was used to determine which factors affected quality of life in our patients. The variables that most strongly predicted a lower QOLIE-31 total score after multiple regression were sleep disorders (P<0.001), socioeconomic status (P<0.001), female gender (P=0.002), and high seizure frequency (P=0.001). In our study, neither depression nor time of evolution of epilepsy had significant influence on QOLIE-31 scores.
Assuntos
Epilepsia/psicologia , Qualidade de Vida , Convulsões/tratamento farmacológico , Transtornos do Sono-Vigília/psicologia , Adulto , Estudos Transversais , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , México , Convulsões/psicologia , Transtornos do Sono-Vigília/complicações , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). METHODS: Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. RESULTS: At the initial evaluation 15.5% (n = 14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5% of the patients from the dementia group continued to have a full dementia disorder and 78.5% no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. CONCLUSIONS: The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Demência/etiologia , Neurocisticercose/complicações , Neurocisticercose/tratamento farmacológico , Adolescente , Adulto , Idoso , Demência/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Escolaridade , Feminino , Lobo Frontal/parasitologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurocisticercose/parasitologia , Testes Neuropsicológicos , Lobo Parietal/parasitologia , Índice de Gravidade de Doença , Lobo Temporal/parasitologia , Resultado do TratamentoAssuntos
Humanos , Masculino , Adolescente , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/terapia , Prognatismo , Aparelhos Ortodônticos , Cefalometria , Anormalidades Maxilomandibulares , Má Oclusão Classe III de Angle , Placas Oclusais , Osteotomia , Planejamento de Assistência ao Paciente , Prognatismo , Braquetes OrtodônticosAssuntos
Neurocisticercose/tratamento farmacológico , Praziquantel/administração & dosagem , Adolescente , Adulto , Cimetidina/administração & dosagem , Cimetidina/efeitos adversos , Carboidratos da Dieta/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Interações Alimento-Droga , Humanos , Masculino , Pessoa de Meia-Idade , Neurocisticercose/diagnóstico , Praziquantel/efeitos adversosRESUMO
Helminths, particularly some Schistosoma species, have been associated with cancer in humans. Neurocysticercosis, produced by cysticerci of the helminth Taenia solium, has been associated with the emergence of brain tumours and haematological malignancies. Local tumours, such as glioblastoma, could be explained by the induction of DNA damage in cells surrounding the cysticercus and chronically exposed to an inflammatory host response. However, systemic effects such as haematological malignancies are not easy to understand. The present work was conducted in Mexico to find out whether DNA damage arises in peripheral lymphocytes in patients with neurocysticercosis. We utilized a highly sensitive technique to analyse chromosomal aberrations, in-situ hybridization with probes against chromosomes 1, 2 and 4, and in addition the blocked-cytokinesis technique was used to determine the formation of micronuclei, a peculiar form of DNA damage. The study was made in lymphocytes from 8 patients before and after the administration of praziquantel, 1 of the 2 drugs used for neurocysticercosis treatment. The frequencies of chromosome aberrations and micronuclei in peripheral blood lymphocytes were higher in the infected patients as compared to those observed both in healthy donors and in the group of patients after praziquantel therapy. Our results suggest that chromosome aberrations induced in peripheral cells during neurocysticercosis could be associated with the development of haematological neoplasias.
Assuntos
Neoplasias Encefálicas/parasitologia , Dano ao DNA , Neoplasias Hematológicas/parasitologia , Linfócitos/ultraestrutura , Neurocisticercose/complicações , Taenia , Adulto , Idoso , Animais , Anti-Helmínticos/uso terapêutico , Neoplasias Encefálicas/genética , Estudos de Casos e Controles , Feminino , Neoplasias Hematológicas/genética , Humanos , Hibridização In Situ , Masculino , Micronúcleos com Defeito Cromossômico/genética , Pessoa de Meia-Idade , Neurocisticercose/tratamento farmacológico , Neurocisticercose/genética , Praziquantel/uso terapêutico , Estatísticas não ParamétricasRESUMO
Cardiovascular dysfunction (CD) in multiple sclerosis (MS) is related to involvement of reflex pathways in the brainstem. The battery of CD tests was applied to a group of 40 healthy subjects and 40 patients with MS, divided in 2 subgroups according to the expanded disability status scale (EDSS). The tests included: 1) postural blood pressure changes, 2) postural heart rate changes, 3) heart rate changes on inspiration/forced expiration and 4) ECG R-R interval measurement on the Valsalva maneuver. Both groups were subjected to the functional independence scale (FIM). Imaging studies were reviewed and autonomic dysfunction at other levels was explored. The results showed a statistically significant difference (P < 0.05) in all tests when comparing patients to controls. Tests 1 and 4 had the highest significance, with findings of more severe involvement in patients with a higher EDSS and lower FIM. A correlation was also found between CD and brainstem lesions on MRI (P < 0.01). A significant number of MS patients had evidence of CD. Test 1 may be considered a simple marker, in daily clinical practice, to detect subclinical CD. Subclinical CD is a cause of disability in this group of patients.
Assuntos
Sistema Cardiovascular/fisiopatologia , Esclerose Múltipla/fisiopatologia , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Índice de Gravidade de Doença , Manobra de ValsalvaRESUMO
OBJECTIVE: We present the results of a prospective and a longitudinal study of IFN-beta 1a (Rebif) in the treatment of Mexican patients with relapsing-remittin multiple sclerosis (MS). PATIENTS AND METHODS: Twenty five patients were included, all of them fulfilled the diagnostic criteria proposed by Poser, had a clinical evolution of at least 2 years, had 2 to 3 acute attacks of MS in the 12 months preceding study entry and an EDSS < 5.5. Six patients were excluded from the trial, one because of anaphylactic shock, 2 progressed to the chronic form and 3 decided not to continue in the study. These patients were considered as treatment failures and represented 24% of the participants entering the trial. The remaining 19 patients (mean age 29.8, 74% females) completed 2-year follow-up. The mean time of disease duration was 48.8 months. Six million units of IFN-beta 1a were applied thrice weekly, in 8 patients (42%) dosage reduction to 6 millions units twice a week was necessary because of leukopenia or elevation in liver enzymes. RESULTS: In the year before treatment with IFN-beta 1a patients had 2.7 +/- 0.93 acute attacks, after treatment the mean number of acute attacks per year was reduced to 1.94 +/- 2.39 (28.9% reduction). When analyzed by gender there was a 62.9% reduction in acute episodes per year in women and a 27.7% reduction in men (p < 0.05). The most frequent side effects were fatigue, headache, local skin reactions, depressed mood, myalgia, weight variations and somnolence. A few patients developed leukopenia, anemia or elevated liver enzymes. In 31.25% of the patients there was an increase in the number of lesions on MRI, in 31.25% there was a reduction in the number of lesions and in 37.5% no change was noted. CONCLUSION: The best-tolerated dose of IFN-beta 1a was 12 million units/week in women and 18 million units/week in men.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Interferon beta/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Adulto , Feminino , Humanos , Interferon beta-1a , Interferon beta/administração & dosagem , Estudos Longitudinais , Masculino , México , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Fifteen-day praziquantel therapy for parenchymal neurocysticercosis has been shown to be effective. Plasma and cerebrospinal fluid concentrations of praziquantel peak two hours after administration. Maintenance of high concentrations of the drug for six hours may be an adequate therapy for the disease. METHODS: Thirty patients with parenchymal neurocysticercosis were treated with three oral doses of praziquantel(25 mg/kg) at two-hour intervals. Intramuscular dexamethasone (10 mg/day) was administered for three days after the praziquantel treatment. RESULTS: Cysts disappeared in 21 patients and showed a decrease in number of 30 to 60% in seven patients. Two patients remained without change. Considering the total number of cysts, this therapy showed a 70.7% eradication rate. Two patients had seizures, six reported headache, and nausea was frequently reported. Patients under antiepileptic treatment did not have seizures. CONCLUSION: The cost and duration of treatment with praziquantel were significantly reduced and the inflammation that follow the destruction of the parasite was treated sequentially.
Assuntos
Anticestoides/administração & dosagem , Neurocisticercose/tratamento farmacológico , Praziquantel/administração & dosagem , Adulto , Anticestoides/efeitos adversos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Quimioterapia Combinada , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurocisticercose/diagnóstico , Praziquantel/efeitos adversos , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The frequency and clinical features of multiple sclerosis (MS) at the National Institute of Neurology and Neurosurgery in Mexico City for the period spanning 1984-1993 is presented. Hospital records of patients with clinically diagnosed MS were selected, the frequency and cumulative frequency of this diagnosis were determined and demographic information and clinical features were recorded. It was found that 70% of the patients were women, 25% were professionals, and 95% were of mixed race. The clinical features of our patients and their neuroimages were consistent with those of MS patients in other populations. Importantly, we found that the frequency of MS has almost doubled over the last 10 years. The reason for this phenomenon is discussed as resulting from better health screening, the availability of nuclear magnetic resonance imaging, and the cultural, demographic and dietary changes that have occurred due to the rapid urbanization of our country.
Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Criança , Feminino , Hospitalização , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/reabilitação , Estudos RetrospectivosRESUMO
Drug holidays as treatment in Parkinson's disease (PD) to ameliorate the effects of chronic L-dopa use are a controversial method. They are used in an attempt to resensitize dopamine receptors in the striatum so that L-dopa therapy can be reinstated at lower doses with fewer of the side effects that normally accompany long-term use of the drug. In the present study, 15 patients with PD were submitted to a 7-day L-dopa drug holiday and then followed for 3 years. The effect of the holiday on parkinsonian symptoms and grade of severity of PD was determined using the Webster and the Hoehn and Yahr scales, administered at intervals over the 3-year period. We found that within the first 6 months post-drug-holiday, there was a dramatic improvement in the rating of the symptoms of PD that was statistically significant (p < 0.005). At 12 months, Webster scale scores had risen, but they remained significantly improved (p < 0.05) in comparison with the first postholiday score. This level of improvement was maintained at 24 and 36 months. The grade of severity of the disease stabilized since Hoehn and Yahr scale scores improved for all patients, except one, for the length of the study. One patient left the study after 6 months for unknown reasons. Of the 14 patients that remained, three were given additional drug holidays: two patients at 12 months and one patient at 12, 24, and 36 months. All patients were able to be maintained on a reduced L-dopa dose regimen of 50-70% of their pre-drug-holiday level for the entire 3-year period. In the patients in whom the drug holiday was least beneficial overall, there was a notable reduction in rigidity and in the "on-off" phenomenon. We conclude that an L-dopa drug holiday is a valuable option in the treatment of PD.
Assuntos
Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Escalas de Graduação PsiquiátricaRESUMO
We designed a prospective study in order to evaluate total urinary catecholamines in patients with subarachnoid hemorrhage (SAH) and correlate them with some prognostic factors and its complications. We studied 24 patients: 19 were normotensive, five had had a previous arterial hypertension that persisted during the SAH, and five developed the hypertension during the SAH. The latter showed cardiac complications with a more severely affected Hunt and Hess scale and a higher level of excretion of urinary catecholamines than the normotensive patients (p < 0.003). The cases with previous arterial hypertension that persisted during the SAH had more complications than the normotensive patients but in a lesser degree compared to chose who developed the hypertension during the SAH.
Assuntos
Catecolaminas/urina , Hemorragia Subaracnóidea/urina , Adolescente , Adulto , Feminino , Humanos , Hipertensão/complicações , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/complicaçõesRESUMO
We studied 15 patients with Parkinson's disease of 40 to 70 years of age; they had more than five years of evolution and of using levodopa. They had "on-off", "wearing-off" phenomena and dyskinesia. The duration of therapy suspension was seven days: they were evaluated daily in the seven days, and every month for six months. The Webster and the Hoehn and Yahr scales were used. Only two patients did not show significant improvement. Thirteen of fifteen patients showed a significant decrease in the Webster scale of up to 8 points. A p value of 0.005 was found at three months which was maintained until the sixth month with a p value of 0.0005; a decrease in this scale was present since the first month. There were no complications following therapy withdrawal. There was a decreased related to depression in most of them and also there was a levodopa dose decrease in seven of them.
Assuntos
Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Adulto , Idoso , Esquema de Medicação , Tolerância a Medicamentos , Discinesia Induzida por Medicamentos/etiologia , Discinesia Induzida por Medicamentos/terapia , Feminino , Humanos , Levodopa/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A 47 years old male with POEMS syndrome is presented. His illness started seven months before admission. He was in poor general conditions and had malnutrition. He had cutaneous hyperpigmentation, skin changes, hepatomegaly, edema of the limbs, quadriplegia, myotatic reflexes abolished, hypotrophy of muscular masses and bilateral papilledema. Immunoglobulins IgA and IgM were abnormal. Bone scanning showed multiple lytic lesions. The study of bone marrow showed megaloblastic changes. Electromyography revealed severe neuropathy and biopsy from sural nerve showed severe demyelinization. At first, he showed improvement with steroids; nevertheless he died two months afterwards from possible bronchoaspiration. The autopsy revealed changes compatible with the clinical diagnosis and in addition an adenoma of the hypophysis. We emphasize the importance of POEMS syndrome in the differential diagnosis of polyneuropathies.