Multiple sclerosis is the most common autoimmune inflammatory demyelinating disease of the central nervous system, and its etiology is believed to have both genetic and environmental components. Several viruses have already been implicated as triggers and there are several studies that implicate members of the Herpesviridae family in the pathogenesis of MS. The most important characteristic of these viruses is that they have periods of latency and exacerbations within their biological sanctuary, the central nervous system. The Epstein-Barr, cytomegalovirus, human herpesvirus 6 and human herpesvirus 7 viruses are the members that are most studied as being possible triggers of multiple sclerosis. According to evidence in the literature, the herpesvirus family is strongly involved in the pathogenesis of this disease, but it is unlikely that they are the only component responsible for its development. There are probably multiple triggers and more studies are necessary to investigate and define these interactions.

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a stable group of patients with relapsing-remitting multiple sclerosis that had their disease-modifying therapy (DMT) withdrawn.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had made continuous use of one immunomodulator and had remained free of disease for at least 5 years, had their DMT withdrawn and were observed from 13 to 86 months.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.

OBJECTIVES: To determine, based on clinical criteria, the proportion of multiple sclerosis (MS) patients responsive to immunomodulators (RI) and nonresponsive to immunomodulators (NRI), and to ascertain whether clinical and epidemiological data differs between RI and NRI patient groups. METHODS: Patients were assessed on rate of exarcerbations per year, for the period before and after commencement of treatment. The RI and NRI groups were compared for several clinical and epidemiological characteristics. DISCUSSION AND CONCLUSION: A total of 31.4% of the patients were nonresponders to the immunomodulatory treatment. The main predictors of immunomodulatory response were early diagnostic and commencement of therapy and high rate of annual exacerbations prior to treatment. Given the arsenal of medication options available for MS management, screening potential candidates for different therapeutic approaches are critical to optimize evolution of patients with the disease.

Objetivos: Analisar eventual influência do diabetes e da hipertensão na antiagregação plaquetária por ácido acetilsalicí­lico (AAS) em diferentes doses. Casuí­stica e Métodos: Estudo observacional transversal, baseado em dados secundários, em doentes diagnosticados com acidente vascular cerebral isquêmico (AVCi) aterotrombótico, regularmente medicados com AAS e acompanhados com a curva de agregação plaquetária (CAP). Foram selecionados 195 pacientes com AVCi prévio. De acordo com a CAP considerou-se hipoagregação plaquetária quando a reação com ADP e adrenalina estava inferior a 70%. Foram comparados grupos de doentes hipoagregados com doses 100, 200 ou 300 mg/dia de AAS. Dessa forma, determinaram-se grupos, para análise estatí­stica, de pacientes hipoagregados do tipo hipertensos sem diabetes e normotensos sem diabetes e grupos de pacientes hipoagregados com diabetes e sem diabetes. Resultados: Dos 195 pacientes selecionados, 165 estavam hipoagregados segundo a curva de agregação plaquetária, sendo 86 hipertensos sem diabetes e 34 normotensos sem diabetes. Entre os hipertensos sem diabetes, 14 hipoagregaram com dose de 100 mg/dia, 48 com 200 mg/dia e 24 com 300 mg/dia de AAS. Já entre os normotensos sem diabetes 6, 18 e 10 pacientes hipoagregaram, respectivamente com estas doses. No grupo de pacientes com diabetes, 45 estavam hipoagregados, sendo 11 com dose 100 mg/dia, 25 com 200 mg/dia e 9 com 300 mg/dia. Já no grupo restante, dos 120 pacientes sem diabetes, 20, 66 e 34 hipoagregaram, respectivamente para estas doses. Conclusão: Em relação í  hipertensão não foi constatada influência da dose para a eficácia da antiagregação (p = 0,95). Entre os pacientes com diabetes a casuí­stica mostra tendência de menor hipoagregação com o AAS. É importante ressaltar que a amostragem de pacientes com diabetes foi pequena, sendo necessário mais estudos para ratificar este resultado.Descritores: Hipertensão, Diabetes, Agregação plaquetária, Acidente vascular cerebral, ícido acetilsalicí­lico

ABSTRACT CONTEXT AND OBJECTIVE: Multiple sclerosis (MS) is a chronic, immune-mediated and degenerative central nervous system (CNS) disease with well-established diagnostic criteria. Treatment can modify the course of the disease. The objective of this study was to describe the initial symptoms of multiple sclerosis in a Brazilian medical center. DESIGN AND SETTING: Descriptive study, conducted in a Brazilian reference center for multiple sclerosis treatment. METHODS: Data on 299 patients with confirmed diagnoses of MS were included in the study. Their medical files were evaluated and the data were analyzed. RESULTS: The most common symptom involved the cranial nerves (50.83%) and unifocal manifestation was presented by the majority of this population (73.91%). The mean time between the first symptom and the diagnosis was 2.84 years. Unifocal symptoms correlated with longer time taken to establish the diagnosis, with an average of 3.20 years, while for multifocal symptoms the average time taken for the diagnosis was 1.85 years. Unifocal onset was related to greater diagnostic difficulty. CONCLUSIONS: MS is a heterogeneous disease and its initial clinical manifestation is very variable.

Introdução: Estamos rodeados por bactérias e parasitas que podem ou não ser patogênicas; conseqüentemente o contágio de doenças infecciosas via indireta pelas mãos é de extrema importância, especialmente em locais públicos e de aglomeração humana como o transporte coletivo. O objetivo do presente trabalho foi analisar o potencial infeccioso do transporte público da cidade de São Paulo, através da identificação de microrganismos e parasitas isolados em ônibus da cidade Metodologia: Realizou-se, no perí­odo de janeiro a julho de 2006, a coleta com "swab" de 120 amostras provenientes de 40 ônibus. Após a identificação dos agentes bacterianos, aplicou-se o teste de sensibilidade em disco difusão Kirby Bauer. Na pesquisa parasitológica utilizou-se fita adesiva transparente (tipo "durex"), passando a face colante da fita sobre as superfí­cies a serem examinadas em microscópio óptico com aumentos de 100 e 400 vezes. Resultados: Todas as amostras foram positivas na investigação microbiológica, com crescimento de um ou mais microrganismos de origem comunitária. Os 5 microrganismos mais freqüentes foram: Micrococcus sp., Burkholderia mallei, Bacillus subtilis, Acinetobacter baumanii, Staphylococcus coagulase negativo. Na pesquisa parasitológica 5 foram positivas( 3 com cisto de Entamoeba, uma com ovo de nematódeo e outra com cisto de protozoário não identificado.Discussão: Superfí­cies ou objetos podem albergar microrganismos e parasitas com condição de sobrevivência nesses locais e de possí­vel transmissão para seres humanos. Em todos os balaustres de ônibus pesquisados foram evidenciados microrganismos e/ou parasitas, potencialmente patogênicos para a população. Torna-se necessária limpeza mais eficaz dos transportes públicos, bem como informar os usuários sobre a importância da lavagem de mãos como medidas de promoção í  saúde pública. Descritores: Transportes, Contaminação, Microbiologia, Bactérias, Parasitos

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). These patients suffer from various comorbidities, including sexual dysfunction (SD). The lesions of MS may affect regions of the CNS along the pathway of sexual response. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a scale that assesses sexual dysfunction. Adapt and validate the MSISQ-19 to Brazilian patients with MS. 204 individuals were evaluated, 134 patients with MS and 70 healthy persons for the control group. It was determined reproducibility, validity, internal consistency and sensitivity of the MSISQ-19-BR. Among patients with MS, 54.3% of male and 71.7% of female presented some kind of SD. In the control group the results were 12.5% and 19.5%, respectively. The MSISQ-19-BR is reproducible, reliable and valid for the Brazilian population and may be used as a tool for assessing the impact of sexual dysfunction in patients with MS.

ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.

Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.