Charles Peter Tilbery

Esclerose múltipla: estudo descritivo de suas formas clínicas em 302 casos

Multiple sclerosis (MS) is one of the most common causes of chronic neurologic disability in young adults. We evaluate, through retrospective study, the epidemiological characteristics, the manifestations ways, the clinical manifestations, the evolution and the level of physical disability of MS in 302 patients. The average patients age was 37.7 and the relation between genders was 3.13F:1M. The average age at the beginning of MS was 29.6; 283 patients were white (94%), 15 patients were black (5%) and 4 patients were yellow; 220 patients (72%) presented relapsing-remmiting clinical form; 82 patients (28%) presented the progressive form (50% secondary form and 50% primarily progressive form). The most common initial symptoms were sensitive (31.7%) and optical (26.8%). The most common evolutive symptoms were pyramidal (72.5%) and of the spinal cord (64.9%). The average of the final EDSS was 3.37 and final NRS was 85.17. The index of the annual outbreak was 0.45. Our findings coincide to the ones in the worldwide literature, however it is important to point out that 60 patients (19.8%) presented benign MS of prognostic value.

Depressão na esclerose multipla forma remitente-recorrente

A possibilidade de correlacao entre depressao e esclerose multipla (EM) e conhecida ha muitos anos, porem os estudos de prevalencia nao sao conclusivos. No nosso meio a prevalencia deste sintoma na EM permanece desconhecida. O objetivo deste estudo e verificar a prevalencia da depressao em pacientes com EM, estudando a sua correlacao com a incapacidade funcional, o sexo, a idade e o tempo de doenca. Foram avaliados 84 pacientes com EM remitente-recorrente (EMRR). A depressao foi avaliada atraves da Escala de Beck e da Escala para Ansiedade e Depressao (HAD), e a incapacidade funcional pela Escala de Incapacidade Funcional Expandida (EDSS). A depressao estava presente em 17,9% e a ansiedade em 34,5% dos pacientes com EMRR. Os maiores escores das escalas de depressao correlacionaram-se com maior incapacidade funcional (p=0,0002), porem nao estao associados ao tempo de doenca, ao sexo ou a idade dos pacientes. Nossos dados indicam que a depressao e frequente nos pacientes com EM e sugerem haver correlacao entre a depressao e a incapacidade funcional.

Esclerose múltipla: adaptação transcultural e validação da escala modificada de impacto de fadiga

OBJECTIVE: The aim of this study is a cross-cultural adaptation and validation of the modified fatigue impact scale for Portuguese (MFIS- BR). METHOD: The MFIS was translated to Portuguese and retranslated to English. Two studies pilot had been carried through to be gotten the MFIS-BR, that was applied to 57 consecutive stable MS patients and 45 healthy controls. The retest was applied 30 days later. RESULTS: In the dwarfed statistics the internal consistency reability was similar to the original scale (0.74-0.86). The MFIS-BR showed be able to identify the different groups. Concerning the reliability the interclass correlation coefficient showed an excellent agreement (0.264-1.0). CONCLUSION: The MFIS-BR fills the criteria of applicability, sensibility witch are similar of the original version.

Fadiga e esclerose múltipla: estudo preliminar de 15 casos através de escalas de auto-avaliação

Fatigue is a common and disabiling symptom in multiple sclerosis but is poorly understood. Self-report measures are designed to capture the patients subjective sense of fatigue. We applied three scales in 15 patients with MS. Nine of them reported fatigue. The scores were high in all of these patients. We conclude that these scales must be used in assemble, to evaluate this symptom. Also, fatigue a very important symptom in multiple sclerosis patients.

Incidental demyelinating inflammatory lesions in asymptomatic patients: a Brazilian cohort with radiologically isolated syndrome and a critical review of current literature

Despite the definition of specific diagnostic criteria to identify radiologically isolated syndrome (RIS) suggestive of multiple sclerosis, its natural history remains incompletely understood. We retrospectively analyzed a Brazilian cohort of 12 patients to clarify their features and to emphasize the role of imaging predictors in clinical conversion. We demonstrated that, although some individuals did not exhibit progression over a lengthy follow-up period (16.7%), most patients will progress clinically or radiologically in the initial years of the follow-up (83.3%). Infratentorial and spinal cord involvement, as well as the total number of lesions, were more relevant predictors of progression than gadolinium enhancement. Further studies remain necessary to define the risk of conversion in males and to clarify the cognitive abilities of RIS patients. This study may provide an improved understanding of the natural course and evolution of incidental magnetic resonance imaging lesions, and further assists with the management of RIS in clinical practice.

Teste de destreza manual da caixa e blocos em indivíduos normais e em pacientes com esclerose múltipla

ABSTRACT - Recently new disease-modifying treatments for multiple sclerosis (MS) were introduced wich canchange the natural course of the disease. In clinical trials with these new agents the Expanded DisabilityStatus Scale (EDSS) is often used as a primary outcome instrument to measure neurological impairment anddisability. A number of limitations have been identified when using the EDSS, some of wich are because theEDSS is an ordinal scale that is heavily biased to locomotor function. In this study we applied the box andblock test of manual dexterity in normal subjects and relapsing-remitting MS patients. The results were that64.8% of the female and 80.7% of the male patients had significant changes on this task compared withnormal subjects, and as this test is easily applied and is sensitive in detecting upper extremity functionalability, we recommend its use in clinical trials to evaluate new drugs in MS patients.KEY WORDS: box and block test of manual dexterity, multiple sclerosis, disability scales.

Esclerose múltipla: análise clínica e evolutiva de 214 casos

The authors report on a series of 214 cases of defined multiple sclerosis according to Poser et al. criteria. These cases were retrospectively selected by medical reports analysed from Santa Casa Medical School (São Paulo) and the private practice, from 1980 to 1993. The data were analysed as for sex, race, onset age of symptoms, onset symptoms, and evolutive symptoms. The results were compared to those found in other Brazilian series and in foreign series. This comparative analysis allows to verify similarities and differences among the several series, and the authors emphasize the necessity of multicentric studies in Brazil to assert with more details the multiple sclerosis profile in our country.The authors report on a series of 214 cases of defined multiple sclerosis according to Poser et al.criteria. These cases were retrospectively selected by medical reports analysed from Santa Casa Medical School (Sao Paulo) and the private practive, from 1980 to 1993. The data were analysed as for sex, race, onset ageof symptoms, onset symptoms, and evolutive symptoms. The results were compared to those found in other Brazilian series and in foreign series. This comparative analysis allows to verify similarities and differences among the several series, and the authors emphasize the necessity of multicentric studies in Brazil to assert with more details the multiple sclerosis profile in our country.Os autores apresentam uma serie de 214 casos de esclerose multipla provenientes de levantamento retrospectivo de prontuarios na Disciplina de Neurologia da Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo e da clinica privada, no periodo de 1980 a 1993. Os dados encontrados foram analisados quanto a sexo, raca, media de idade de inicio dos sintomas, sintomas iniciais e sintomas evolutivos da doenca. Os resultados foram analisados comparativamente aos encontrados em outras series nacionais e estrangeiras.

Genomic analysis of ERVWE2 locus in patients with multiple sclerosis: absence of genetic association but potential role of human endogenous retrovirus type W elements in molecular mimicry with myelin antigen

Human endogenous retroviruses (HERVs) arise from ancient infections of the host germline cells by exogenous retroviruses, constituting 8% of the human genome. Elevated level of envelope transcripts from HERVs-W has been detected in CSF, plasma and brain tissues from patients with Multiple Sclerosis (MS), most of them from Xq22.3, 15q21.3, and 6q21 chromosomes. However, since the locus Xq22.3 (ERVWE2) lack the 5′ LTR promoter and the putative protein should be truncated due to a stop codon, we investigated the ERVWE2 genomic loci from 84 individuals, including MS patients with active HERV-W expression detected in PBMC. In addition, an automated search for promoter sequences in 20 kb nearby region of ERVWE2 reference sequence was performed. Several putative binding sites for cellular cofactors and enhancers were found, suggesting that transcription may occur via alternative promoters. However, ERVWE2 DNA sequencing of MS and healthy individuals revealed that all of them harbor a stop codon at site 39, undermining the expression of a full-length protein. Finally, since plaque formation in central nervous system (CNS) of MS patients is attributed to immunological mechanisms triggered by autoimmune attack against myelin, we also investigated the level of similarity between envelope protein and myelin oligodendrocyte glycoprotein (MOG). Comparison of the MOG to the envelope identified five retroviral regions similar to the Ig-like domain of MOG. Interestingly, one of them includes T and B cell epitopes, capable to induce T effector functions and circulating Abs in rats. In sum, although no DNA substitutions that would link ERVWE2 to the MS pathogeny was found, the similarity between the envelope protein to MOG extends the idea that ERVEW2 may be involved on the immunopathogenesis of MS, maybe facilitating the MOG recognizing by the immune system. Although awaiting experimental evidences, the data presented here may expand the scope of the endogenous retroviruses involvement on MS pathogenesis.

Reabilitação vestibular em pacientes com esclerose múltipla remitente-recorrente

Multiple sclerosis (MS) is a demyelinating, inflammatory illness, that attack the white matter of the central nervous system, and abnormal vestibular sensations (vertigo, disequilibrium) are frequent. The vestibular rehabilitation (VR) is determined by mechanisms of adaptations, neural substitutions and compensations. This study evaluated the improvement of the central or peripheral vertigo in patients with relapsing-remitting MS submitted to the VR (exercises of Cawthorne-Cooksey), through the scale of Berg and Dizziness Handicap Inventory (DHI). In this sample of 4 cases the VR, carried through in a period of 2 months, demonstrated the improvement in 3 patients according to the Berg scale and in 2 patients considering that of the DHI.

Multiple sclerosis and herpesvirus interaction

Multiple sclerosis is the most common autoimmune inflammatory demyelinating disease of the central nervous system, and its etiology is believed to have both genetic and environmental components. Several viruses have already been implicated as triggers and there are several studies that implicate members of the Herpesviridae family in the pathogenesis of MS. The most important characteristic of these viruses is that they have periods of latency and exacerbations within their biological sanctuary, the central nervous system. The Epstein-Barr, cytomegalovirus, human herpesvirus 6 and human herpesvirus 7 viruses are the members that are most studied as being possible triggers of multiple sclerosis. According to evidence in the literature, the herpesvirus family is strongly involved in the pathogenesis of this disease, but it is unlikely that they are the only component responsible for its development. There are probably multiple triggers and more studies are necessary to investigate and define these interactions.