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Moreira M, Sanvito WL, Melges LDM. Professor Emeritus Charles Peter Tilbery [1944-2020]. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:530-532. [PMID: 32844899 DOI: 10.1590/0004-282x20200092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Marcos Moreira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora MG, Brazil
| | - Wilson Luiz Sanvito
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo SP, Brazil
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Abstract
Magnetic resonance imaging (MRI) has had an enormous impact on multiple sclerosis, enabling early diagnosis and providing surrogate markers for monitoring treatment response in clinical trials. Despite these advantages, conventional MRI is limited by lack of pathological specificity and lack of sensitivity to grey matter lesions and to microscopic damage in normal appearing tissue. Quantitative MRI techniques such as measures of parenchymal volume loss, magnetisation transfer imaging, diffusion tensor imaging, and proton magnetic resonance spectroscopy have enhanced our understanding of the nature and mechanism of tissue injury and repair in multiple sclerosis, and provided more specific correlates of neurological deficits and disability accrual. Some of these techniques may be of potential use in clinical trials as surrogate outcome measures for measuring treatment effects on neurodegenerative injury, which is currently difficult to quantify in clinical trials. In this respect, measures of brain volume, T1 hypointensity and magnetisation transfer ratio, and optical coherence tomography appear to be the most promising in the short term. The evidence for a role of neurodegeneration in the pathogenesis of multiple sclerosis, and particularly in the accumulation of irreversible disability, has become increasingly strong over recent years. This has prompted the search for new treatments that can effectively slow down, halt or even reverse such neurodegenerative processes, and in this way restore nervous system function. For this reason, there has been much interest in the development and validation of surrogate markers of neurodegeneration and neuroprotection for use in clinical trials. Advances in magnetic resonance imaging (MRI) technology have allowed the development and implementation of a number of methods that may be promising in this respect. To assess the utility of these methods and to identify needs for further research, sixty experts in neuropathology, clinical measurement, imaging and statistics participated in a meeting held in Amsterdam in 2008 under the aegis of the National Multiple Sclerosis Society. In the proceedings of the meeting, published in 2009 [1], brain volume changes, T1 hypointensity, magnetisation transfer ratio and optical coherence tomography were deemed the most promising measures for screening the neuroprotective capacity of new agents. Other MRI techniques, such as DTI, (1)H-MRS and functional MRI, although potentially useful, require more observational data to help determine the optimal trial design. This article will review some of the issues that were discussed at this meeting, and present some of the imaging techniques that were considered to be the most promising.
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Affiliation(s)
- Matilde Inglese
- Department of Radiology and Neurology, New York University, New York, USA
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Polachini CRN, Spanevello RM, Casali EA, Zanini D, Pereira LB, Martins CC, Baldissareli J, Cardoso AM, Duarte MF, da Costa P, Prado ALC, Schetinger MRC, Morsch VM. Alterations in the cholinesterase and adenosine deaminase activities and inflammation biomarker levels in patients with multiple sclerosis. Neuroscience 2014; 266:266-74. [PMID: 24508813 DOI: 10.1016/j.neuroscience.2014.01.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/21/2014] [Accepted: 01/25/2014] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the CNS that cause functional disability in young adults. It has unknown etiology characterized by the infiltration of lymphocytes and macrophages into the brain. The aim of this study was to evaluate the acetylcholinesterase (AChE) activity in lymphocytes and whole blood, as well as butyrylcholinesterase (BChE) and adenosine deaminase (ADA) activities in serum. We also checked the levels of nucleotides, nucleosides, biomarkers of inflammation such as cytokines (interleukin (IL)-1, IL-6, interferon (IFN)-γ, tumor necrosis factor-alpha (TNF-α) and IL-10) and C-reactive protein (CRP) in serum from 29 patients with the relapsing-remitting form of MS (RRMS) and 29 healthy subjects as the control group. Results showed that AChE in lymphocytes and whole blood as well as BChE, and ADA activities in serum were significantly increased in RRMS patients when compared to the control group (P<0.05). In addition, we observed a decrease in ATP levels and a significant increase in the levels of ADP, AMP, adenosine and inosine in serum from RRMS patients in relation to the healthy subjects (P<0.05). Results also demonstrated an increase in the IFN-γ, TNF-α, IL-1, IL-6 and CRP (P<0.05) and a significant decrease in the IL-10 (P<0.0001) in RRMS patients when compared to control. Our results suggest that alterations in the biomarkers of inflammation and hydrolysis of nucleotides and nucleosides may contribute to the understanding of the neurological dysfunction of RRMS patients.
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Affiliation(s)
- C R N Polachini
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - R M Spanevello
- Programa de Pós-Graduação em Bioquímica e Bioprospecção, Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário, Capão do Leão, 96010-900 Pelotas, RS, Brazil
| | - E A Casali
- Universidade Federal do Rio Grande do Sul, Instituto de Ciências Básicas da Saúde, Porto Alegre, 90035-003 Porto Alegre, RS, Brazil
| | - D Zanini
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - L B Pereira
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - C C Martins
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - J Baldissareli
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - A M Cardoso
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - M F Duarte
- Centro de Ciências da Saúde, Universidade Luterana do Brazil, Campus Santa Maria, Santa Maria, RS, Brazil
| | - P da Costa
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - A L C Prado
- Departamento de Fisioterapia e Reabilitação, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Campus Universitário, Camobi, 97105-900 Santa Maria, RS, Brazil
| | - M R C Schetinger
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - V M Morsch
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Química, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
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Olival GSD, Cavenaghi VB, Serafim V, Thomaz RB, Tilbery CP. Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:516-20. [DOI: 10.1590/0004-282x20130081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/06/2013] [Indexed: 11/22/2022]
Abstract
This article describes the clinical and radiological evolution of a stable group of patients with relapsing-remitting multiple sclerosis that had their disease-modifying therapy (DMT) withdrawn. Forty patients, which had made continuous use of one immunomodulator and had remained free of disease for at least 5 years, had their DMT withdrawn and were observed from 13 to 86 months. Out of the followed patients, 4 (10%) patients presented with new attacks. In addition to these patients, 2 (5%) patients had new lesions revealed by magnetic resonance imaging that did not correspond to clinical attacks. Despite these results, the difficult decision to withdraw medication requires careful analysis. Withdrawal, however, should not be viewed as simply the suspension of treatment because these patients should be evaluated periodically, and the immunomodulators should be readily reintroduced if new attacks occur. Nonetheless, medication withdrawal is an option for a select group of patients.
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Yamout BI, Dahdaleh M, Al Jumah MA, Al-Shammri S, Al Sharoqi I, Al-Tahan AR, Bohlega S, Deleu D, Inshasi J, Khalifa A, Szólics M. Adherence to disease-modifying drugs in patients with multiple sclerosis: a consensus statement from the Middle East MS Advisory Group. Int J Neurosci 2010; 120:273-9. [PMID: 20374075 DOI: 10.3109/00207450903541087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adherence to therapy is a key issue in chronic illnesses. In addition, several features of multiple sclerosis (MS) and its treatment may increase the likelihood of patient nonadherence and discontinuation of treatment. Nonadherence will obviously compromise the efficacy of disease-modifying drugs in patients with MS. This subject was discussed by a group of local MS specialists from the Middle East. The group debated several key questions about the features and causes of patient nonadherence and its management. Further, they made recommendations for optimizing treatment adherence in this area.
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Affiliation(s)
- Bassem I Yamout
- Internal Medicine, American University of Beirut, Beirut, Lebanon.
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