Background Adherence to disease-modifying therapies is determinant to attain maximal clinical benefit in multiple sclerosis (MS). RebiSmart® is an electronic auto-injector for subcutaneous delivery of interferon β-1a (INF-β1a) that monitors adherence by featuring a log of each drug administration for objective evaluation. The aim of this study was to assess long-term adherence to INF-β1a by using the RebiSmart® device in Mexican patients with relapsing MS. Methods This is an observational multicenter study on patients with relapsing MS treated with INF-β1a subcutaneously delivered by the RebiSmart® device. Adherence was computed as the number of injections received during the study period divided by the number of injections scheduled and expressed as percent. Results A total of 66 patients from 6 specialized MS centers were evaluated (45 females and 21 males, mean age 43.91±13.32 years). Mean adherence was 79.51±18% (median: 85.54%, range: 34.4-100%). During a median follow-up of 27.5 months (mean 33.36±29.39 months) the annualized relapse rate had a mean of 0.50±1.63. Mean initial EDSS was 1.90±1.52, and mean EDSS at the end of follow-up was 1.80±1.74. Compared with their counterparts, the mean number of relapses was significantly lower among patients with high (>80%) adherence (0.25±0.44 vs 0.67±92 relapses, respectively; P = 0.03). The proportion of relapse-free patients was 75.0% among patients with high adherence and 53.3% in low-PLOS ONE
Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.
Multiple sclerosis (MS) is the leading cause of neurological disability among young adults. The disease-modifying treatments (DMTs) have been a breakthrough in the care of this patients, becoming a treatable disease. Today, we face a broad spectrum of treatment possibilities, which should be used rationally to provide the maximum benefit for the patients. In the context of the introduction of ocrelizumab as a treatment option in the Mexican MS DMT portfolio, a group of neurologists was convened to analyze the potential transition among DMT from their experience, through a desk research and expert opinion. As a result, here we describe the different considerations suggested for switching from different DMT to ocrelizumab that includes profiling studies, washout periods, and follow-up considerations. We concluded that the switch from other DMT previously used to ocrelizumab could be convenient and safe, as long as there is an adequate selection and profiling of the patients.
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Background: Cervical dystonia (CD) is the most common form of focal dystonia, in which application of botulinum neurotoxin type A (BoNT-A) is the first-line treatment. However, information related to its long-term effectiveness is sparse. The aim of this study was to evaluate satisfaction and clinical response in patients with CD. Methods: An international, observational, multicenter, and prospective study was conducted (INTEREST IN CD2) to evaluate the course of patients treated with BoNT-A over 3 years, with intermediate assessments at each injection visit. This is a sub-analysis that considers information from Latin American countries (Mexico and Brazil). Data from patients with CD were collected in an electronic case report form. The main outcomes were satisfaction at the time of the visit, before BoNT-A injection, regarding the control of the symptoms assessed with a Likert scale and the CD features evaluated by Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Descriptive statistics were performed considering the significance of 95%. Results: Data from 79 patients were analyzed; 84.8% received abobotulinumtoxin A with a mean dose of 599.7 ± 238.05 U; 7.93 ± 3.01 treatment cycles in 7.45 ± 4.25 muscles; and an average BoNT-A application of 120.3 ± 25.5 days. At baseline, 37.2% of patients stated that they were completely satisfied; meanwhile, at the end of the follow-up, the figure was 70.3%, suggesting an improvement on the rate of today's satisfaction of 88.9%. The total baseline TWSTRS score was 40.2 ± 14.1, while at 3 years it was 23.2 ± 11.5, a tendency to decrease this score was observed registering a greater reduction, from −17.0, after 36 months. Conclusion: Results of this study suggest an improvement in the proportion of satisfied patients with CD treated with BoNT-A during a 36-month follow-up.
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