Effective interventions for treating multiple sclerosis (MS) require prompt treatment optimization which usually involves switching disease modifying drugs (DMDs). The patterns of prescription and the reasons treatment changes, especially in low prevalence populations, are unknown. We aimed to describe the persistence, reasons of DMD switches and prescription patterns as well as their associated factors using survival and network analysis. 701 cases were included of which 94% received treatment. 29.9%, 18.7% and 11.9% of patients had one, two and three or more DMD changes, respectively, for an estimated incidence rate (95%CI) of 1.09 (1.01–1.17) per patient. The main reasons for changing DMD were disease activity, followed by non-serious adverse events and disability. Younger age at MS onset and insurer status were the main determinants of treatment change, which was not influenced by the efficacy or mode of administration of individual DMDs. Network analysis showed that interferons and fingolimod were the most central DMDs and that most DMD switches involved them.
Introduction: Seizures related to metabolic disorders are common phenomena in many clinical contexts. However, clinical manifestations and neuroimaging findings in the context of a hyperglycemic crisis are less frequent phenomena with unclear pathophysiology.Case report: A 68-year-old man presented focal seizures and right homonymous hemianopsia after a non-ketotic hyperglycemic crisis. Brain MRI showed cortical diffusion restriction and subcortical T2 / FLAIR hypointensity in left occipital, temporal (mesial) and parietal lobes. Spectroscopy was performed showing a nonspecific pattern, cerebrospinal fluid was normal and there was improvement with glycemic control. MRI findings were considered secondary to the hyperglycemic crisis.Conclusion: Non-ketotic hyperglycemic states can manifest with several rare neurological alterations and recognizing them early is of vital importance given their potential reversibility. As in other metabolic disorders, epileptic seizures in this context can have focal-type characteristics. Although pathophysiological mechanisms are not clearly elucidated yet, multiple neuroimaging techniques promise to establish patterns that allow accurate and timely diagnosis.
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