Adriana Tarulla

Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study)

Background The influence of pregnancy on Multiple Sclerosis (MS) has been extensively studied but such influence on Latin American women with MS has not been characterized. Our objective was to describe the course of pregnancy and birth outcome in Argentinean MS patients and the evolution of MS during pregnancy and after delivery. Method We used a retrospective design in eight MS centers in Argentina and administered a survey to women with definite MS (Mc Donald) with pregnancies during or after MS onset. We contacted 355 women of which 81 met inclusion criteria. We recorded 141 pregnancies. Results Involuntary abortion was observed in 16% of pregnancies (95% CI = 10–23). Thirty five women received immunomodulatory therapy (IMT) before 42 pregnancies. Twenty three (55%) out of 42 pregnancies were exposed to IMT. The mean time of IMT discontinuation before conception in 19 (45.2%) pregnancies without exposure, was 104 days (95% CI = 61.0–147.0). There were 103 deliveries: 79% full term. Birth defects were detected in 19% of pregnancies exposed to IMT (95% CI = 4–46) and in 2% of non-exposed (95% CI = 0.3–8.0). The mean relapse rate was: pre-pregnancy year: 0.22 (95% CI = 0.12–0.32); pregnancy: 0.31 in 1st (95% CI = 0.10–0.52), 0.19 (95% CI = 0.03–0.36) in 2nd, and 0.04 in 3rd trimester (95% CI = –0.04–0.12); 1st trimester post delivery: 0.82 (95% CI = 0.42–1.22). Conclusion We observed a higher rate of birth defects among infants exposed to immunomodulators in utero than those not exposed. The reduction in MS relapses during 2nd and 3rd trimester of pregnancy and its increase during postpartum is consistent with previous reports.

Latin American algorithm for treatment of relapsing-remitting multiple sclerosis using disease-modifying agents

OBJECTIVE It is estimated that circa 50,000 individuals have relapsing-remitting multiple sclerosis in Latin America. European and North-American algorithms for the treatment of multiple sclerosis do not foresee our regional difficulties and the access of patients to treatment. METHODS The Latin American Multiple Sclerosis Forum is an independent and supra-institutional group of experts that has assessed the latest scientific evidence regarding efficacy and safety of disease-modifying treatments. Accesses to treatment and pharmacovigilance programs for each of the eight countries represented at the Forum were also analyzed. RESULTS A specific set of guidelines based upon evidence-based recommendations was designed for Latin America. Future perspectives of multiple sclerosis treatment were also discussed. CONCLUSIONS The present paper translated an effort from representatives of eight countries discussing a matter that cannot be adapted to our region directly from purely European and North-American guidelines for treatment.

ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis

UNLABELLED The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. METHOD Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and <7; group 3 with EDSS ≥7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars. RESULTS 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) for patients with an EDSS between 0-3; USD 40,705 (95%CI 37,199-46,300) for patients with EDSS >3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7. CONCLUSIONS This is the first Argentine study evaluating the costs of MS considering disease severity.

Sociedad Neurológica Argentina: Nueva gestión en tiempos de cambio

Los tiempos están cambiando. El modelo actual de comunicación científica está atravesando un momento de transformación profunda como producto del exceso de información. La rapidez y el caudal en la recepción de conocimientos aumentan día a día, provocando constantes cambios en los medios de divulgación, en los adelantos científicos y en las expresiones culturales. En este marco, la Sociedad Neurológica Argentina (SNA) enfrenta un nuevo desafío. En un escenario caracterizado por la internacionalización de la ciencia y la interdisciplinariedad, queda determinada la tendencia de la nueva gestión. Como toda sociedad científica, la SNA responde a las demandas de sus asociados, de otra manera no podría fortalecerse. Se imparte como una necesidad compartir el conocimiento y promover el crecimiento: un accionar únicamente posible mediante un sólido avance, con proyectos y objetivos claros. De este modo, una planificación estratégica acorde deberá estar basada en la capacidad de ser proactivos e innovadores en nuestras actividades. No obstante, el logro de estos objetivos no solo recae en el Directorio. Requiere de la participación del resto de los asociados, a quienes invitamos a acercarse a su sociedad, a proponer ideas y proyectos que les permitan afianzar, así, su sentido de identidad. Es importante que los miembros de la SNA se eleven sobre sus intereses individuales para poder otorgar a la sociedad todo su potencial. Creo que las sociedades que pierden el sentido de pertenencia de sus miembros o que no logran nutrirse de nuevas ideas tienen poca posibilidad de sobrevivir a estos cambios. La educación continua de los profesionales; el refuerzo de las relaciones institucionales con la comunidad científica nacional e internacional; la elaboración de estrategias con el fin de prevenir enfermedades neurológicas y su difusión por acciones de extensión comunitaria, entre otros temas, representan metas excluyentes en nuestro plan de gestión.