RESUMO
A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.
Assuntos
Esclerose Múltipla/epidemiologia , Região do Caribe/epidemiologia , Coleta de Dados , Notificação de Doenças , Etnicidade , Geografia , Humanos , América Latina/epidemiologia , Prevalência , América do Sul/epidemiologia , Raios UltravioletaRESUMO
BACKGROUND AND PURPOSE: Numerous case series have demonstrated that lesions on brain MRI are common in neuromyelitis optica (NMO), but there has not been an attempt to survey and synthesize the literature on neuro-radiology of brain findings in NMO. OBJECTIVES: To review the studies on conventional brain MRI in NMO and to propose to incorporate characteristic brain MRI lesions into the diagnostic criteria of NMO. METHODS: We searched for articles with descriptions of brain MRI findings in NMO in EBSCO, EMBASE, PubMed/Medline, Science Citation Index, and SCOPUS. RESULTS: Brain abnormalities are seen in majority of NMO patients as disease duration increases. A minority of NMO patients meet Barkhof criteria for space dissemination in multiple sclerosis (MS), and these criteria should not be used to exclude NMO diagnosis. Distinctive brain lesions of NMO are cataloged and described. CONCLUSIONS: Brain lesions in NMO are a consistent feature of the disease. International consensus MRI criteria are needed for NMO analogous to the existing criteria for MS.
Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética , Neuromielite Óptica/diagnóstico , Bases de Dados Factuais/estatística & dados numéricos , HumanosRESUMO
Few studies report a protective role of childhood solar exposure to multiple sclerosis. Our objective was to confirm the protective role of childhood solar exposure in multiple sclerosis in Cuba, Martinique and Sicily. This was a matched case- control study, and cases met Poser criteria for clinically, laboratory (definite, probable) multiple sclerosis. Controls were resident population, without neurological disorder, living close to cases (within 100 km), matched for sex, age (+/-5 years), residence before age 15. We recruited 551 subjects during a 1-year period (193 cases, Cuba n = 95, Sicily n = 50, Martinique n = 48; 358 controls). Some (89%) met definite clinical multiple sclerosis criteria (relapsing remitting form (with and without sequel) (74%), secondary progressive (21%), primary progressive (5%)). Odds ratios in a uni-variate analysis were: family history of multiple sclerosis (5.1) and autoimmune disorder (4.0); wearing shirt (3.5), hat (2.7), pants (2.4); sun exposure causing sunburn (1.8); sun exposure duration (1 h more/day; weekends 0.91, weekdays 0.86); bare-chested (0.6); water sports (0.2). Independent factors in the multivariate analysis were family history of multiple sclerosis (4.8 (1.50-15.10)), wearing pants under sunlight (1.9 (1.10-3.20)), sun exposure duration (1 h more/ day, weekdays 0.90 (0.85-0.98), weekends 0.93 (0.87-0.99)), water sports (0.23 (0.13-0.40)). We conclude that outdoor leisure activities in addition to sun exposure reports are associated with a reduced multiple sclerosis risk, with evidence of dose response.
Assuntos
Esclerose Múltipla/epidemiologia , Esclerose Múltipla/prevenção & controle , Luz Solar , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Cuba/epidemiologia , Feminino , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Sicília/epidemiologia , Raios Ultravioleta , Adulto JovemRESUMO
BACKGROUND: In Caucasian populations neuromyelitis optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French West Indies (FWI) and 0.52 /100,000 in Cuba, but the NMO antibody status is unknown. OBJECTIVE: To assess the NMO-IgG antibody status of Cuban/FWI RNMO patients, comparing with European cases tested at the same laboratories. METHODS: Serum NMO-IgG antibodies were assayed in 48 R-NMO patients (Wingerchucks 1999 criteria): Cuba (24)/FWI (24), employing Lennon et als method. We compared the demographic, clinical, disability and laboratory data between NMO-IgG +/- patients. All the data were reviewed and collected blinded to the NMO-IgG status. RESULTS: Seropositivity of the NMO-IgG antibody demonstrated a lower rate in the Caribbean (33.3%), as compared with Caucasian patients from Spain/Italy (62.5%) and France (53.8%). Caribbean patients with NMO-IgG (+) displayed more attacks, more spinal attacks and a higher EDSS than NMO-IgG (-) cases, while brain and spinal cord MRI lesions were more frequent during remission, with more vertebral segments, more gray, white matter and holocord involvement. CONCLUSIONS: NMO IgG positive antibodies in NMO patients had a lower rate in the Caribbean area - where the population has a predominant African ancestry - than in Caucasian Europeans, suggesting the influence of a possible ethnic factor in the pathogenesis of the disease, but they confer a worse course with more attacks, more disability and MRI lesions.
Assuntos
Autoanticorpos/sangue , População Negra , Imunoglobulina G/sangue , Neuromielite Óptica/etnologia , Neuromielite Óptica/imunologia , População Branca , Adulto , Encéfalo/patologia , Cuba/epidemiologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Martinica/epidemiologia , Neuromielite Óptica/diagnóstico , Recidiva , Índice de Gravidade de Doença , Medula Espinal/patologia , Adulto JovemRESUMO
INTRODUCTION: The association of neuromyelitis optica (NMO) and multiple sclerosis (MS) has been reported, but details of the cases were not described. We report two Venezuelan Caucasian sisters with human leukocyte antigen (HLA) typing. RESULTS: Patient 1 fulfilled McDonald, et al. criteria with HLA A*24; B*07,*15; DRB1*01,*16 (DR2 positive). Patient 2 fulfilled the NMO revised criteria of Wingerchuck, et al. with HLA A*02,*24; B*07,*40; DRB1*04,*08, similar to Canadian aboriginal NMO cases and the Yukpa population from Venezuela. CONCLUSION: These cases confirmed the coexistence of NMO and MS in sisters, and further studies are needed to understand the genetic linkage between these diseases.
Assuntos
Teste de Histocompatibilidade , Esclerose Múltipla/genética , Neuromielite Óptica/genética , Adulto , Saúde da Família , Feminino , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/etnologia , Esclerose Múltipla/patologia , Neuromielite Óptica/etnologia , Neuromielite Óptica/patologia , Irmãos , Venezuela , População Branca/genéticaRESUMO
Type I Interferon (IFN-alpha/beta) therapy has altered the natural course of multiple sclerosis. In this paper we evaluate the possible molecular mechanisms involved in the in vitro effects of IFN-alpha/beta on peripheral blood mononuclear cells from patients with clinically definite Relapsing-Remitting Multiple Sclerosis. The total RNA from IFN-alpha, IFN-beta treated cells and untreated cells was extracted and amplified for CD86, CD28, CTLA-4, TNF-alpha, IFN-gamma, CCL2, CCR5, IL-13, MMP-9, TIMP-1, CD25, TGF-beta, IL-10 and the transcriptional factor Foxp3 by Reverse Transcription-Polymerase Chain Reaction and the CD4+CD25high subset was evaluated using flow cytometry. In general, there were no significant differences concerning the modulation of the genes studied in the response to IFN-alpha and IFN-beta treatments, which suggest a similar mechanism of action for both interferons. However, we found a significant increment in IFN-gamma expression after IFN-alpha but not after IFN-beta treatments. The in vitro treatment of mononuclear cells from multiple sclerosis patients with both interferons significantly increased the CD25 mRNA. Furthermore, we observed a CD25/Foxp3 correlation and an increment of the CD4+CD25high subset, indicating that the induction of regulatory T cells could be a crucial mechanism involved in the type I interferon effects.
Assuntos
Citocinas/metabolismo , Interferon Tipo I/imunologia , Leucócitos Mononucleares/imunologia , Esclerose Múltipla/imunologia , Subpopulações de Linfócitos T/imunologia , Linfócitos T Reguladores/imunologia , Apresentação de Antígeno , Barreira Hematoencefálica , Células Cultivadas , Citocinas/imunologia , Expressão Gênica , Humanos , Interferon Tipo I/farmacologia , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Esclerose Múltipla/metabolismo , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/metabolismo , Linfócitos T Reguladores/efeitos dos fármacos , Linfócitos T Reguladores/metabolismoRESUMO
OBJECTIVE: Intrathecal measles(M)- rubella(R)- and varicella zoster(Z)-antibody synthesis in German and Cuban multiple sclerosis (MS) patients are compared considering the different rubella epidemiology in the tropics. PATIENTS AND METHODS: Twenty-three Cuban MS patients with a representative age distribution and gender ratio like the group of 177 German MS patients were analysed for albumin, IgG, IgA IgM, oligoclonal IgG and MRZ- antibodies in cerebrospinal fluid (CSF) and serum. RESULTS: Cuban MS patients show similar CSF data patterns like German patients and high frequencies of intrathecal measles- (78/78%) and varicella zoster- (59/55%) antibody synthesis correspondingly. A lower frequency of intrathecal rubella antibody synthesis (rubella-AI >or= 1.5) in Cuban patients (30%, gender ratio of increased rubella - AI m:f = 1:6) compared with German patients (60%, m:f = 1:1.8) is explained by low incidence of rubella infections in Cuba. Only about 10% of the male population (not immunized before 1986, in contrast to females) had rubella antibodies compared to at least 60% in a European male population, representing the relation of increased rubella-AI in male MS patients. CONCLUSION: In MS the frequency of intrathecal antibody synthesis is limited by the fraction of seropositives in the population. Natural infection or vaccination are a necessary and equivalent precondition contributing to the arguments against microorganisms as a cause of MS.
Assuntos
Anticorpos Antivirais/líquido cefalorraquidiano , Imunização/estatística & dados numéricos , Vírus do Sarampo/imunologia , Sarampo/imunologia , Esclerose Múltipla , Adulto , Distribuição por Idade , Anticorpos Antivirais/sangue , Cuba/etnologia , Encefalite por Varicela Zoster/imunologia , Feminino , Alemanha/epidemiologia , Herpesvirus Humano 3/imunologia , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/líquido cefalorraquidiano , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina M/sangue , Imunoglobulina M/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/virologia , Rubéola (Sarampo Alemão)/imunologia , Vírus da Rubéola/imunologia , Estudos Soroepidemiológicos , Distribuição por SexoRESUMO
Neuromyelitis optica (NMO) has been attributed to different underlying pathological events. The aim of this paper is to present the first case report of a patient with Down's syndrome (DS) who died of a fulminant NMO. A 29-year-old woman with DS developed acute transverse myelitis, with complete visual loss and swollen optic discs. Two days later, she developed quadriplegia, respiratory arrest and died. The anatomical study demonstrated typical findings of DS in the brain without demyelinating lesions. A severe destruction of medulla and cervical cord with a very high degree of demyelination of the optic nerves was typical of monophasic NMO (Devic's disease). Most of the cases of NMO in Cuba are of the relapsing form, but this case report is the first one with monophasic NMO and DS with a very aggressive course. The link of the pathogenetic relationship between DS and NMO remains unclear; it may well be coincidence but the fact that the patient died very shortly after the onset suggests, at least on clinical grounds, that the presence of DS could have accelerated the fatal evolution of NMO.
Assuntos
Síndrome de Down/complicações , Neuromielite Óptica/complicações , Adulto , Autopsia , Síndrome de Down/patologia , Feminino , Humanos , Bulbo/patologia , Neuromielite Óptica/patologia , Nervo Óptico/patologia , Medula Espinal/patologiaRESUMO
UNLABELLED: The revision of MEDLINE from 1966 to 2003 did not report any association between multiple sclerosis (MS) and Melkersson-Rosenthal syndrome (MRS). This is a case report of a 51-year-old woman, with history of four recurrent Bell's palsies. In 1999 she developed a right facial paralysis due to a supranuclear pyramidal lesion with right monoparesis. The family history showed five relatives with recurrent Bell's paralysis and plicata tongue. PHYSICAL EXAMINATION: right Bell's paralysis, left supranuclear facial paralysis, furrowed tongue, right hemiparesis with pallor of the optic disks. Brain magnetic resonance imaging (MRI) demonstrated the typical lesions of MS and CSF oligoclonal bands. This is the first observation of a patient with hereditary MRS and MS. The link between both diseases is discussed.
Assuntos
Síndrome de Melkersson-Rosenthal/complicações , Síndrome de Melkersson-Rosenthal/genética , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/genética , Feminino , Humanos , Pessoa de Meia-Idade , LinhagemRESUMO
INTRODUCTION: Multiple sclerosis (MS) is an inflammatory disease in its early stages whose primary or secondary immunological mechanisms produce reversible or irreversible lesions in the myelin and axons in the central nervous system. The first case of MS in Cuba was reported in 1965. Current prevalence of MS is considered to be 10 cases/100,000 inhabitants. AIMS: The aim of this study was to characterise MS in Western Cuba from a clinical point of view and in comparison with other similar studies carried out in two other regions in the country. PATIENTS AND METHODS: 50 patients living in the western region were clinically assessed. Statistical tests were carried out to compare this survey with two similar studies conducted in the central and eastern regions. RESULTS: 80% of our patients were females, predominantly white skinned, the main events in their family histories were neurological diseases and psychiatric diseases, essentially schizophrenia, the chief triggering event being psychic tension, the most frequent form of progression was the remittent recurring form, followed by secondary progressive form, and then the primary progressive; the main symptoms at onset were visual, followed by pyramidal and sensory; the most strongly affected functional system was the pyramidal and then the sensory system; the functional systems are more affected in the primary progressive form, except the visual and the brainstem; the largest group of patients corresponded to those that had a history of over 10 years with the disorder. By far the majority of results compared with the series from the central region and from Santiago de Cuba were similar, but some significant differences did appear on comparing these two series. CONCLUSIONS: The study shows the characteristics of the disease in the Western region valuated using distinct parameters and several differences between the three series can be observed fundamentally with regard to skin colour, triggering events, symptoms at onset and functional involvement in the forms of progression.