Protocolo diagnóstico y terapéutico del brote de esclerosis múltiple

  1. Delgado, F. Romero
  2. Margarit, B. Povedano
  3. Monteiro, G. Carvalho
  4. Izquierdo, A. Yusta
Zeitschrift:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Datum der Publikation: 2019

Titel der Ausgabe: Enfermedades del sistema nervioso (IX)Enfermedades desmielinizantes del sistema nervioso central

Serie: 12

Nummer: 78

Seiten: 4630-4633

Art: Artikel

DOI: 10.1016/J.MED.2019.05.014 DIALNET GOOGLE SCHOLAR

Andere Publikationen in: Medicine: Programa de Formación Médica Continuada Acreditado

Zusammenfassung

Resumen La mayoría de las enfermedades desmielinizantes cursan con brotes y períodos de remisión. El diagnóstico del brote es clínico, entendiendo como tal la aparición de nuevos síntomas neurológicos o el empeoramiento de los existentes durante un período de tiempo superior a 24 horas, en ausencia de fiebre u otra condición que pudiera ocasionar un empeoramiento transitorio. Si estos producen discapacidad, deben ser tratados para acortar los tiempos de recuperación y mejorar la calidad de vida del paciente. El tratamiento habitualmente se realiza mediante bolos de megadosis de metilprednisolona; si no se obtiene respuesta, el tratamiento con plasmaféresis ha demostrado eficacia. Most demyelinating diseases progress with flare-ups and periods of remission. The diagnosis of a flare-up is clinical and is defined as the onset of new neurological symptoms or the worsening of existing symptoms for a period greater than 24h, in the absence of fever or other condition that could cause temporary worsening. If these flare-ups cause disability, they should be treated to shorten the recovery time and improve the patient's quality of life. The treatment is typically performed with a bolus megadose of methylprednisolone; if there is no response, treatment with plasmapheresis may be considered as it has been shown effective.

Bibliographische Referenzen

  • Abboud H, Petrak A, Mealy M, Sasidharan S, Siddique L, Levy M. Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. Mult Scler. 2016;22(2):185-92.
  • Alam SM, Kyriakides T, Lawden M, Newman PK. Methylprednisolone in multiple sclerosis: a comparison of oral with intravenous therapy at equivalent high dose. J Neurol Neurosurg Psychiatry. 1993;56(11):1219-20.
  • Andrés C. Interés de los brotes en la esclerosis múltiple. Fisiopatología y tratamiento. Rev Neurol. 2003;36(11):1058-64.
  • Berkovich RR. Acute multiple sclerosis relapse. Contin Lifelong Learn Neurol [Internet]. 2016;22(3):799-814.
  • Burton JM, O’Connor PW, Hohol M, Beyene J. Oral versus Intra-venous Steroids for Treatment of Relapses in Multiple Sclerosis. En: Burton JM, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2009. p. CD006921.
  • Citterio A, La Mantia L, Ciucci G, Candelise L, Brusaferri F, Midgard R. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev. 2000;(4):CD001331.
  • Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology [Internet]. 2011;76(3):294-300.
  • De Andres C, García MI, Goicoechea H, Martínez-Ginés ML, García-Domínguez JM, Martín ML. Genes differentially expressed by methylprednisolone in vivo in CD4 T lymphocytes from multiple sclerosis patients: potential biomarkers. Pharmacogenomics J. 2018;18(1):98-105.
  • Kalincik T. Multiple sclerosis relapses: epidemiology, outcomes and management. A systematic review. Neuroepidemiology. 2015;44(4):199-214.
  • Le Page E, Veillard D, Laplaud DA, Hamonic S, Wardi R, Lebrun C. Oral versus intravenous high dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (CO-POUSEP): A randomised, controlled, double-blind, noninferiority trial. Lancet. 2015;386(9997):974-81.
  • Llufriu S, Castillo J, Blanco Y, Ramió-Torrentà L, Río J, Vallès M¡. Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months. Neurology¡. 2009;73(12):949-53.
  • Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sorensen PS, Thompson AJ¡. Defining the clinical course of multiple sclero-sis: The 2013 revisions. Neurology¡. 2014;83(3):278-86.
  • Martinelli V, Rocca MA, Annovazzi P, Pulizzi A, Rodegher M, Boneschi FM¡. A short term randomized MRI study of high dose oral vs intravenous methylprednisolone in MS. Neurology. 2009;73(22):1842-8.
  • Meca-Lallana JE, Hernández-Clares R, León-Hernández A, Genovés Aleixandre A, Cacho Pérez M, Martín-Fernández JJ. Plasma exchange for steroid refractory relapses in multiple sclerosis: an observational, mri pilot study. Clin Ther [Internet]. 2013;35(4):474-85.
  • Meca-Lallana JE, Rodríguez-Hilario H, Martínez-Vidal S, Saura-Luján I, Genovés-Aleixandre A, Mateo-Bosch E. Plasmaféresis: su utilidad en la esclerosis múltipley otros procesos desmielinizantes del sistemanervioso central. Estudio observacional. Rev Neurol. 2003;37(10):917-26.
  • Miller DM, Weinstock-Guttman B, Béthoux F, Lee J-C, Beck G, Block V. A meta-analysis of methylprednisolone in recovery from multiple sclerosis exacerbations. Mult Scler [Internet]. 2000;6(4):267-73.
  • Myhr KM, Mellgren SI. Corticosteroids in the treatment of multiple sclerosis. Acta Neurol Scand [Internet]. 2009;120Supl189:73-80.
  • Sand IK. Neuromyelitis optica spectrum disorders. Contin Lifelong Learn Neurol [Internet]. 2016;22:864-96.
  • Sorensen PS, Midgard R, Barnes D, Selmaj K, Visser LH, Sellebjerg F. EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. Eur J Neurol. 2005;12(12):939-46.
  • Zivadinov R, Rudick RA, De Masi R, Nasuelli D, Ukmar M, Pozzi-Mucelli RS. Effects of IV methylprednisolone on brain atrophy in relapsing remitting MS. Neurology. 2001;57(7):1239-47.
Fuente de los datos: Dialnet