Papers by Dagoberto Callegaro
Natalizumab treatment for multiple sclerosis: updates and considerations for safer treatment in JCV positive patients
Arquivos de Neuro-Psiquiatria, 2014
Natalizumab is currently one of the best options for treatment of patients with Multiple Sclerosi... more Natalizumab is currently one of the best options for treatment of patients with Multiple Sclerosis who have failed traditional prior therapies. However, prolonged use, prior immunosuppressive therapy and anti-JCV antibody status have been associated with increased risk of developing progressive multifocal leukoencephalopathy (PML). The evaluation of these conditions has been used to estimate risks of PML in these patients, and distinct (sometimes extreme) approaches are used to avoid the PML onset. At this time, the biggest issue facing the use of Natalizumab is how to get a balance between the risks and the benefits of the treatment. Hence, strategies for monitor JCV-positive patients undergoing Natalizumab treatment are deeply necessary. To illustrate it, we monitored JCV/DNA in blood and urine of a patient receiving Natalizumab for 12 months. We also bring to discussion the effectiveness of the current methods used for risk evaluation, and the real implications of viral reactivation.
Visual Neuroscience, 2008
We assessed chromatic discrimination in multiple sclerosis~MS! patients both with~ON! and without... more We assessed chromatic discrimination in multiple sclerosis~MS! patients both with~ON! and without~no ON! a history of optic neuritis using the Cambridge color test~CCT!. Our goal was to determine the magnitude and chromatic axes of any color vision losses in both patient groups, and to evaluate age-related changes in chromatic discrimination in both patient groups compared to normals. Using the CCT, we measured chromatic discrimination along the protan, deutan and tritan axes in 35 patients with MS~17 ON eyes! and 74 age matched controls. Color thresholds for both patient groups were significantly higher than controls' along the protan and tritan axes~p Ͻ 0.001!. In addition, the ON and no-ON groups differed significantly along all three-color axes~p Ͻ 0.001!. MS patients presented a progressive color discrimination impairment with age~along the deutan and tritan axes! that was almost two times faster than controls, even in the absence of ON. These findings suggest that demyelinating diseases reduce sensitivity to color vision in both red-green and blue-yellow axes, implying impairment in both parvocellular and koniocellular visual pathways. The CCT is a useful tool to help characterize vision losses in MS, and the relationship between these losses and degree of optic nerve involvement.
Journal of The Neurological Sciences - J NEUROL SCI, 1997
Pediatric Neurology, 1992
We report the clinical, genetic, biochemical, and radiographic findings of a progressive disorder... more We report the clinical, genetic, biochemical, and radiographic findings of a progressive disorder affecting three brothers, ages PEDIATRIC NEUROLOGY Vol. 8 No. 5 375
Pediatric multiple sclerosis: Evaluation of laboratory, neuroimaging, and neurophysiologic procedures: Report of 14 cases
Pediatric Neurology, 1992
Neurology, 2014
Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disord... more Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disorders (NMOSD) who have myelin oligodendrocyte glycoprotein (MOG) antibodies, aquaporin-4 (AQP4) antibodies, or seronegativity for both antibodies.
Prevalence of Multiple Sclerosis in the City of São Paulo, Brazil, in 1990
Neuroepidemiology, 1992
A case register of multiple sclerosis (MS) was set up in the city of São Paulo, Brazil, situated ... more A case register of multiple sclerosis (MS) was set up in the city of São Paulo, Brazil, situated at a latitude of 23-24 degrees south. Cases were notified by neurologists, neuroradiologists and by an association of patients with MS. Prevalence rate was 4.27 x 10(-5) (men: 2.89 x 10(-5); women: 5.59 x 10(-5)), with a preponderance of young adults. We discuss here whether these rates are artifact due to poor health care facilities, to poor notification and deficiencies in diagnosis, or whether these rates are really low.
Multiple Sclerosis Journal, 2014
Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spina... more Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spinal cord tumors. Both patients were later diagnosed with neuromyelitis optica spectrum disorders (NMOSD) supported by their AQP4seropositivity. Pathological review of both biopsies revealed demyelinated lesions with thickened vessel walls and tissue rarefaction. Immunohistochemical staining demonstrated findings compatible with acute NMOSD lesions in one case while the other case exhibited findings consistent with chronic NMOSD lesions. A pre-biopsy differential diagnosis of longitudinally extensive spinal cord tumors should include NMOSD. Specific biopsy features, such as cystic changes with vascular wall thickening and astrocyte injury, should raise suspicion for NMOSD.
Recurrent neuromyelitis optica in Brazilian patients: clinical, immunological, and neuroimaging characteristics
Multiple Sclerosis Journal, 2010
Neuromyelitis optica has not been thoroughly studied in Brazilian patients following the discover... more Neuromyelitis optica has not been thoroughly studied in Brazilian patients following the discovery of NMO-IgG and its specific antigen aquaporin-4. In this study we aimed to describe the clinical NMO-IgG immunological status and neuroimaging characteristics of recurrent neuromyelitis optica in a series Brazilian patients. We undertook a retrospective study of 28 patients with recurrent neuromyelitis optica, according to 1999 Wingerchuk's diagnostic criteria. Data on NMO-IgG status, clinical features, and MRI findings were analyzed. Three men and 25 women were evaluated. Median age at onset of disease was 26 years (range 7-55); median time of follow-up was 7 years (range 2-14). The mean time elapsed between the first and the second attack was 17 months (median 8.5; range 2-88). NMO-IgG was detected in 18 patients (64.3%). Four patients died due to respiratory failure. Most patients presented with cervical (36%) and cervical-thoracic myelitis (46.4%). Holocord lesion was the most common pattern of involvement (50%) on the axial plane. We did not find a statistical association between myelitis extension and NMO-IgG result. Our series of Brazilian patients showed a younger age of onset than previously reported. In our series, in contrast to previous reports, there was no correlation between the extension of myelitis and NMO-IgG positivity.
The Journal of Urology, 2011
regression analysis showed that gait (Rϭ2.931, Pϭ0.007) is only signs correlated with OABSS in wo... more regression analysis showed that gait (Rϭ2.931, Pϭ0.007) is only signs correlated with OABSS in women and finger taps (Rϭ1.961, Pϭ0.020) and ED (Rϭ1.283, Pϭ0.028) are correlated with OABSS in men.
Journal of the Neurological Sciences, 1997
Neuropsychological dysfunction had not been considered a major cause of impairment in Multiple Sc... more Neuropsychological dysfunction had not been considered a major cause of impairment in Multiple Sclerosis (MS) until a battery of validated, standardised cognitive studies demonstrated that cognitive deficits were more common than it was believed.
Journal of the Neurological Sciences, 1997
162 The association of two rare neurological diseases: a multicentre study of 16 patients with AChR antibody myasthenia gravis and AQP4 antibody neuromyelitis optica spectrum disorder
Journal of Neurology, Neurosurgery & Psychiatry, 2012
Brain and Development, 1995
We present clinical data from 14 mutiple sclerosis (MS) patients who have been admitted to our ho... more We present clinical data from 14 mutiple sclerosis (MS) patients who have been admitted to our hospital between January 1980 and May 1992, whose age of onset ranged from 2-15 years. Our patients could be classified as having a clinically definite form of the disease. Initial symptoms varied from minor, such as motor or sensory impairment, bladder dysfunction, to the worst clinical presentation, suggesting diffuse encephalopathy. All the patients had a relapsing-remitting course. We report the paraclinical and laboratory examinations that were done in these patients. Over the period 1980 to 1992 these patients had 39 attacks. CSF analysis was performed in the phase of activity of the disease on 23 occasions and was normal in 12. At least one brain CT scan was performed in 9 patients and showed white matter abnormalities in 6. Cranial magnetic resonance imaging was done in 6 patients and were abnormal in 5. Visual evoked potential (EP) was abnormal in 7 of 8 patients; brainstem acoustic EP was abnormal in 4 of 8 patients and somatosensory EP in 4 of 8. MS is not so rare in childhood and although its diagnosis is essentially a clinical one, paraclinical investigations are of great value in the identification of demyelinating disorders in childhood.
Study of oligoclonal bands restricted to the cerebrospinal fluid in multiple sclerosis patients in the city of São Paulo
Arquivos de Neuro-Psiquiatria, 2009
The frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid (CSF) from patient... more The frequency of oligoclonal bands (OCB) restricted to the cerebrospinal fluid (CSF) from patients with multiple sclerosis (MS) varies widely in different populations. The objective of this study was to determine the frequency of these OCB in a group of MS patients in the city of São Paulo. Techniques used to detect OCB consisted of isoelectric focusing followed by immunoblotting. Oligoclonal bands were found in 49 (54.4%) out of 90 patients with clinically definite MS; in (31.2%) of the 16 patients with clinically isolated syndrome; in 7 (17.9%) of 39 patients with inflammatory disorders of the central nervous system (IDCNS), and in none of the individuals with no neurological condition (control group). The specificity of the method was 100% when compared to the control group and 82.1% when compared to the IDCNS group. These results suggest that the frequency of CSF OCB is much lower in Brazilian MS patients from São Paulo city than that reported in MS series from Caucasian populations.
Arquivos de Neuro-Psiquiatria, 2000
Objectives: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in... more Objectives: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in Brazil in 1998. Method: Structured Clinical Report Forms (CRFs) sent to 2,505 Brazilian neurologists from January to September 1998 to be filled with demographic and clinical data regarding any ALS patient seen at any time during that year. Results: Five hundred and forty CRFs were returned by 168 neurologists. Data on 443 patients meeting the criteria of probable or definite ALS according to El Escorial definition were analysed: 63 probable (14.2%) and 380 definite (85.8%). Two hundred and fifty-nine (58.5%) of the patients were male, mean age of onset was 52. Spinal onset occurred in 306 patients (69%); bulbar onset in 82 (18.5%), and both in 52 (11.7%). Twenty-six (5.9%) had a family history of ALS. Two hundred and fifty-nine (58.6%) were seen by private practitioners, and 178 (40.2%) at a hospital clinic. Age-ajusted incidence shows a peak incidence at the 65-74 years old range. Conclusions: The disease's characteristics are similar to those described in international studies, except for age of onset (Brazilian patients are younger). This difference is not confirmed when figures are age-adjusted.
Arquivos de Neuro-Psiquiatria, 2002
The association between multiple (MS) sclerosis and cerebral gliomas has been sporadically report... more The association between multiple (MS) sclerosis and cerebral gliomas has been sporadically reported in the literature, causing a long lasting discussion if these lesions occur coincidentally or if MS plaques may actually lead to the genesis of gliomas. We report a 36 year old man who developed a rapid onset of right side weakness and loss of vision, having established a diagnosis of MS which was confirmed by CSF analysis and MRI. Nine years later he developed progressive tetraparesis, leading initially to suspicion of illness relapse and a demyelinating plaque in the spinal cord. However, after MRI investigation, a spinal cord tumor was diagnosed. The patient underwent cervical spine laminotomy for microsurgical removal of the spinal cord tumor diagnosed as ependimoma. The neurological deficits improved significantly.
Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: I. As evidências para o uso de imunossupressores, plasmaférese e transplante autólogo de células tronco
Arquivos de Neuro-Psiquiatria, 2002
There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few yea... more There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.
Arquivos de Neuro-Psiquiatria, 2008
Objective: To determine the seroprevalence of neuromyelitis optica antibody (NMO)-IgG in Brazilia... more Objective: To determine the seroprevalence of neuromyelitis optica antibody (NMO)-IgG in Brazilian patients with clinical diagnosis of relapsing neuromyelitis optica, also known as Devic's disease. Method: We determined NMO-IgG titers in 28 patients (25 of them females) that fulfilled the 1999 NMO diagnostic criteria proposed by Wingerchuk et al. Results: NMO-IgG was detected in 18 NMO patients (64.3%). Conclusion: Our results showed that seroprevalence of NMO-IgG in Brazilian NMO patients was similar to the observed in other studies. KEY WORDS: neuromyelitis optica, Devic's disease, NMO-IgG, seroprevalence. Soroprevalência do anticorpo NMO-IgG em pacientes brasileiros com neuromielite óptica Resumo -Objetivo: Determinar a soroprevalência do anticorpo neuromielite óptica (NMO)-IgG em pacientes brasileiros com diagnóstico de neuromielite óptica recorrente, também conhecida como doença de Devic. Método: Nós pesquisamos a presença do anticorpo NMO-IgG em 28 pacientes (25 do sexo feminino) que preenchiam os critérios diagnósticos para NMO propostos por Wingerchuk et al. em 1999. Resultados: Dezoito pacientes (64,3%) apresentaram a pesquisa positiva do NMO-IgG. Conclusão: Nossos resultados demonstraram que a soroprevalência do anticorpo NMO-IgG em pacientes brasileiros com NMO é semelhante àquela encontrada em outros estudos. PALAVRAS-CHAVE: neuromielite óptica, doença de Devic, NMO-IgG, soroprevalência.
Arquivos de Neuro-Psiquiatria, 1999
Five patients with a tumefactive lesion were clinically followed from 1992 to 1993. Four patients... more Five patients with a tumefactive lesion were clinically followed from 1992 to 1993. Four patients were female; age ranged from 32 to 57 years, the duration of symptoms varied from 3 days to 3 years. Neurological examination disclosed dementia in two patients, aphasia in three, hemiparesis in four, hemihypoaesthesia in three, optical neuritis in two, tetraparesis with sensitive level and neurogenic bladder in one. MRI disclosed lesions with a hypersignal on images assessed at T2 and hyposignal at T1, and gadolinium heterogeneous enhancement; these lesions were located in the: a) temporooccipital region bilaterally and brain stem, b) frontoparietal white matter , c) basal ganglia, bilateral white matter and brain stem, d) left parietal region, e) cervical spinal cord, with enlargement of this region. Cerebral biopsy was performed in three patients; acute and subacute demyelinating disease was diagnosed by histological examination. Two patients had an evolutive diagnosis; exclusion of other pathologies and clinical and radiological improvement after corticotherapy, pointed to an inflammatory disease.
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Papers by Dagoberto Callegaro