4-13-07 Characteristics of multiple sclerosis in Brazil a multicentric study in a prevalence cohort — South Atlantic project — Phase I

Alvarenga, Regina Maria Papais; Alves, Sandra; Miranda-Santos, C.; Tilbery, Charles Peter; Cm, Poser; Alvarenga, Hélcio; Carvalho, Ana Teresa Pugas; Rêgo, Amália Cínthia Meneses; Mota, Suelen Mandelli; Colin, D.; Silva, E.; Gomes, Saint Clair; Penna, Pete; Roseira, C.; Negreiros, Marco Aurélio; Holander, Clarice; Peixoto, Erika Paula Machado; Silveira, Rita de Cássia dos Santos; Vasconcelos, Cláudia Cristina Ferreira; Silva, C.; Lacativa, Maria Clinete Sampaio; Skacel, M.; Cagy, M.; Novis, Sarah J.; Costa, M Grana; Sohler, Márzia Puccioni; Canutto, Rafael Felipe Carvalho; Brandão, Carlos Otávio; Almeida, Ana C.; Costa, Raquel; Barreira, Amilton Antunes; Sobrinho, Jairo; Costa, Aline Bárbara Pereira; Rocha, Maria Ângela Wanderley; Ferraz, Andrei; Lorenti, M.A.; Barbosa, Jennifer; Fernandez-Filho, J.; Damasceno, Benito; Quagliato, Elizabeth Maria Aparecida Barasnevicius; Marchioni, T.; Maciel, Ethel Leonor Nóia; Andrade-Filho, Antônio Souza; Souza, Yuri Mascarenhas de Andrade; Souza, Ariani Impieri de; Souza, Isabela Afonso; Tosta, Elza Dias; Ximenes, W.; Paula, Weslla Karla Albuquerque Silva de; Oliveira, Kaline Maria Maciel de; Mundim, T.; Bruim, V.; Teixeira, Cassiano; Souza, S W De; Dintz, D.; Olavo, J.; Santos, Etelvina Lucas dos; Vega, Marelyn; Santos, Ernestina; Siqueira, Heloise Helena; Silva, N.; Ataíde, Luiz; Carvalho, Viviane Amaral; Brito, Luiz Giulian; Santos, Sophie Dos; Silva, I.; Laurentino, Silvia Gomes; Barreto, Marina Carvalho Arruda; Costa, Joana Pinto da; Bianchini, O.; Jardim, César; Bender, Arthur S.; Rabolini, Giorgio; Tsubouchi, M.; Paolo, Livrea; Almeida, Sandra Maria Garcia de; Kay, Cláudia Suemi Kamoi; Teive, Hélio A.G.; Arruda, Walter Oleschko; Werneck, Lineü Cesar

doi:10.1016/s0022-510x(97)85989-8

Cited by 5 publications

(5 citation statements)

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“…These data support the proposition that the majority of patients with Devic's syndrome should only rarely be included as cases of MS. 6 RNMO must be differentiated from relapsing remitting MS (RRMS) on the basis of demographic, clinical, MRI, and CSF features. Recent data from the South Atlantic Project, a Brazilian survey on MS confirm that Brazilian MS patients have clinical, MRI, CSF, and genetic data [23][24][25] that are quite similar to the "western type" of MS. Demographic data indicated that in Brazilians, a highly ethnically diversified population, the disease was most prevalent in young white women. RRMS was present in 89% and a primary progressive disease in 11%; the EDSS scores in the RRMS group showed mild disability in 70%, moderate in 9.8%, and severe in 19.9% of the patients after a mean duration of disease of seven years.…”

Section: Discussionmentioning

confidence: 95%

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Optic neuromyelitis syndrome in Brazilian patients

Papais-Alvarenga¹,

Miranda-Santos

Puccioni-Sohler

et al. 2002

J Neurol Neurosurg Psychiatry

136

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Objectives: To report the clinical features and outcome of 24 Brazilian patients with optic neuromyelitis syndrome (ONM); discuss the underlying pathological events associated with the ONM syndrome; review the nosological situation of ONM in the group of inflammatory and demyelinating diseases of the central nervous system. Patients and Methods: Patients with ONM treated at the Hospital da Lagoa, Rio de Janeiro were studied. Demographic, clinical, magnetic resonance imaging, cerebrospinal fluid, and pathological data were analysed. Results: The study consisted of 20 women, four men of whom 10 were white and 14 Afro-Brazilians. Clinical course was recurrent in 22 cases and monophasic in two. Neurological manifestations at inclusion were: sensory impairment (66%), bilateral (41.6%) or unilateral blindness (20.8%), paraplegia or quadriplegia (37.5%). The EDSS was moderate/severe in 70.8%. The underlying pathological events were respectively pulmonary tuberculosis and upper respiratory infection in the two monophasic cases; in the 22 recurrent ONM patients: pulmonary tuberculosis (3), neurocysticercosis (1), polyarteritis nodosa (1), antinuclear antibody and rheumatoid factor (1), antiphospholipid antibody primary syndrome (1), diabetes mellitus (1), hypothyroidism (1), and amenorrhea-galactorrhea (4). Normal cerebrospinal fluid was found in 52% and an inflammatory profile in 48%. Only four recurrent ONM white patients had brain and spinal cord magnetic resonance imaging and cerebrospinal fluid findings compatible with the diagnosis of multiple sclerosis. Large lesions were seen in 62% of spinal magnetic resonance images. Six of 12 recurrent ONM Afro-Brazilian died. There were no statistical differences in the demographic data of the two ethnic groups. Afro-Brazilians were significantly more severely impaired and had a higher mortality rate than the white patients. Conclusion: These cases were classified as follows: two monophasic acute disseminated encephalomyelitis; one recurrent disseminated encephalomyelitis; three recurrent ONM associated with Hughes syndrome, autoantibodies and polyarteritis nodosa; six recurrent ONM with endocrinopathies; and finally, four muliple sclerosis cases. The remaining cases were not associated with any other condition. It would seem clear that ONM is a syndrome rather than a single disease.

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Section: Discussionmentioning

confidence: 95%

“…Another important clinical difference between Brazilian RRMS 23 and ONM Brazilian patients is the degree of impairment and disability on follow up. There is a statistically significant difference between the EDSS and the FS scores: higher impairment and more disability in the ONM group (fig 3).…”

Section: Discussionmentioning

confidence: 99%

Optic neuromyelitis syndrome in Brazilian patients

Papais-Alvarenga¹,

Miranda-Santos

Puccioni-Sohler

et al. 2002

J Neurol Neurosurg Psychiatry

136

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“…There were no differences in the cytology, protein and albumin quotient between the groups (Figs 1, 2, 3). WBC counts higher than 35/mm 3 were observed in 3% (3/ 98) of the definite MS cases and 4% (1/25) of the probable. Levels of protein higher than 80 mg/dl were detected in only one case of definite MS (84 mg/dl).…”

Section: Csf Analysismentioning

confidence: 97%

“…It seems to be related with different aspects as: genetic and environmental factors 2 . The frequency and distribution of multiple sclerosis in the Brazilian population is unknown, but the disease is not rare in Brazil 3 .…”

mentioning

confidence: 99%

Multiple sclerosis in Brazil: analysis of cerebrospinal fluid by standard methods

Puccioni-Sohler

Passer

Oliveira

et al. 1999

Arq. Neuro-Psiquiatr.

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-The demonstration of intrathecal IgG synthesis has been used as an important laboratory parameter to support the diagnosis of multiple sclerosis(MS). The Committee for European Concerted Action for Multiple Sclerosis has recommended a protocol for the assessment of intrathecal IgG synthesis. We applied this methodology to determine the cerebrospinal (CSF) profile of 128 Brazilian patients with MS. We detected hypercytosis lower than 35 cells/mm 3 in 97%, protein lower than 80mg/dl in 99%, normal blood-CSF barrier function in 76%, increased IgG local production around 53% and oligoclonal IgG bands by isoelectric focusing in 85% of the definite MS patients. The diagnostic accuracy of the quantitative analysis was lower than the qualitative. The detection of oligoclonal bands was especially important in the cases of normal quantitative assays of IgG. In addition, we found a lower frequency of inflammatory reaction in CSF in our MS cases, in comparison to some European studies.KEY WORDS: multiple sclerosis, cerebrospinal fluid, oligoclonal bands, isoelectric focusing. Esclerose múltipla no Brasil: análise do líquido cefalorraquidiano por métodos padronizadosRESUMO -A demonstração da síntese intratecal de IgG tem sido usada como importante parâmetro de apoio laboratorial ao diagnóstico de esclerose múltipla (EM). O Comitê Europeu de Ação para Esclerose Múltipla recomenda um protocolo para avaliação de síntese intratecal de IgG. Esta metodologia foi utilizada para determinar o perfil do líquido cefalorraquidiano (LCR) de 128 pacientes com o diagnóstico de esclerose múltipla. Verificouse pleocitose menor do que 35 células/mm 3 em 97%, produção local de IgG por métodos quantitativos em 53% e presença de bandas oligoclonais em 85% dos casos de EM clinicamente definida. A análise qualitativa apresentou maior acurácia diagnóstica do que a avaliação quantitativa de IgG. A detecção de bandas oligoclonais foi especialmente importante nos casos de analise quantitativa de IgG. Observamos menor frequência de reação inflamatória no LCR, em relação aos estudos europeus. PALAVRAS-CHAVE: esclerose múltipla, líquido cefalorraquidiano, bandas oligoclonais, focalização isoelétrica.

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“…However, prevalences as high as 88/100,000 have been reported [19] . Studies from Brazil show variable prevalences within the country [20,21] , perhaps due to their ethnic heterogeneity. In Sao Paulo (23-24° south), Callegaro et al [22] found a prevalence of 15/100,000.…”

Section: Ms In Latin Americamentioning

confidence: 99%