Multiple sclerosis following SARS-CoV-2 infection

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The first case of multiple sclerosis (MS) shortly after COVID-19 is presented.

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Viral infections strongly relate to MS onset and its relapses.

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SARS-CoV-2 can play a role in the triggering of demyelinating diseases.

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Systemic immune response against SARS-CoV-2 could reach CNS leading to demyelination.

SARS-CoV-2 infection can produce neurological features. The most common are headache, anosmia and dysgeusia but patients may also develop other central nervous system (CNS) injuries.

We present a patient affected by Covid-19 who initially consulted for decreased visual acuity. The MRI showed inflammation in the right optic nerve and demyelinating lesions in the CNS.

We speculate that an immune mechanism induced by SARS-CoV-2, which can activate lymphocytes and an inflammatory response, plays a role in the clinical onset of the disease. This pathogen may be associated with either the triggering or the exacerbation of inflammatory/demyelinating disease.

Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia

BACKGROUND

Antiepileptic drugs are the first-line treatment for trigeminal neuralgia (TN). Carbamazepine and oxcarbazepine are the most studied with well-known efficacy. Eslicarbazepine acetate is a third-generation antiepileptic drug that has not previously been evaluated for the treatment of TN. We aim to assess the efficacy, tolerability and safety of eslicarbazepine for TN.

DESIGN AND METHODS

Retrospective, open-label, multicentric, intention-to-treat study. We included patients older than 18 years who met the ICHD-3 beta diagnostic criteria for TN. We evaluated the variation of intensity and frequency of pain paroxysms before and after treatment with eslicarbazepine. Secondary objectives assessed were tolerability and safety of eslicarbazepine.

RESULTS

Eighteen patients were included, 15 women, mean age 65.2 years old, mean follow-up 21.1 months. The mean number of drugs tested before eslicarbazepine was 2; 10 patients used eslicarbazepine as monotherapy. After the treatment with ESL, the median of pain intensity improved from 9.5 to 2.5 (p < 0.001) and the median of pain paroxysms frequency improved from 70 episodes per week to 0.37 (p < 0.001). Responder rate was 88.9%; 44.4% became asymptomatic after treatment. Sixty-one per cent of patients presented some adverse event; four patients discontinued eslicarbazepine for this reason. Despite this, 16 patients (88.9%) noticed a good subjective tolerance to eslicarbazepine. The retention rate at 6 months was 77.8% and at 12 months 61.1%.

CONCLUSIONS

Our study supports the hypothesis that eslicarbazepine acetate is an effective, safe and well-tolerated treatment for the treatment of TN. Further studies are warranted to corroborate these results.

SIGNIFICANCE

Eslicarbazepine acetate has shown to be an effective, safe and well-tolerated drug for TN. This is the first study that evaluated the efficacy of this drug on TN in humans.

[Intravenous thrombolytic treatment in acute ischemic stroke: initial results in the Complejo Hospitalario Universitario de Albacete]

AIM

To analyze the safety profile and clinical outcome of patients with acute cerebral ischemia who received open treatment with tissue plasminogen activator (rt-PA) in a hospital without previous experience.

PATIENTS AND METHODS

This prospective and observational study were realized from January 2004 to January 2007. A total of 1,704 consecutive patients with ischemic stroke were attended. 72 of them (4.2%) were treated with rt-PA within 3 hours from the symptoms onset. We analyzed age, vascular risk factors, initial and 24 hours neurological state by the National Institute of Health Stroke Scale (NIHSS), incidence of intracerebral hemorrhage and mortality and independence at 90 days. Patients were treated by neurologist and stroke monitoring was performed in the emergency area.

RESULTS

Baseline median NIHSS was 16. At 24 hours, 53% of patients had improved = or > 4 points in the NIHSS and 33% showed = or > 10 points improvement or total recovery. The median time from stroke onset to rt-PA treatment was 160 minutes. Symptomatic intracerebral hemorrhage occurred in two patients (2.7%). Overall mortality at 90 days was 9.7%, but was due to hemorrhagic brain complications only in one case. At three months, 51% of patients were independent according to the modified Rankin scale.

CONCLUSIONS

Treatment of acute ischemic stroke within three hours with intravenous rt-PA is safe and is associated with favorable outcome when it is applied by neurologists following approved protocols even in hospitals without previous experience.