An African-American male presented with bilateral visual impairment, gait difficulties, and bladder and bowel incontinence raising concerns for multiple sclerosis (MS) or neuromyelitis optica (NMO). He was identified to be HIV-1 infected with high viral load and low CD4+ counts. Magnetic resonance imaging (MRI) of the brain was abnormal, but atypical for MS. MRI of the cervical and thoracic spinal cord showed multiple areas of myelitis with a longitudinally extensive thoracic transverse myelitis that showed enhancement with gadolinium suggestive of NMO. Cerebrospinal fluid showed oligoclonal IgG bands but did not show reactivity to aquaporin 4. Patient underwent treatment for the acute exacerbation with intravenous corticosteroids and treatment of the HIV infection with highly active antiretroviral therapy (HAART). A year later, his viral load was <20 copies/ml and CD4+ counts were normal. Vision did not significantly improve, but his ambulation improved from a near total non-ambulatory state to ambulating without aids and resolution of the bladder and bowel incontinence. A demyelinating disorder of the central nervous system (CNS) like MS or NMO has been previously reported in the context of HIV infection. The remarkable improvement of symptoms has also been previously reported with HAART, and these observations have led to clinical trials of MS with HAART therapy in the absence of HIV infection. We reviewed the few cases of CNS demyelinating disorders with HIV infection reported in the literature and speculate on the mechanisms of pathogenesis.
<p>La Esclerosis Múltiple (EM) es una enfermedad neurodesmielinizante de origen inmunológico que afecta a personas entre los 16 a los 35 años de edad y en la cual del 36% al 82% de los pacientes manifiestan dolor como síntoma común. La EM tiene una prevalencia mundial de 4,41 por cada 100.000 habitantes, afectando alrededor de 2,5 millones de personas en todo el mundo y cerca de 400.000 en Estados Unidos; en Colombia es de 4,3 por cada 100.000 habitantes, presentándose la mayoría de los casos en Risaralda seguido por Bogotá. Los síndromes de dolor neuropático de tipo central se presentan por lesión o disfunción del sistema nervioso central, causando discapacidad y deterioro de la calidad de vida de los pacientes. En este artículo se hace una revisión sobre la efectividad analgésica y efectos secundarios de los canabinoides en el tratamiento de dolor neuropático de tipo central en pacientes con EM. Se realizó una estrategia de búsqueda identificando ensayos clínicos aleatorizados sobre tratamientos de dolor neuropático de tipo central en EM con canabinoides y se seleccionaron seis estudios que compararon canabinoides vs placebo. Basados en los artículos revisados se puede concluir, que hay una disminución significativa del dolor neuropático de tipo central en pacientes que padecen EM con la administración de canabinoides y los efectos secundarios son leves, siendo los más frecuentes vértigo, xerostomía, somnolencia y alteraciones en el equilibrio los cuales no alteran la calidad de vida del paciente.</p>
The administration of colestipol HCl for 15 days was sufficient to reduce plasma teriflunomide concentrations by greater than 96%. Although colestipol HCl did not completely eliminate teriflunomide with the same effectiveness as cholestyramine, it may offer an alternative method for accelerated elimination of teriflunomide with potentially improved tolerability and more favorable dosing and administration options.
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