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Biomedical subjects

J Río

Publications and source records attributed to J Río.

At least 19 recordsLinked to original sources
PubMed2000

[Neutralizing antibodies in patients with multiple sclerosis treated with interferon beta-1b].

BACKGROUND: Neutralising antibodies (NABs) against interferon beta have been described in one third of patients with multiple sclerosis treated with interferon beta. We have analysed the frequency of NABs and their clinical consequences. PATIENTS AND METHODS: We have studied 68 patients. NABs were determined by protein A Myxovirus assay. RESULTS: Positive NABs were detected in 13% of the patients after 2 years of treatment. CONCLUSIONS: It does not seem to exist a relationship between presence of NABs and a poor evolution of the disease in our patients with multiple sclerosis treated with beta interferon.

Adjuvants, Immunologic↗
PubMed2000

Proton magnetic resonance spectroscopy in primary and secondary progressive multiple sclerosis.

The objective of this study was to characterize and compare the proton magnetic resonance spectrum of a voxel, containing lesions or normal-appearing white matter (NAWM), in primary-progressive (PP) and secondary-progressive (SP) multiple sclerosis (MS) patients. Single-voxel proton magnetic resonance spectroscopy and magnetic resonance imaging were performed in 35 MS patients (17 PP and 18 SP) and 17 controls. Spectra from an 8 ml voxel located in the parieto-occipital region were obtained with a spin-echo pulse sequence (1600 ms/135 ms/256, TR/TE/acquisitions). Resonance areas due to N-acetylaspartate (NAA), creatine/phosphocreatine (Cr) and choline compounds (Cho) were determined, and results expressed in terms of area in arbitrary units or as metabolite ratios. With respect to the control group, there were significant reductions in NAA and NAA/Cho ratio in the PP-lesion, SP-lesion, PP-NAWM and SP-NAWM groups. There were no significant differences between the PP-NAWM and SP-NAWM groups. These results support the existence of metabolic changes in the white matter of PP and SP patients and suggest that there is neuronal damage and/or loss in both clinical courses. Finally, characterization of the parieto-occipital region showed no significant differences in the spectral pattern of NAWM between PP and SP clinical courses of MS.

Adult↗
PubMed1999

[Optic neuritis, brain stem syndromes and myelitis: rapid conversion to multiple sclerosis].

BACKGROUND: To establish the early risk of multiple sclerosis (MS) following isolated demyelinating syndromes. PATIENTS AND METHOD: 36 patients with optic neuritis, 24 with brainstem syndromes, 27 with spinal cord syndromes and 8 patients with a poliregional syndrome were included in a prospective protocol: including clinical data, immunological determinations, oligoclonal bands, visual, somestesic and brainstem evoked potentials and a magnetic resonance imaging (MRI) study. RESULTS: MRI showed the presence of signal abnormalities in 70% of the patients. The conversion rate (CR) was 18.5%. In patients with a normal MRI, CR was 4% compared to 26% in patients with an abnormal MRI (p = 0.05). CONCLUSIONS: The early conversion rate to MS is significantly increased when MRI is abnormal.

Adolescent↗
PubMed1999

Emotional state of patients with relapsing-remitting MS treated with interferon beta-1b.

BACKGROUND: Depression has been cited as a possible side effect of interferon beta-1b (IFNbeta-1b) therapy in patients with MS. This association remains unproven because of a lack of longitudinal studies. OBJECTIVE: To determine the changes in emotional state in relapsing-remitting (RR) MS patients during the first 2 years of treatment with IFNbeta-1b. METHODS: Emotional state was evaluated in a sample of 90 patients at the onset of IFNbeta-1b treatment during an inclusion period of 2.5 years. Seventy-five patients were evaluated at their 12th month of treatment and 56 patients at their 24th month. We assessed their emotional state with the following psychological tests: Hamilton Depression Rating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: We found significant improvement in emotional state after the first and second years of treatment. CONCLUSIONS: Our findings show that IFNbeta-1b does not increase depression or anxiety in RR MS patients during the first and second years of IFNbeta-1b treatment. In fact, slight but significant improvement in depression and anxiety symptoms was observed during this period.

Female↗
PubMed1999

Immunological profile of patients with primary progressive multiple sclerosis. Expression of adhesion molecules.

Adhesion molecules are important in the trafficking of peripheral leucocytes into the central nervous system, a major event in the pathogenesis of multiple sclerosis, which is an inflammatory and demyelinating disease. The latest MRI evidence supports clinical divergence between forms of multiple sclerosis with relapses and the primary progressive form without relapses, which shows fewer and smaller inflammatory lesions. With the aim of elucidating whether different pathogenic mechanisms are involved in primary progressive multiple sclerosis, we compared membrane expression of the adhesion molecules ICAM-1 (CD54), LFA-1alpha (CD11a), VLA-4 [alpha(4)/beta(1) integrin (CD49d/CD29)], L-selectin (CD62L) and ICAM-3 (CD50) in peripheral blood and the serum-soluble forms ICAM-1, L-selectin, VCAM-1 and ICAM-3 in 89 patients (39 with the primary progressive form, 25 with the secondary progressive form and 25 with the relapsing-remitting form) and 38 healthy controls. We found a significant decrease in leucocyte surface expression of most of the adhesion molecules tested and an increase in soluble ICAM-1 and L-selectin levels in secondary progressive and relapsing-remitting multiple sclerosis compared with primary progressive multiple sclerosis, which gave results similar to those in controls. These results, which are supported by MRI evidence, show that trafficking of autoreactive leucocytes through the blood-brain barrier is crucial to the pathogenesis of secondary progressive and relapsing-remitting forms of multiple sclerosis, whereas other mechanisms leading to progressive axonal damage would account for primary progressive forms of the disease.

Adult↗
PubMed1998

Amelioration of flulike symptoms at the onset of interferon beta-1b therapy in multiple sclerosis by low-dose oral steroids is related to a decrease in interleukin-6 induction.

Low-dose oral steroid use at the onset of interferon beta-1b (IFNbeta-1b) therapy in relapsing-remitting multiple sclerosis (RR-MS) patients reduces flulike symptoms. To determine the mechanism by which steroid treatment minimizes these side effects, we analyzed the percentage of interleukin-6 (IL-6)-, interferon-gamma (IFN-gamma)-, tumor necrosis factor alpha (TNF-alpha)-, and IL-10-producing cells before and after 3 months of IFNbeta-1b therapy onset. Our results support a relationship between IL-6 induction and fever. Such side effects can be ameliorated by steroids.

Acetaminophen↗
PubMed1998

Low-dose steroids reduce flu-like symptoms at the initiation of IFNbeta-1b in relapsing-remitting MS.

To determine whether low-dose prednisone reduces flu-like symptoms at the initiation of interferon beta 1-b (IFNbeta-1b), we studied 71 patients with clinically definite, relapsing-remitting multiple sclerosis who were started on IFNbeta-1b. Patients were randomized to receive prednisone plus paracetamol or only paracetamol and were monitored for side effects. Systemic side effects were minimal in the steroid group compared with the nonsteroid group during the first 15 days of treatment (p=0.005). At 3 months, both groups showed a similar frequency of flu-like symptoms. No differences in local reaction between the two groups were observed throughout the study.

Acetaminophen↗
PubMed1998

[Profile of efficacy and safety in the treatment of remittent-recurrent multiple sclerosis with interferon beta-1b].

BACKGROUND: Interferon beta 1b (IFN beta-1b) has showed a reduction of exacerbation rate and a decrease in multiple sclerosis activity as evidenced by MRI. After the approval of IFN beta-1b in our country more than 1,000 patients are under treatment, however the experience is limited. The purpose of this study is to describe the clinical results and the tolerance of IFN beta-1b during the postmarketing period in our country. MATERIAL AND METHODS: We studied 95 patients treated with IFN beta-1b. An exhaustive follow-up has been performed in order to assess the tolerance and the efficacy of the drug. We registered the haematological and biochemical abnormalities, secondary effects, relapses, clinical evolution and drop-outs. RESULTS: Mean age was 32.5 +/- 9 years, and the mean follow-up was 13.2 months. Seventy patients (74%) have been followed for more than one year. Haematological abnormalities are frequent, lymphopenia being the most common finding (37%). Flulike symptoms appear in 90% of the patients and skin reaction in the 70%. We have observed a drop-out rate of 7%. One patient developed depressive symptoms and the treatment was temporally discontinued. We have observed a significant decrease in relapses of the disease, however disability has not changed in the first year after treatment. CONCLUSIONS: IFN beta-1b has been well tolerated in the postmarketing period. The profile of secondary effects is similar, although not identical to that reported. The patient awareness of secondary effects and the realistic expectations of the drug are important in order to decrease the drop-out rate.

Adjuvants, Immunologic↗
PubMed1997

[The development of multiple sclerosis following an isolated episode of optic neuritis. Magnetic resonance study].

BACKGROUND: An important controversy on the development of multiple sclerosis (MS) after an isolated episode of optic neuritis (ON) exists. Magnetic resonance imaging (MRI) is the method of election in order to detect demyelinated lesions in MS. The current study was designed to determine the prevalence of brain abnormalities on MRI and to asses the further development of MS after an isolated idiopathic ON in our population. PATIENTS AND METHODS: From 1991 to 1995, 60 patients with decrease of visual acuity were studied, 35 (28 women, half age 31 +/- 10 years) completed criteria of idiopathic ON. A brain MRI was performed in all patients after the diagnosis of idiopathic ON and they subsequently were followed in the outpatient clinic from our center for a mean time of 29 +/- 16 months. 24 out of the 35 patients were treated with corticosteroids in different ways. RESULTS: It has been found 43% of the patients with idiopathic ON to have brain lesions by MRI. During the follow-up 14% of the patients developed a clinically definite MS; all of them had a pathological brain MRI at the basal evaluation (p = 0.009). None of the patients that were treated with high-dose of intravenously corticosteroids developed MS. CONCLUSIONS: The prevalence of silent cerebral lesions in the MRI after an idiopathic ON is elevated in our population although further development of MS is lower possibly due to the short follow-up carried out. The presence of lesions in the MRI confers a high risk for developing MS after an idiopathic ON.

Adolescent↗
PubMed1996

[Cerebral proton spectroscopy of people infected with the human immunodeficiency virus].

BACKGROUND: This article presents a combined magnetic resonance imaging and proton spectroscopy protocol (MRI/1H-MRS) applied to study the brain of human immunodeficiency virus (HIV) infected patients. The spectroscopic results were compared with clinical and radiological parameters. PATIENTS AND METHODS: The proton spectra of 57 HIV patients and 20 control subjects were obtained from a volume of interest of 8 cm3 located in the parietooccipital region of the brain that did not include any focal lesion. The resonance areas due to N-acetyl aspartate (NAA), creatine (Cr) and choline (Cho) were obtained. The MRI exam allowed us to determine the presence of focal or diffuse lesions and the degree of atrophy. Finally, the clinical exploration included the performance of a Mini-Mental test. The NAA/Cr, NAA/Cho and Cho/Cr ratios were correlated with clinical characteristics, the result of the Mini-Mental test, the presence of lesions and the degree of atrophy. RESULTS: There were altered spectral patterns in a volume of the brain that did not contain any focal lesion. The decrease in the NAA/Cr or NAA/Cho ratios was significative when considering the presence of atrophy, the existence of signs of cognitive deficiencies or the diagnosis of AIDS-dementia complex. CONCLUSIONS: The spectral changes found in the present study suggest the existence of neuronal lesions that would be due to the HIV-infection. A combined MRI/1H-MRS study may provide a more complete information about the neurological impairment by HIV and could constitute a marker of AIDS-dementia complex.

Adult↗
PubMed1996

[Interobserver variability in the evaluation of functional systems and Kurzke expanded disability status scale in a multiple sclerosis patient].

Changes in the progression of disability is still the main variable measured in clinical trials involving patients with multiple sclerosis (EM). The amplified scale of the state of disability (EEDA) of Kurtzke continues to be the most widely used scale. One of the most important limitations of the EEDA is interobserver variability. The object of our study was to find the interobserver variability between members of our EM unit in patients with EEDA between 0 and 3.5 when applying functional systems (SF) and EEDA. Seven patients with recurrent remittent EM (EEDA 0-3.5), participating in a multicentric trial with natural beta-interferon, were assessed monthly for 12 months by two of four neurologists. The SF were assessed and the EEDA applied separately and without knowing the former. 80 paired examinations were made. Complete concordance of SF was only seen when a variation of 2 points was allowed, while it was very high for a variation of 0 and 1 points. Complete concordance for EEDA was seen in 36.6% of the cases and only in 11% was there discordance of 1 or 1.5 points. The average variability of EDSS was 0.39. There was greater variability when the two scores were at different levels of incapacity.

Disability Evaluation↗
PubMed1995

Asterixis associated with anatomic cerebral lesions: a study of 45 cases.

INTRODUCTION: Asterixis is an uncommon sign in structural central nervous system disorders. When asterixis is present, one cannot rule out the possibility of a focal lesion, but it is almost always due to a metabolic encephalopathy. PATIENTS AND METHODS: In the last five years all patients with uni- or bilateral neurologic asterixis attended in our hospital have been studied. Cerebral computed tomogram or magnetic resonance imaging was performed in all patients with uni or bilateral asterixis. RESULTS: We describe 45 patients with different forms of structural cerebral pathology who presented unilateral (37 patients) or bilateral (8 patients) asterixis not associated to either toxic or metabolic disorder. Central nervous system ischemic or hemorrhagic disorders were found to be the most frequent causes of asterixis (95.5%) and the thalamus the most frequent localization for unilateral asterixis to result (54%). CONCLUSIONS: Bilateral asterixis is not always associated with toxic or metabolic disorders and it may be a sign of some structural neurologic alterations. A good correlation was found between the presence of unilateral asterixis and structural intracranial disease.

Adult↗