Fernando Caceres

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.

Argentine Patagonia: prevalence and clinical features of multiple sclerosis

There are few studies reporting multiple sclerosis prevalence rates in the Buenos Aires region, Argentina (latitude 34°S) (between 12–18.5/100 000 inhabitants), and no studies have been performed in the larger region between parallels 36° and 55°S. The aim of this study is to determine the prevalence rates and clinical features of multiple sclerosis in residents of the Argentine Patagonia. Four cities from the region were selected for this study, giving a sample population of 417 666 inhabitants (~24% of the total Patagonia population). 1st March 2002 was determined as prevalence day. Patients were ascertained using multiple case-finding methods. The point prevalence rate was 17.2/100 000 (17.2 age-adjusted to the world population). Prevalence rates were higher for women than for men, 22.1 versus 12.2/100 000 inhabitants (21.4 versus 12.7 sex-adjusted to the world population). The study population was mainly of European descent and mestizoes. Clinical features were similar to those reported in other countries. This study shows that Argentine Patagonia is a medium-risk area with no south–north gradient between parallels 55° and 36°S. The Patagonia population shows recent internal migration that makes it difficult to determine whether the exposure to potential risk factors has been long enough to modify the disease incidence.

Epidemiological characteristics of cognitive impairment of multiple sclerosis patients in a Latin American country

We assessed cognitive performance and physical disability in 111 multiple sclerosis (MS) patients and 222 healthy controls in a multicenter study in Argentina to obtain the prevalence of cognitive impairment (CI) in a population of MS outpatients in Argentina. MS patients presented significantly lower scores in all Brief Repeatable Battery of Neuropsychology (BRB-N) tests than did the control group. The prevalence of CI was 43.2%. This study allowed us to obtain actual figures on the number of MS patients with CI in a Latin American sample. This validation is a very useful tool for clinical practice and for research studies to assess cognition in MS.

A new assessment tool for patients with multiple sclerosis from Spanish-speaking countries: validation of the Brief International Cognitive Assessment for MS (BICAMS) in Argentina

Abstract Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an international assessment tool for monitoring cognitive function in multiple sclerosis (MS) patients. BICAMS comprises the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test – Second Edition (CVLT II) and the Brief Visuospatial Memory Test – Revised (BVMT-R). Our objective was to validate and assess the reliability of BICAMS as applied in Argentina and to obtain normative data in Spanish for this population. Method: The sample composed of 50 MS patients and 100 healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients. Results: The sample’s average age was 43.42 ± 10.17 years old, and average years of schooling were 14.86 ± 2.78. About 74% of the participants were women. The groups did not differ in age, years of schooling, or gender. The MS group performed significantly worse than the HC group across the three neuropsychological tests, yielding the following Cohen’s d values: SDMT: .85; CVLT I: .87; and BVMT-R: .40. The mean raw scores for Argentina normative data were as follows: SDMT: 56.71 ± 10.85; CVLT I: 60.88 ± 10.46; and BVMT-R: 23.44 ± 5.84. Finally, test–retest reliability coefficients for each test were as follows: SDMT: r = .95; CVLT I: r = .87; and BVMT-R: r = .82. Conclusion: This BICAMS version is reliable and useful as a monitoring tool for identifying MS patients with cognitive impairment.

The Effect of Culture on Two Information-Processing Speed Tests.

The Symbol Digit Modalities Test (SDMT) has been proposed to replace the Paced Auditory Serial Addition Test-3 (PASAT-3) in the Multiple Sclerosis Functional Composite because it has the same validity but easy and shorter administration. However, among the two tests, the one that is most affected by culture is still unknown. The purpose of this study was to compare the performance of Argentinian and North American populations on the SDMT and PASAT-3. The SDMT and PASAT-3 were administered to 137 healthy volunteers from Buffalo, NY, and 137 healthy participants from Buenos Aires, Argentina. Participants were matched by gender, age (±2), and education (±1). Significant differences were found on the SDMT but not on the PASAT-3. Significant and low correlations were found between the tests and years of education. The SDMT is more affected by culture than is the PASAT-3. Possible interpretations of this result are presented.

Increasing prevalence of multiple sclerosis in Buenos Aires, Argentina.

UNLABELLED In 1996, the prevalence of multiple sclerosis (MS) for the metropolitan area of Buenos Aires using the capture-recapture method was estimated to be between 14 and 19.8 cases per 100,000 inhabitants. The aim of this study was to update the prevalence to 2014 following the same methodology. METHODS Gran Buenos Aires is the denomination that refers to the megalopolis comprised by the autonomous city of Buenos Aires and the surrounding conurbation of the province of Buenos Aires. The study was carried out taking December 2014 as the prevalence month. We used the capture-recapture method to estimate the prevalence of MS cross-matching registries from 6 MS Centers from the metropolitan area of Buenos Aires. Log-linear model Poisson regression was used to estimate the number of affected MS patients not detected by any of the 6 sources considered. RESULTS 1035 registries were obtained from the 6 lists from 910 different patients detected. The population of the area based on 2010 census was 12,806,866, the number of MS cases estimated amongst source interactions were 4901. The estimated prevalence was 38.2 per 100,000 inhabitants (95% CI 36.1-41.2). CONCLUSION The study is an update almost 20 years after the first one in the area showing a significant increase in the previous reported prevalence. Our findings are in line with previous studies performed in other regions of the world.

Normatization of the Symbol Digit Modalities Test-Oral Version in a Latin American Country

The aim of this study was to standardize the Symbol Digit Modalities Test (SDMT)-Oral version in a healthy population living in Argentina and to analyze the influence that age, gender, and education have on the SDMT. Secondarily, it is intended to analyze the performance of patients with multiple sclerosis (MS) on this test. Two hundred ninety-seven healthy participants were evaluated; they had an average age of 39.28 years and 13.87 years of schooling; 77.8% were women. The sample was segmented according to age in three groups: younger than 35 years old, 36 to 50 years old, and 51 to 70 years old. The sample was also segmented according to years of schooling in three groups: 11 years or less, 12 to 16 years, and more than 16 years. All participants were evaluated with the oral version of the SDMT. A clinical sample of 111 patients with MS was also assessed. The mean on the SDMT for the total sample was 51.34 (SD = 12.76). The differences were significant between all groups, p < .05, according to age. The participants with a higher level of education performed better than did those with moderate education and those with less schooling, p < .05. There was a significant difference between patients with MS and healthy controls, p < .01. The SDMT is influenced by age as well as by schooling, although not by gender. The norms displayed here will be useful to accurately evaluate the yield of the patients in the neuropsychological clinic when comparing them with their group of reference. It was also demonstrated that the SDMT can discriminate between patients with MS and healthy people.

Validation of the PASAT in Argentina

ABSTRACT The Paced Auditory Serial Addition Test (PASAT) is one of the most used neuropsychological tests to assess information processing speed and working memory in brain injured patients. This study was carried out with the purpose of obtaining normative data for the PASAT-3″ in a healthy Argentinean population, which would result in a reference control population. The PASAT-3″ was administered in a sample of 296 healthy voluntary subjects, born and living in Argentina. The age range went from 20 to 70 years-old. The level of education was 0 to 13 or more years of schooling. The sample obtained a mean of 44.60 (SD = 10.72) in the PASAT-3″. It was found that the score obtained in the PASAT-3″ was related to the age and the level of instruction of the participants. Their performance diminished as age increased and, conversely, it increased as the level of instruction was higher. Normative data was obtained for a Latin American population from Argentina. Percentile distributions obtained by decades of age and different levels of education should be considered as useful reference values for clinicians and investigators when applying the PASAT-3″ to assess cognitive function in different pathologies.

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.

Vulnerabilidad psicosocial del cuidador familiar. Creencias acerca del estado de salud del paciente neurológico y el sentimiento de sobrecarga

Resumen Objetivo Se intenta evaluar el papel de las creencias del cuidador familiar sobre el estado de salud del paciente neurologico y su relacion con el sentimiento de sobrecarga como factores de riesgo psicosocial para su salud psicofisica, desde el modelo de estres psicologico propuesto por Lazarus y Folkman. Sujetos y metodos Fueron entrevistados 128 cuidadores familiares (35 asistian a pacientes con traumatismo craneoencefalico, 38 a pacientes con esclerosis multiple y 55 a pacientes con demencia), seleccionados con la estrategia de muestreo estadistico no probabilistica, de tipo accidental. Se siguio el diseno descriptivo-comparativo, de corte transversal. Fueron utilizados un cuestionario de datos sociodemograficos y de creencias del cuidador, y la Escala de Sobrecarga del Cuidador de Zarit y Zarit. Resultados Cuanto mas negativas las creencias del cuidador, mayor probabilidad de que experimenten sentimientos mas intensos de sobrecarga. Los cuidadores de pacientes con esclerosis multiple creen, en mayor proporcion que los otros, en un mal estado de salud del enfermo, asociado a sentimientos de sobrecarga mas intensos, resultando ser los mas probablemente vulnerables frente al estres. Discusion El esclarecimiento del papel que cumplen los factores de riesgo psicosocial del cuidador familiar de enfermos neurologicos brindara elementos de juicio de interes para generar estrategias de intervencion psicoeducativas para ellos, paralelas a las clinicas, para el resguardo de su bienestar, y asi contar con una buena red de cuidado informal para este tipo de pacientes.