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Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Natalizumab is the first monoclonal antibody approved as a monotherapy for the treatment of relapsing-remitting multiple sclerosis (RRMS). It decreases the migratory capacity of peripheral blood mononuclear cells through inflammatory endothelium, via binding the alfa4-betal integrin, the main homing molecules involved in lymphocyte migration to inflammatory sites in the central nervous system. Objectives: The aim of this prospective study was to estimate the proportion of disease-activity free patients, as documented by relapse rate and progression of disability after one year of treatment. Methods: Thirty MS patients receiving at least one year of Natalizumab treatment (12 to 50 infusions) were analyzed. All were diagnosed with RRMS, according to the McDonald criteria. Clinical and demographic data were collected, including gender, disease duration, number of flare-ups in the previous year, and EDSS scores. Clinical relapses and changes in EDSS score during treatment were reported, as well as any other medical event occurring as a result of Natalizumab treatment. Results: Mean age was 35.7 years (range 20yr to 56yr); 24 female patients and 6 male. Mean disease duration was 11.2 years and mean EDSS score was 4 (range 1 to 6.5). Previous use of immunossupressor drugs occurred in 21 patients. The relapse rate after 1 year of treatment (ARR) decreased 89.1% and the EDSS decreased by 1 point. Four patients discontinued the treatment. Conclusions: In our experience, Natalizumab was at least as effective as has been documented in pivotal clinical trials and other open-label surveys. During the 12 month follow-up period, we observed a dramatic reduction in mean ARR of about 89% when compared to the year prior to beginning Natalizumab treatment, and a reduction in EDSS score when compared to baseline. Unfortunately, all of the patient MRI controls are not available, which prevents the verification of the disease-free status. [ABSTRACT FROM AUTHOR]

Background: Longitudinally extensive transverse myelitis (LETM), a propagated spinal cord (SC) inflammation causing hyperintensity on T2-weighted magnetic resonance imaging (MRI) over 3 or more vertebral segments, is widely regarded as a spectrum of neuromyelitis optica (NMOSD). 2he broad differential diagnosis of LETM patients is a subject of recent discussion, but fairly studied. Objectives: To report the differential diagnosis of LETM patients. Methods: A cross-sectional evaluation of 128 consecutive patients admitted to the Neurology Department - Sao Paulo University Hospital, between January 2005 and November 2012, meeting the inclusion criteria of inflammatory transverse myelitis according to the Transverse Myelitis Consortium Working Group (TMCWG) and contiguous spinal cord MRI lesion extending over 3 or more vertebral segments. Complete demographic and clinical histories were taken, together with laboratory exams, spinal fluid analysis, and brain and spinal cord MRI. Indirect immunofluorescence assay was used to evaluate aquaporin-4 antibody (NMO-IgG). Results: 128 female patients (70%), 28 Caucasian (15%), with mean age of 38 years (range 11-72yr). Differential diagnosis of patients included: 84 with NMO (46.8%), 25 recurrent LETM (14%), 30 isolated LETM (16%), 3 MS (1.6%), infectious in 20 (11%), systemic disease in 8 (4.4%), arterial-venous malformation in 8 (4.4%), metabolic in 2 (1%), tumor in 2 (1%) and actinic in 1 (0.5%). NMO-IgG seropositivity was exclusively found in: NMO patients (65%), recurrent LETM (44%) and isolated LETM (20%). LETM associated with rheumatologic, infectious vascular, metabolic, tumoral and actinic etiology were all NMO-IgG negative. Conclusions: NMOSD is the main diagnosis of LETM in our sample, mainly considering those who are NMO-IgG positive (63%). However, it is essential to maintain a high index of suspicion for possible and serious etiologies: infectious and vascular LETM may represent a critical subset with a distinct therapy and prognosis. NMO-IgG was negative for all patients with non-inflammatory myelopathy, mimicking LETM, and infectious myelitis presenting as extensive spinal cord lesion. "Idiopathic" seronegative LETM represent almost 14% of the entire cohort. 2he role of current antiaquaporin-4 antibody assays, as well as new antibodies associated with LETM, such as anti-MOG, must be better studied, especially in sero-negative patients. [ABSTRACT FROM AUTHOR]

Background: Memory is one of the most common cognitive functions affected by multiple sclerosis (MS). Objective: To describe magnetic resonance spectroscopy (MRS) findings in the hippocampus of patients with relapsing remitting MS, early in the disease course and investigate the association between metabolites and memory. Methods: MRS was performed at 3T using different echo times (TE = 135 ms and 35 ms) and a single-voxel located along the left hippocampus. Data were processed using LCModel and the concentration of metabolites weighted for content of tissue water and correction to the percentage of different tissue types. Brain and hippocampi volumetric analyzes were performed by Freesurfer. Subjects underwent a neuropsychological battery from which a memory retention score (RS) was extracted using Hopkins Verbal Learning and Logical Memory tests. Results: Twenty-nine patients (21 female; mean disease duration 2.5 years) and 25-paired controls were included. In the MS group, we observed a significant N-acetyl aspartate (NAA) reduction of 8.3% (p=0.029; TE 135 ms) and an increase in the concentrations of creatine (Cr), choline (Cho) and myoinositol (mI) to the order of 13.5%, 17.9% and 28.3%, respectively (p=0.043; p=0.009; p=0.042; TE = 35 ms). Patients showed a hippocampal volume loss of 9% (p=0.014). Regarding memory, no difference in RS between groups was found (p = 0.756). An unexpected negative correlation was observed between RS and NAA in patients (r = -0.486, p = 0.007), and lower NAA levels observed in those with compromised memory (10.6 vs 12; p = 0.009). Conclusion: In the early stages of MS, structural and metabolic changes in the hippocampus were found that reflect neuronal loss and/or dysfunction and gliosis. The negative correlation between NAA and memory found only in MS patients is speculative at this moment. Further analyses are necessary to evaluate such findings, which face the complex pathophysiology of the disease. [ABSTRACT FROM AUTHOR]

Background: Neuromyelitis optica (NMO) and its limited forms are demyelinating autoimmune diseases of the central nervous system that preferentially affect the spinal cord and the optic nerve. Several clinical forms of neuromyelitis optica spectrum disorders (NMO-SD) have been observed and range from a limited event of longitudinally extensive transverse myelitis (LETM) to relapsing NMO. Objectives: To assess the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with NMO-SD, a population that has not been previously evaluated in this regard. Methods: We prospectively evaluated 7 men and 23 women (mean age 41.1 ± 13.5 years) with an established diagnosis of NMO-SD, who were invited to participate irrespective of the presence of LUTS. Neurological evaluation was assessed with the Expanded Disability Status Scale (EDSS). LUTS were evaluated by the Overactive Bladder questionnaire (OAB-V8) and by the International Prostate Symptom Score (I-PSS). Quality of life (QOL) was evaluated using the Life Satisfaction questionnaire (LiSat-9). All patients underwent videourodynamics. Results: The mean time of neurological disease duration was 33.8 ± 30.8 months. Neurological evaluation showed a mean EDSS score of 5.3 ± 1.8. The most frequent videourodynamics findings were detrusor overactivity (DO) with detrusor-sphincter dyssynergia (DSD) in 11 (36.6%) patients, DSD alone in 7 (23.3%) and DO without DSD in 6 (20%). Voiding dysfunction assessed by I-PSS and OAB-V8 increased with the degree of neurological impairment (p=0.018 and p=0.006, respectively). Patients with DSD had a significantly higher symptoms score in the I-PSS (p=0.029) and the OAB-V8 (p=0.008), and greater neurological impairment (p=0.027). Patients with more severe neurological impairment were associated with a worse QOL (p=0.022). Conclusions: A high prevalence of LUTS and voiding dysfunction was shown, with DSD and DO as the main urodynamic findings. Detrusor-sphincter dyssynergia was associated with more severe neurological impairment. The severity of the neurological impairment correlates with QOL. [ABSTRACT FROM AUTHOR]

Background: Brainstem symptoms can be the first manifestation of neuromyelitis optica (NMO) and related spectrum disorders (NMOSD). They can exhibit as a cervical spinal cord lesion extending to the medullary region, or as a brainstem-restricted lesion. These lesions commonly cause intractable nausea, vomiting, and/or hiccups, but oculomotor symptoms or ataxia are infrequent. Objectives: To report the prevalence of brainstem symptoms and lesions on magnetic resonance imaging (MRI) as the first attack of NMOSD. Methods: A retrospective study involving 83 NMO/NMOSD patients followed at the Hospital das Clínicas, University of Sao Paulo (Sao Paulo, Brazil). A cell-based assay was used to detect aquaporin-4 (AQP4)-antibodies. Results: Of the 83 patients included, 67.5% (56/83) had NMO and 32.5% (27/83) had NMOSD. Brainstem symptoms were the first clinical symptom of NMOSD in 31.3% (26/83) of patients. There were brainstem symptoms as the first attack without an extension of a cervical spinal cord lesion in 16.8% (14/83) of individuals, and as an extension of LETM in 14.5% (12/83) of patients. At least one attack with brainstem symptoms during the disease course was present in 51.8% (43/83) of the total number of patients. Conclusions: Brainstem symptoms as the sole manifestation of a first NMOSD attack may not be uncommon. Patients with intractable nausea, vomiting, and/or hiccups, especially those with brainstem lesions shown on an MRI, should be tested for AQP4-antibodies. [ABSTRACT FROM AUTHOR]

Background: Neuromyelitis optica is an autoimmune disease of the central nervous system that presents predominantly with optic neuritis (ON) and myelitis. The association of the IgG class antibodies directed against the aquaporin-4 channel (AQP4-IgG) allows early diagnosis of limited forms, such as ON or myelitis, considered part of the spectrum of NMO disorders (NMOSD). Acute exacerbations are treated with methylprednisolone, followed by plasmapheresis in refractory patients. AQP4-IgG seropositivity supports the use of therapy based on humoral immunity, such as plasmapheresis, but differences in the response of seronegative patients are poorly described. Objectives: To evaluate the efficacy and safety of plasma exchange in NMO patients resistant to treatment by methylprednisolone. Methods: A retrospective analysis of 19 patients with NMO and NMOSD (2006 diagnostic criteria) refractory to methylprednisolone, treated between March 2006 and April 2013. The Expanded Disability Status Scale (EDSS) was used to compare results both pre- and post-treatment. Results: Of the 19 patients, 2 were male, and the mean age was 32.5 years. Patients with a diagnosis of NMO numbered 16 and 3 had NMOSD. The average age at treatment onset was 35.3 years. Twenty-four relapses were treated: 9 ON, 12 longitudinally extensive transverse myelitis, 2 with both clinical symptoms and 1 with cerebral symptoms (nausea and vomiting). The mean interval between the onset of relapse and the beginning of plasmapheresis was 55.5 days and the average number of sessions was 5.7 (range 2-7) in a period of 1-2 weeks. The mean EDSS score pre-treatment was 7.1 (range 5 to 9.5) and post-treatment was 5.8 (range 2.5 to 9.5). Complications related to the procedure were encountered by 12 patients. AQP4-IgG status was positive for 12 patients and 1 was awaiting the result. Conclusion: It is concluded that plasmapheresis is effective and well tolerated by most patients with NMO and NMOSD, independent of their AQP4-IgG serum status. [ABSTRACT FROM AUTHOR]

Background: Longitudinally extensive transverse myelitis (LETM), a propagated subset of spinal cord (SC) inflammation, has a broad differential diagnosis, including neuromyelitis optica spectrum disorders (NMOSD) and infections. Proper diagnosis is essential due to the critical role of a therapeutic approach. LETM may occur as a manifestation of neuroschistosomiasis in its clinical course. Schistosomiasis, with a prevalence of around 200 million people worldwide, represents an important diagnosis in a globalized world, where borders no longer restrict diseases and pathogens. Objectives: To report the clinical course of LETM associated with neuroschistosomiasis (NS). Methods: Prospective follow-up of patients from a cohort of LETM fulfilling definite diagnosis of NS (DNS) where schistosoma eggs found in SC biopsy; probable NS (PoNS) where presence of low thoracic or lumbar SC involvement, positive epidemiology plus demonstration of schistosomal infection; possible NS (PoNS) where only low thoracic or lumbar SC lesion and positive epidemiology were present. Exclusion criteria were: systemic disease associated with LETM and seropositivity for NMO-IgG. Results: A total of 16 consecutive patients with LETM fulfilled the diagnostic criteria for DNS(1), PrNS (9) or PoNS (6). All were non-caucasian and 11 were male (68%). Mean age: 30.9 years (range 17-51). Median time of follow-up: 3.5 years (range 0.5-6). MRI showed thoracic lesion (5), thoracolumbar (8) and entire spinal cord lesion (2). Cerebrospinal fluid demonstrated median 61.1 cell/mm3 (range 1-320), and 72.1 protein (range 27-254). Median extension of lesion: 10.5 vertebral segments (range 10 to 22). Four patients (25%) experienced corticosteroid-dependent relapse. Conclusions: LETM associated with NS may evolve with recurrence. We are unable to verify if recurrent LETM represents a propagated inflammation secondary to egg deposits or a sera-negative spectrum of NMO. Stricter criteria are necessary to distinguish infectious LETM of NMOSD. It is possible that parasite infection triggers an immune-mediated inflammatory cascade, justifying the corticosteroids dependent state in our patients. [ABSTRACT FROM AUTHOR]

Background: The degenerative processes can be predictors of the neurological deficit in multiple sclerosis (MS), affecting both the white (WM) and gray matters (GM), which can be reflected by loss of microstructural complexity in WM compartments and cortical atrophy, respectively. Objectives: To access the signs of WM degeneration in the segmented corpus callosum (CC) using diffusion tensor imaging (DTI) quantitative indices, and the degree and distribution of cortical atrophy in MS patients, looking for correspondences between the DTI abnormalities of CC WM tracts and the areas of cortical atrophy. Methods: 31 relapsing remitting MS (RRMS) patients (22 women, mean age 30.5 years ± 8.7, mean EDSS 1.1 ± 0.9) and 34 healthy volunteers (HV) (27 women, mean age 32.3 years ± 7.8) were submitted to brain examinations in a 3T scanner (Intera Achieva, PHILIPS Healthcare, Best, Netherlands). The patients were out of clinical relapses, had been free from previous immunomodulatory therapy and steroid-free for at least 90 days before the examinations. From DTI with 32 encoding directions were extracted the indices of fractional anisotropy (FA), mean (MD), radial (l^) and axial (lçç) diffusivities in 5 segments of the mid-sagital section of the CC. The cortical thickness was obtained by automatic segmentation of volumetric T1 images. Results: The FA, MD l^ and were abnormal in all 5 CC segments of the RRMS and the lçç was abnormal only in the splenium, anterior and posterior mid-bodies of the CC. The anterior cortex of both temporal lobes, right inferior parietal, some orbital-frontal and insular regions showed significant atrophy, with a tendency in the superior frontal gyrus. Conclusions: The regional distribution of the cortical atrophy corresponds to some of the cortical connections of the CC segments with abnormal lçç. If WM and GM degenerative processes follow similar distributions, lçç can be a potential biomarker of WM degeneration. [ABSTRACT FROM AUTHOR]

Introduction: The hygiene hypothesis suggests an inverse relationship between the prevalence of parasitic infections and the frequency of multiple sclerosis (MS). Objective: To study whether antibodies against parasites could be demonstrated more frequently in blood serum from MS patients with oligoclonal bands (OCB) than from MS patients without OCB. Methods: We studied serum samples from 164 patients who had previously been examined to investigate OCB. Parasitic antibodies were analyzed through unidimensional electrophoresis of proteins on polyacrylamide gel against Taenia antigens, searching for anti-parasitic antibodies: (1) specific (low molecular weight); (2) nonspecific (high molecular weight). Results: In the group of MS patients, those with OCB presented anti-Taenia antibodies at a similar frequency to those without OCB (p = 0.9). The same was obtained for nonspecific antibodies (p = 0.3). This finding was repeated when the group with clinically isolated syndrome was studied to detect anti-parasitic antibodies in relation to the presence or absence of OCB (p = 0.6). Likewise, in the group of inflammatory neurological diseases, there was no significant difference when considering patients with and without OCB in relation to the presence of specific (p = 0.06) or nonspecific (p = 0.9) anti-parasitic antibodies. OCB were not detected in patients from the control group. Discussion: Frequency of specific anti-parasitic antibodies was similar in MS patients with or without OCB; Frequency of nonspecific anti-parasitic antibodies was similar in MS patients with or without OCB. It was not possible to attribute the low frequency of OCB in this sample of patients to the presence of anti-parasitic antibodies in the serum. The set of anti-parasitic antibodies, irrespective of specificity, presented similar frequency in patients with MS and controls. Conclusion: Anti-parasitic antibodies are detected with similar frequency in MS patients with OCB and in MS patients without OCB. [ABSTRACT FROM AUTHOR]

Background: The incapacitating potential of fatigue requires studies on its prevalence and associated factors. Objective: To investigate the sociodemographic and clinical factors associated with fatigue in Relapsing-Remitting Multiple Sclerosis (MS) patients in the Hospital of the University of São Paulo (HC-USP). Materials and Methods: Study conducted from May 2011 to August 2012, with 115 patients with mild to moderate disability (EDSS 0-5), age ≤ 45 years, and stable for at least 6 months. Interview was done using the Brazilian version of the Fatigue Severity Scale (FSS-BR), the Modified Fatigue Impact Scale (MFIS-BR) and sociodemographic questionnaire. To verify the association between fatigue and independent variables selected, a multivariate analysis of those who had a bivariate analysis showing a value of p <0.20 was carried out. A logistic regression model was used, and variables with p <0.05 remained in the final model. The odds ratios (Oil) were estimated for each of the variables with their respective confidence intervals (CI95%). Results: In the bivariate analysis fatigued patients (n = 46) were associated with marital status (p = 0.016), "be active" (work, study and volunteer) (p = 0.002) and EDSS (p = 0.001). The chance of fatigue occurring in married was 2.29 times compared to the unmarried (OR = 2.29 (CI95% 1.01 to 5.20)). The active ones showed a higher chance of fatigue 2.65 times those inactive (OR = 2.65 (CI95% 1.05 to 6.64)). Those with EDSS> 2 had 3.02 odds compared to those with EDSS ≤ 2 (OR = 3.02 (CI95% 1.09 to 8.31). Conclusion: Married were more likely to be fatigued as was found in another study. Literature indicates that, marital concerns are associated with less healthy behaviors and increased perception of disability, which may be contributing to this fatigue. Active people perform regular and external social activities that require physical and mental energy. Some studies have found an association between fatigue and EDSS as found in this study. [ABSTRACT FROM AUTHOR]

Background: Fatigue is one of the most frequent symptoms of Multiple Sclerosis (MS) that impact everyday life of patients. Being aware of fatigue prevalence is important to understand its manifestations and give support to therapeutic interventions that will help in the daily management of this symptom. Objective: Describe the prevalence of fatigue in Relapsing-Remitting MS patients treated at the Clinical Hospital of the University of São Paulo (HC-USP). Methods: Clinic-prospective study with 115 patients from May 2011 to August 2012. Mild to moderate disabled patients were included (0-5 at Expanded Disability Status Score - EDSS), until 45 years of age, without any other associated diseases or outbreaks for at least 6 months, regardless the time of the disease. The Brazilian version of the Fatigue Severity Scale (FSS-BR) and Modified Fatigue Impact Scale (MFIS-BR) were applied. Methods: MRS was performed at 3T using different echo times (TE = 135 ms and 35 ms) and a single-voxel located along the left hippocampus. Data were processed using LCModel and the concentration of metabolites weighted for content of tissue water and correction to the percentage of different tissue types. Brain and hippocampi volumetric analyzes were performed by Freesurfer. Subjects underwent a neuropsychological battery from which a memory retention score (RS) was extracted using Hopkins Verbal Learning and Logical Memory tests. Results: The sample represents 10% of the MS patients of the service, from 17 to 45 years old, with time of diagnosis from 0 to 19 years and EDDS from 0 to 5. The majority were women (73.9%), more than a half of them were engaged in labor-intensive activities (56.6%), and 72.2% were employees, volunteers and students. Regarding education, 69.9% had at least an incomplete college education. Those who were considered fatigued had FSS-BR points ≥ 4 and MFIS-BR points ≥ 38, which resulted in a total of 46 patients (40%)[IC95% : 30.9 - 49.1]). Conclusion: The population is primarily composed of women and perform regular and social activities, which can be related to the high level of education. Fatigue prevalence is lower when compared to a similar study that used FSS-BR with a lower cutoff point. The two scales presented a high level of agreement, reinforcing the fact that the use of combined scales is the best option to evaluate fatigue. This was the first study of the combined use of FSS -- BR and MFIS - BR in Brazil and one of the few to use MFIS-BR [ABSTRACT FROM AUTHOR]

Visual perception of verticality constitutes an important component of balance. A subjective visual vertical (SVV) test can reflect impairment of graviceptive pathways and can evaluate this sense with accuracy. Although the Expanded Disability Status Scale (EDSS) is considered the gold standard assessment for disability in Multiple Sclerosis (MS), it is known to be insensitive to detecting subtle functional impairments, such as balance complaints. SVV could be used to test these subtle balance complaints. Objectives: To compare SVV tilt in two MS groups divided according to balance complaints and to assess if the degree of disability (EDSS) is correlated to increased SVV tilt. Patients and Methods: Ninety-eight outpatients were recruited with a diagnosis of relapsing-remitting MS and an EDSS score between 0 - 4.5. They were divided into two groups: no balance complaints (NC) and balance complaints (IC). SVV perception was tested using a 30cm long luminous portable rod in a dark room in order to eliminate any visual reference cues. The rod was positioned at a 30 degree oblique angle in the frontal plane and then moved to the left and right 10 times. The subject was instructed to notify each time they believed the rod to be in a vertical position. The median of absolute values was considered, with an accuracy of 1 degree. Statistical analysis was performed using the Mann-Whitney test to compare the median of SVV deviations between MS groups, and Spearman's test to assess the correlation between SVV values and EDSS scores. Results: MS patients with balance complaints showed an increase of SVV tilt (p=0.003). The correlation between SVV deviation and EDSS also proved significant, thus patients with more disability showed worse perception of verticality (Spearman's correlation, r = 0.330, P < 0.001). Conclusion: MS patients with balance complaints have impaired perception of verticality, as measured by the SVV test. SVV tilt may be a sensitive sign for use in evaluating and following disability degree. [ABSTRACT FROM AUTHOR]

Background: The JC virus (JCV) is a double-stranded DNA polyomavirus that takes its name from the initials of the patient from whom it was first isolated. Initial infection with JCV is thought to occur in tonsillar tissue after inhalation, although transmission of the virus through ingestion of contaminated food or water has also been suggested. JCV is thought to be transported across the blood-brain barrier within B cells. Subsequently, JCV can establish productive infection of oligodendroglia. Objectives: The aim of the present study is report the prevalence of JCV in MS patients at Hospital das Clínicas, of Sao Paulo. Some patients were tested during Natalizumab treatment and some before. Methods: A sample size of 87 MS patients were tested using the JCV test provided by Biogen Idec. Results: Eighty-seven MS patients: 70 female; 17 male. JCV positivity was 54% (47 patients). Mean age was 34.9 years (range 17yr to 57yr). Of those patients receiving Natalizumab treatment, 15 tested virus positive, and 11 were initially tested negative when the first test was done. Conclusions: Blood samples taken from healthy individuals indicate that 50-90% of adults have been exposed to the virus, with 19-27% of these people sheddingJCV in their urine. The seroprevalence of JCV increases with age. The prevalence of JCV among MS patients ranges from 48% to 69% in the world, in line with our sample. These results suggest the importance of risk stratification and monitoring of MS patients receiving Natalizumab treatment. [ABSTRACT FROM AUTHOR]

Background: Neurobrucellosis is an infection caused by gram-negative bacteria of the genus Brucella. Human infection usually results from occupational contact with infected animals or ingestion of unpasteurized milk products or other animal tissues. 2he incubation period varies from 1 week to several months, with an average of 3 to 4 weeks. Symptoms are nonspecific and include fever, headache, vomiting, and meningeal irritation. Systemic manifestations of brucellosis may be present. If treated, the prognosis usually is good, although cases with serious neurologic sequelae have been reported. Objectives: To report a case of neurobrucellosis as a differential diagnosis of demyelinating disease. Methods: A 16-year-old youth from Tocantins first presented four years previously with relapsing fevers, chronic fatigue, and arthralgias. He was initially treated for systemic lupus erythematosus with central nervous system involvement due to his symptoms and laboratory findings. Despite receiving corticoid therapy for 9 months, he showed no sign of improvement and developed a bilateral and progressive deafness. The correct diagnosis of neurobrucellosis was made at the age of fourteen and treatment with antibiotics followed, halting the disease progression. Results: 2010 - Cerebral Spinal Fluid (CSF): 9 cells (99% lymphomononuclear), positive Pandy test, 19 mg/dl glucose, 151 mg/dl protein (28% gamma), oligoclonal bands positive, and Brucellosis antibodies. MRI: white matter signals changes in bilateral periventricular and subcortical of the temporal lobe. Conclusions: This case illustrates that acquired progressive focal neurologic deficits with inflammatory CSF, the presence of oligoclonal bands, and white matter signal changes on an MRI may occur during the course of neurobrucellosis. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is the most frequent chronic immune-mediated disorder of the central nervous system, presenting with relapse (RRMS) or progression. Primary progressive multiple sclerosis (PPMS) is characterized by continuous worsening without distinct relapses. As described by Lucchinetti (2000), there are four patterns of demyelination in MS: pattern I demyelination induced by macrophage toxins; pattern II induced by antibodies against myelin proteins; pattern III characterized by loss of myelin-associated glycoprotein (MAG) leading to oligodendrogliopathy; pattern IV with primary death of oligodendrogliocytes. There is little data about immunopathogenesis in PPMS. Objectives: Our aim is to report the anatomopathological findings in a case of PPMS. Methods: C.C.C, a 40 year old male presented in 2009 with progressive walking disability over 4 months. Clinical examination found cerebellar ataxia, weakness in all four limbs and bilateral Babinski sign. Neuroimaging detected an isolated frontal gadolinium-enhancing lesion and multiple discontinuous cervical lesions. Cerebral spinal fluid analysis revealed 6 cells with predominance of lymphocytes without oligoclonal bands. This case did not fulfill the requirements of the 2005 McDonald PPMS diagnosis criteria, thus an early biopsy was done. Results: Frontal lesion biopsy was consistent with necrotic lesion heavily infiltrated by macrophages and early gliosis, without lymphocytes, compatible with pattern I. Conclusions: PPMS is consistent with an inflammatory disease, however, there is no response to anti-inflammatory drugs, few gadolinium enhancing lesions and progressive injury of white and gray matter. ]his data suggests that PPMS has quantitative and qualitative inflammatory process differences from other MS phenotypes. Early biopsy of this case of PPMS found initial pathologic findings of RRMS. We speculate that PPMS has a different immunopathologic process that determines a rapid disease course from a common pathological base. This reinforces the need for further study related to the immunopathogenesis of PPMS. [ABSTRACT FROM AUTHOR]

An introduction to a series of abstracts at Brazilian Committee for Treatment in Multiple Sclerosis (BCTRIMS) 2011 Annual Meeting is presented including topics on Devic's neuromyelitis optica (NMO), race miscegenation, and multiple sclerosis.

The author discusses the study of multiple sclerosis (MS) and associated ailments in Brazil. He cites the scientific facts that hinted the important role that biomarkers could play in the near future in various circumstances, specifically in patients with genetic susceptibility to acquire the disease. He cites the so called Devic's neuromyelitis optica (NMO), which is being suspected to have a MS variant.

An introduction to the journal "Arquivos de Neuropsiquiatria" is presented in which the author mentioned the publication of Abstracts of Posters, introduced at The Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) 10th Annual Meeting held in Sao Paulo, Brazil from August 27 to 29, 2009.