The emergence of novel Coronavirus 2019 and the subsequent pandemic are presenting a challenge to neurologists managing patients with multiple sclerosis (MS). The clinical management has dramatically altered and it was necessary to change and/or adapt it to the new situation. Regarding relapses management, the use of intravenous corticosteroids and hospitalization during MS relapses increase the risk of viral exposure. Objective: To review the efficacy and safety of high dose oral corticosteroids in acute relapses treatment compared to intravenous corticosteroids. Methods: Descriptive review of the utility of high dose oral corticosteroids for MS relapses treatment was performed. We searched the literature available on PubMed and Scientific Electronic Library Online (Scielo). We focused on different trials comparing the use of high dose intravenous vs oral corticosteroids. Results: Five studies were selected. One hundred and eighty two patients receiving treatment with high dose oral corticosteroids were included. The most frequent schedule was oral methylprednisolone 1000 mg (over three days). There were no significant differences between both routes of corticosteroids administration. Conclusion: Neurologists should be aware of the current evidence on the similar efficacy of both oral and intravenous corticosteroids for MS relapses. Using oral steroids during the pandemic would be a safe option for patients.
Introducción y objetivo: El síndrome pseudobulbar se define por episodios involuntarios o exagerados de risa o llanto, posteriores a una enfermedad específica. El síndrome pseudobulbar después del accidente cerebrovascular se reporta entre el 11%-34% de los pacientes. En nuestra población está subdiagnosticado. Determinamos su frecuencia en un grupo de pacientes post-ACV. Pacientes y métodos: Estudio observacional prospectivo desde junio/2017 a junio/2018. Se evaluaron dos poblaciones: ACV crónico (Grupo A) y ACV agudo (Grupo B). Se excluyeron pacientes con enfermedad psiquiátrica grave, deterioro cognitivo y/o afasia. Se realizaron las escalas PLACS (“pathological laughing and crying scale”) y CNS-LS (“Center for Neurologic Study-Lability Scale”). El síndromepseudobulbar se definió por criterios diagnósticos más ambas escalas positivas. Resultados: Cincuenta pacientes fueron evaluados. El 68% eran hombres. Edad media: 65±12 años. Grupo A: 19 casos y grupo B: 31 casos. PLACS positiva: 21% grupo A y 29% grupo B. CNS-LS positiva: 58% grupo A y 26% grupo B. Ambas escalas positivas en 8 pacientes (2 en crónico y 6 en agudo). Tres de ellos tenían depresión asociada. Conclusiones: El síndrome pseudobulbar debe examinarse cuidadosamente luego del ACV. La depresión post-ACV debe diferenciarse de la labilidad emocional por síndrome pseudobulbar. La administración de una sola escala no seríasuficiente para la orientación diagnóstica.
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