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Literatura académica sobre el tema "Paraparesie"

Autor: Grafiati
Publicado: 4 de junio de 2021
Última modificación: 5 de febrero de 2022

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Artículos de revistas sobre el tema "Paraparesie"

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Aljaafari, Danah y Noman Ishaque. "Paraparetic Variant of Guillain-Barré Syndrome in First 24 Hours of Postpartum Period: A case report". Sultan Qaboos University Medical Journal [SQUMJ] 20, n.º 2 (28 de junio de 2020): 227. http://dx.doi.org/10.18295/squmj.2020.20.02.015.

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Guillain-Barré syndrome (GBS) is a heterogeneous disorder with a diverse clinical presentation ranging from weakness of certain body regions to tetraparesis with autonomic dysfunction and respiratory failure. Paraparetic GBS is a variant of GBS which is characterised by weakness limited to the lower limbs only. It is crucial to identify such topographical presentations, as a delay in diagnosis can lead to delayed initiation of specific treatment, which can negatively impact the outcome. We report a 29-year-old female patient who presented to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, in 2017 with rapid onset asymmetrical weakness of lower extremities associated with bladder dysfunction during the immediate postpartum period. The weakness spared cranial nerves and arms and imaging studies of the spine was unremarkable. Cerebrospinal fluid investigations showed cyto-albuminologic dissociation and nerve conduction studies showed features of demyelination. The patient was diagnosed with a paraparetic variant of GBS and treated with intravenous immunoglobulin. She had almost recovered completely at the two–month follow-up.Keywords: Paraparesis; Guillain-Barré Syndrome; Demyelination; Postpartum Period; Case Report; Saudi Arabia.
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Marco Orsini, Marco Orsini, Marcos RG de Feitas, Mariana P. Mello, Reny de Souza Antonioli, Nelson Kale, Júlia Fernandes Eigenheer, Carlos Henrique Melo Reis y Osvaldo JM Nascimento. "Hidroterapia no gerenciamento da espasticidade nas paraparesias espásticas de várias etiologias". Revista Neurociências 18, n.º 1 (31 de marzo de 2001): 81–86. http://dx.doi.org/10.34024/rnc.2010.v18.8507.

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A espasticidade é uma manifestação clínica comum resultante da lesão do neurônio motor superior no sistema nervoso central. É uma condição que afeta adultos e crianças com uma grande variedade de patologias agudas e crônicas, sendo a característica predominante de diversas condições. Um dos aspectos mais incapacitantes das doenças que cursam com paraparesia espástica refere-se ao comprometimento progressivo da marcha, podendo levar aos indivíduos a permanecerem confinados a cadeira de rodas. A hidroterapia, por suas propriedades de suporte, assistência e resistência, constitui uma alternativa para a reabilitação física de pacientes neurológicos. Com base nisto este artigo tem como objetivo discutir os principais efeitos da hidroterapia na minimização das deficiências e incapacidades funcionais decorrentes da espasticidade em pacientes com paraparesias espásticas.
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Hassan, Anhar, Shivam Om Mittal, William T. Hu, Keith A. Josephs, Eric J. Sorenson y J. Eric Ahlskog. "Natural History of “Pure” Primary Lateral Sclerosis". Neurology 96, n.º 17 (26 de febrero de 2021): e2231-e2238. http://dx.doi.org/10.1212/wnl.0000000000011771.

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ObjectiveTo assess whether primary lateral sclerosis (PLS), classified as pure when the EMG is normal, converts to amyotrophic lateral sclerosis (ALS) after longitudinal follow-up.MethodsRetrospective chart review was performed of patients with pure PLS at Mayo Clinic in Rochester, MN (1990–2016). Inclusion criteria required a normal EMG during the first 4 years of symptoms.ResultsForty-three patients had pure PLS (25 female, 58%) with a median onset age of 50 years (range 38–78 years) and median follow-up at 9 years’ disease duration (range 4–36 years). The ascending paraparesis phenotype (n = 30, 70%) was most common, followed by hemiparetic onset (n = 9, 21%) and bulbar onset (n = 4, 9%). Among the 30 paraparetic-onset cases, bladder symptoms (n = 18, 60%) and dysarthria (n = 15, 50%) were more common than pseudobulbar affect (n = 9, 30%) and dysphagia (n = 8, 27%). By the last follow-up, 17 of 30 (56%) used a cane and 6 (20%) required a wheelchair. The paraparetic variant, compared with hemiparetic and bulbar onset, had the youngest onset (48 vs 56 vs 60 years, respectively; p = 0.02). Five patients died; 1 patient required a feeding tube; and none required permanent noninvasive ventilation. Two patients developed an idiopathic multisystem neurodegenerative disorder, which surfaced after 19 and 20 years. Two patients developed minor EMG abnormalities. The remainder 39 had persistently normal EMGs.ConclusionsPure PLS did not convert to ALS after a median of 9 years’ disease duration follow-up in our study population. The ascending paraparetic phenotype was most common, with earlier onset and frequent bladder involvement. After years of pure PLS, <5% develop a more pervasive neurodegenerative disorder.
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Carletti, Beatrice Enrica, Irene Espadas y Daniel Sanchez-Masian. "Thoracic vertebral canal stenosis due to articular process hypertrophy in two cats treated by hemilaminectomy with partial osteotomy of the spinous process". Journal of Feline Medicine and Surgery Open Reports 5, n.º 2 (julio de 2019): 205511691986317. http://dx.doi.org/10.1177/2055116919863176.

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Case summary A 9-year-old neutered female British Shorthair cat (case 1) and a 13-year-old neutered male domestic shorthair cat (case 2) showed signs of chronic T3–L3 myelopathy, which progressed over 6 and 12 months, respectively. On presentation, case 1 had moderate pelvic limb proprioceptive ataxia and ambulatory paraparesis, and case 2 was non-ambulatory paraparetic and had urinary incontinence. Bilateral enlargement of the articular process joints at T11–T12 in case 1 and T3–T4 in case 2 causing dorsolateral extradural spinal cord compression was shown on MRI. Surgical decompression by a unilateral approach through hemilaminectomy with partial osteotomy of the spinous process was performed in both cases. The side of the approach was chosen based on the severity of the cord compression. Surgery resulted in a satisfactory outcome with short hospitalisation times. On discharge, case 1 showed mild postural reaction deficits on both pelvic limbs. Case 2 had regained urinary continence and could ambulate unassisted, although it remained severely ataxic. The 6 month follow-up showed very mild paraparesis and proprioceptive ataxia in both cats. No chronic medical treatment was required. Relevance and novel information This is the first report to describe clinical presentation, imaging features, surgical treatment and outcomes of thoracic vertebral canal stenosis owing to bilateral articular process hypertrophy in cats with no adjacent spinal diseases. Thoracic articular process hypertrophy should be included in the differential diagnosis of adult cats with chronic progressive myelopathy. Hemilaminectomy with partial osteotomy of the spinous process might be an appropriate surgical technique in these cases.
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Chaudhuri, Arunima, SamirK Hazra, AmitK Bandopadhyay y Soma Datta. "Postspinal paraparesis". Journal of Obstetric Anaesthesia and Critical Care 2, n.º 1 (2012): 54. http://dx.doi.org/10.4103/2249-4472.99333.

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Tribus, Clifford B. "Transient Paraparesis". Spine 26, n.º 9 (mayo de 2001): 1086–89. http://dx.doi.org/10.1097/00007632-200105010-00021.

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Fattahi, Arash, Seyed Mohammad Reza Mohajeri, Abdolhadi Daneshi y Ardeshir Shahivand. "Hyperextension thoracic spine fracture with complete neurological recovery after surgical fixation: A case report". Surgical Neurology International 11 (30 de mayo de 2020): 137. http://dx.doi.org/10.25259/sni_226_2020.

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Background: Hyperextension thoracic spine fractures (HTSFs) typically involve the anterior ligamentous complex of the spine. These patients often present with paraplegia and warrant early surgical reduction/fixation even though few deficits resolve. Here, we present the unusual case of a 40-year-old male whose paraparetic deficit resolved following reduction/fixation of a T7-T8 HTSF. Case Description: A 40-year-old male presented with a thoracic computed tomography (CT) documented T7- T8 HTSF following a motor vehicle accident. His neurological examination revealed severe paraparesis, but without a sensory level (ASIA motor score 78). The chest CT angiogram scan revealed a hypodensity in the aorta, representing a small traumatic aortic dissection responsible for the patient’s right hemothorax; 450 ml of blood was removed on chest tube placement. He underwent urgent/emergent thoracic spine reduction and fixation at the T7-T8 level. Within 5 postoperative months, he recovered fully neurological function (ASIA motor score 100). Conclusion: We recommend urgent/emergent surgical reduction/stabilization for patients with thoracic HTSF to decrease offer the potential for neurological recovery and avoid secondary injury due to continued compression.
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Crowe, Yvette C., Georgina Child, Richard Lam y Ross McGregor. "Congenital block vertebrae and intervertebral disc protrusion in a young cat". Journal of Feline Medicine and Surgery Open Reports 5, n.º 2 (julio de 2019): 205511691986803. http://dx.doi.org/10.1177/2055116919868037.

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Case summaryA 6-month-old domestic shorthair cat was evaluated for proprioceptive ataxia of the pelvic limbs. Over 2 months, the cat became poorly ambulatory, paraparetic with proprioceptive ataxia and developed a firm, distended bladder with intermittent overflow urinary incontinence. Block vertebrae (T1–3, T4–5 and T10–11) and lordosis were identified on radiographs of the vertebral column. MRI revealed T3/4 intervertebral disc protrusion with severe extradural compression, secondary syringohydromyelia caudal to the protrusion and generalised intervertebral disc disease throughout the cervical and thoracic vertebrae. Dorsal laminectomy at T3/4 resulted in resolution of paraparesis and marked improvement in coordination and strength. Block vertebrae are usually considered an incidental finding. In this patient, angular deformation (lordosis) and adjacent segment disease probably contributed to clinically significant intervertebral disc degeneration and protrusion.Relevance and novel informationThere are few case reports in the literature of multiple congenital vertebral malformations causing neurological deficits in cats. This is the first reported case of successful surgical management of intervertebral disc protrusion, possibly secondary to block vertebrae and lordosis in a cat.
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Raj, Anil K., Peter D. Neuhaus, Adrien M. Moucheboeuf, Jerryll H. Noorden y David V. Lecoutre. "Mina: A Sensorimotor Robotic Orthosis for Mobility Assistance". Journal of Robotics 2011 (2011): 1–8. http://dx.doi.org/10.1155/2011/284352.

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While most mobility options for persons with paraplegia or paraparesis employ wheeled solutions, significant adverse health, psychological, and social consequences result from wheelchair confinement. Modern robotic exoskeleton devices for gait assistance and rehabilitation, however, can support legged locomotion systems for those with lower extremity weakness or paralysis. The Florida Institute for Human and Machine Cognition (IHMC) has developed the Mina, a prototype sensorimotor robotic orthosis for mobility assistance that provides mobility capability for paraplegic and paraparetic users. This paper describes the initial concept, design goals, and methods of this wearable overground robotic mobility device, which uses compliant actuation to power the hip and knee joints. Paralyzed users can balance and walk using the device over level terrain with the assistance of forearm crutches employing a quadrupedal gait. We have initiated sensory substitution feedback mechanisms to augment user sensory perception of his or her lower extremities. Using this sensory feedback, we hypothesize that users will ambulate with a more natural, upright gait and will be able to directly control the gait parameters and respond to perturbations. This may allow bipedal (with minimal support) gait in future prototypes.
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Ferreira, Adelmo, Bonfim Alves Silva Jr, F. Menezes Braga, Núbia M. Noschese Gargiulo y J. Norberto Stávale. "Paraparesia por gota". Arquivos de Neuro-Psiquiatria 47, n.º 4 (diciembre de 1989): 479–83. http://dx.doi.org/10.1590/s0004-282x1989000400017.

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Os autores apresentam um caso de bloqueio de canal raquidiano por tofo em paciente de 23 anos de idade com gota tofácea crônica e artrite gotosa, que desenvolveu paraparesia crural. Submetido a laminectomia, com exérese de acúmulos de cristais junto ao ligamento amarelo, não houve melhora do déficit motor. A revisão da literatura mostrou 9 casos previamente relatados.
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Tesis sobre el tema "Paraparesie"

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Erhart, Camille. "Embolies de cholesterol : une etiologie rare d'une paraparesie chez un sujet age". Université Louis Pasteur (Strasbourg) (1971-2008), 1992. http://www.theses.fr/1992STR1M050.

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CHBICHEB, MOHAMMED. "Contribution a l'etude des paraparesies spastiques progressives et isolees de l'adulte". Angers, 1993. http://www.theses.fr/1993ANGE1066.

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Gessain, Antoine. "Virus HTLV-1 et paraparesie spastique tropicale. Un rétrovirus leucemogene associe a une maladie neurologique : épidémiologie, caractérisation des isolats viraux associes et aspects moléculaires". Paris 7, 1992. http://www.theses.fr/1992PA077309.

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Le virus htlv-i retrovirus isole chez l'homme en 1980 est endemique au japon, dans la region caraibe, en amerique du sud et en afrique intertropicale. Dans ces regions 1 a 30% de la population generale a des anticorps seriques anti-htlv-i. Ce virus est l'agent etiologique de la leucemie t de l'adulte (atl) et d'une neuromyelopathie chronique denommee paraparesie spastique tropicale/myelopathie associee a l'htlv-i (tsp/ham). Ce travail realise entre 1983 et 1991 comporte quatre etapes successives. 1) dans un travail initial d'epidemiologie clinique et de terrain, j'ai participe a la decouverte de l'association entre htlv-i et tsp/ham, lien qui a ete confirme par la suite dans de nombreuses zones d'endemie virale. Nous avons par ailleurs decrit la presence de ce type de pathologie en afrique noire et en france metropolitaine. Enfin le lien de causalite entre ce virus et les tsp/ham a ete demontre par l'etude d'un cas post-transfusionnel. 2) nous avons ensuite isole et caracterise sur le plan immunologique, biochimique et moleculaire le virus htlv-i present chez les patients ayant une tsp/ham et montre qu'il etait similaire a celui que l'on peut isoler chez des patients ayant un atl. 3) par la suite, nous avons demontre l'existence d'une charge virale importante au niveau des cellules mononucleees du sang peripherique de ces patients et demontre que paradoxalement il existait a ce niveau une tres faible expression virale. 4) enfin dans un travail d'epidemiologie moleculaire, nous avons sequence une portion du gene d'enveloppe de l'htlv-i chez des sujets ayant soit une tsp/ham, soit un atl soit etant seropositifs. Les resultats sont les suivants: ? la variabilite in vivo de l'htlv-i au cours du temps chez un meme individu ou chez differents hotes successifs est tres faible voire nulle sur une periode de quelques annees, ? les rares changements nucleotidiques observes sont similaires dans les souches virales de meme origine geographique, ? aucune mutation specifique d'une pathologie hematologique ou neurologique n'a pu etre mise en evidence, ? il existe des variants moleculaires de l'htlv-i en afrique (zaire) et surtout en melanesie. ? les virus htlv-i de melanesie, dont nous avons sequence dans sa totalite l'un d'entre eux, sont les htlv-i les plus distants connus par rapport aux souches prototypes. ? la faible variabilite genetique in vivo de l'htlv-i peut etre utilisee comme un outil moleculaire pour suivre la transmission de ce virus chez differents hotes successifs mais aussi pour mieux comprendre les anciens mouvements de populations comportant des sujets infectes par ce virus
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Almeida, Camila de. "Aplicabilidade, validação e reprodutibilidade do Spinal Cord Independence Measure version III (SCIM III) nos pacientes com paraparesia espástica". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-29052015-101117/.

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Objetivo: verificar a aplicabilidade, reprodutibilidade e validade do SCIM III nos pacientes com paraparesia espástica. Método: estudo transversal incluindo 30 sujeitos (66% mulheres; 41,5±14,7 anos) com paraparesia espástica de etiologia genética, infecciosa ou a esclarecer que foram avaliados pela análise computadorizada da marcha, versão brasileira da SCIM III (0-100 pontos), MIF (18-126 pontos), por 2 examinadores (A e B) no mesmo dia e 1 semana depois (A). Resultados: o coeficiente de correlação intraclasse (CCI) para o uso da SCIM III indicou boa reprodutibilidade intra e inter-examinadores (CCI=0,9). A correlação de Spearman entre a SCIM III e a parte motora da MIF foi considerada adequada e estatisticamente significante (Spearman=0,6; p=0,001). A correlação entre as subescalas da SCIM III e os domínios da MIF foi considerada forte e significante para auto-cuidado (Spearman=0,8; p0,001) e moderada para transferências (Spearman=0,6; p=0,0005) e locomoção (Spearman=0,6; p=0,0006). A subescala mobilidade da SCIM III mostrou correlação positiva e significante para cadência (Spearman=0,8; p0,001), velocidade da marcha (Spearman=0,7; p0,001) e comprimento do passo (Spearman=0,6; p0,001). Conclusões: A SCIM III é um instrumento de avaliação funcional reprodutível intra e inter examinadores e capaz de avaliar o nível de independência dos indivíduos com paraparesia espástica. O SCIM III é mais sensível que a MIF, especialmente para pacientes com maior independência. Cadência, velocidade de marcha e comprimento do passo se correlacionaram com a subescala mobilidade
Purpose: to verify the applicability, reproducibility, and validity of the SCIM III patients with non-traumatic spastic paraplegia. Method: The cross-sectional study included 30 subjects (66% females; 41.5 ± 14.7 y) older with spastic paraparesis of any etiology were assessment by computerized gait analysis and with the Brazilian versions of SCIM III (0-100 points), FIM (18-126 points) by 2raters (A and B) at the same day and 1 week later (A). Results: The intraclass correlation coefficient (ICC) for the use of SCIM III indicated good intra and inter-evaluator reproducibility (ICC = 0.9). Correlation between the SCIM III and the motor FIM was appropriate (Spearman=0.6; p0.001). SCIM III subscales and the FIM domains correlated strongly for self-care (Spearman=0.8; p0.001), moderately for transfers (Spearman=0.6; p=0.0005) and locomotion (Spearman=0.6; p=0.0006). SCIM III mobility subscale positively correlated with the cadence (Spearman=0.8; p0.01), gait speed (Spearman=0.7; p0.01), and step length (Spearman=0.6;p0.01). Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with spastic paraplegia. The SCIM III is more sensitive than the FIM for non-traumatic spastic paraplegic patients with higher levels of independence. Linear gait parameters correlated with its mobility subscale.
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Silva, Felipe von Glehn 1978. "Espectro da neuromielite óptica : estudo clínico, imunológico e de neuroimagem". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310332.

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Orientadores: Leonilda Maria Barbosa dos Santos, Benito Pereira Damasceno
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-22T19:26:19Z (GMT). No. of bitstreams: 1 Silva_FelipevonGlehn_D.pdf: 6687964 bytes, checksum: 5e92607a118fbc6e4c8085aa93b540a0 (MD5) Previous issue date: 2013
Resumo: A Neuromielite óptica (NMO) é uma doença inflamatória e desmielinizante do SNC, de natureza autoimune, caracterizada por surtos graves de neurite óptica e mielite transversa, de evolução mais freqüente na forma recidivante-remitente, com pouca remissão dos déficits entre as crises, altamente incapacitante. A presença do anticorpo anti-aquaporina 4 (anti-AQP4) foi descrito em 73% a 91% dos pacientes com diagnóstico de NMO. Doenças autoimunes podem frequentemente ser desencadeadas após infecções por micro-organismos, como agentes virais. A NMO e a infecção pelo HTLV-1 possuem prevalência coincidentemente elevada em certas áreas do globo, como o Brasil. Com o objetivo de avaliar a associação do HTLV-1 com a NMO, foi pesquisada a presença de anti-AQP4 e anti-HTLV-1 em 34 pacientes com DENMO, 43 pacientes infectados com HTLV-1, assintomáticos ou com a doença mielopatia associada ao HTLV-1 (HAM/TSP) e 23 controles sadios. Nenhum paciente com DENMO apresentou sorologia positiva para HTLV-1. Nenhum paciente infectado pelo HTLV-1 apresentou soropositividade para anti-AQP4. 60% dos casos de DENMO foram positivos para anti-AQP4. Esses resultados sugerem que a mielopatia associada à variante aguda da HAM/TSP e aquela associada ao anticorpo anti-AQP4 são entidades clínicas distintas, e provalvemente, não relacionadas de forma patogênica ao HTLV-1 em nosso meio. O cérebro humano expressa amplamente AQP4, mas estudos anatomopatológicos e de neuroimagem não detectaram lesões corticais desmielinizantes ou infiltrados inflamatórios no DENMO. A fim de avaliar melhor a presença de alterações estruturais nas substâncias cinzenta e branca encefálicas no DENMO, foram estudados 34 pacientes por RNM de 3T e tomografia de coerência óptica retiniana pareados com controles sadios, divididos nas apresentações NMO, mielite transversa longitudinal extensa (MTLE) e neurite óptica (NO), além de soropositivos versus soronegativo para anti-AQP4 e 5 anos ou menos de doença versus mais de 5 anos de doença. Houve maior grau de atrofia retiniana nos grupos NMO e NO, além dos grupos anti-AQP4+ e mais de 5 anos de doença. Foi constatado maior grau de atrofia cortical cerebral e estruturas da substância branca nos grupos NMO e MTLE, anti-AQP4+ e mais de 5 anos de doença. A atrofia retiniana se correlacionou positivamente com a atrofia do lobo occipital. Esses dados sugerem que o DENMO está associado à atrofia de estruturas das substâncias cinzenta e branca cerebrais; que a atrofia não se limita apenas às áreas das vias sensorial, motora e visual, mas é mais difusa; que quanto maior o tempo de doença e a presença do anticorpo anti-AQP4, maior é o grau de atrofia cortical, configurando estes fatores, tempo e anti-AQP4+, como de pior prognóstico; e a correlação positiva entre atrofia da camada de fibras nervosas retinianas e atrofia pericalcarina, além da escala de incapacidade funcional expandida (EDSS), sugere que a degeneração neuronal retrógrada e/ou anterógrada do tipo Walleriana é um importante causador da atrofia cortical no DENMO
Abstract: Neuromyelitis optica (NMO) is an inflammatory disease of the central nervous system (CNS) of putative autoimmune aetiology, which is characterized by severe attacks of myelitis and optic neuritis (ON). A relapsing course with rapid accumulation of neurological deficits with little or no remission is common. The NMO is autoimmune in nature and antibodies to Aquaporin 4 (AQP4) are associated with the development of the disease. AQP4 is the most common water channel protein of CNS; present in astrocytes processes, endothelium and piamater meninges. It predominates at some sites of the CNS, as optic nerve, brain stem and gray matter of medulla, the same sites of the usual inflammatory lesions. Autoimmune diseases may be triggered by microorganism infections and NMO and HTLV-1 infection have coincidentally high prevalence in certain areas of the world including Brazil. To study a possible relationship between these two diseases, we determined the seroprevalence of antibodies to AQP4 in 43 patients with HTLV-1 infection, asymptomatic or with HTLV-1 associated myelopathy (HAM/TSP) and that of HTLV-1 antibodies in patients with neuromyelitis optica spectrum disorders (NMOSD). AQP4ab positivity was found in 60% of NMOSD patients, but in none of the HAM/TSP patients and none of the asymptomatic HTLV-1 infected individuals. Conversely, all AQP4-Ab-positive NMOSD patients were negative for HTLV-1 antibodies. The results argue both against a role of antibodies to AQP4 in the pathogenesis of HAM/TSP and against an association between HTLV-1 infection and the development of AQP4-Ab. Moreover, the absence of HTLV-1 in all patients with NMOSD suggests that HTLV-1 is not a common trigger of acute attacks in patients with AQP4-Ab positive NMOSD in populations with high HTLV-1 seroprevalence. Although AQP4 is also expressed widely in the human brain cortex, beyond the common sites of lesions in NMO, recent studies have found no MRI or histopathological evidence for cortical demyelination. To investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMO and its incomplete forms, isolated longitudinally extensive transverse myelitis and optic neuritis, and to assess the prognostic impact of GM and WM abnormalities in these conditions, we performed both 3T high-resolution T1-weighted and diffusion tensor MRI in thirty-four patients with NMO spectrum disorders (NMOSD) and 34 matched healthy controls. Voxel-based morphometry (SPM8/MATLAB2012b), cortical analyses (Freesurfer), and diffusion tensor imaging analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, retinal nerve fiber layer was measured by means of optic coherence tomography (OCT). These analyses resulted in following findings: (1) NMOSD is associated with GM and WM atrophy, which encompasses more brain structures than the motor, sensory, and visual pathways; (2) this atrophy is more widespread in patients with NMO and LETM than in patients with ON; (3) the extent of GM atrophy correlates with disease duration, and (4) GM/WM atrophy in NMOSD is more pronounced in AQP4 antibody-seropositive than in -seronegative patients. Furthermore, it was demonstrated for the first time in NMOSD a correlation between RNFL atrophy and GM atrophy in the occipital lobes as assessed by OCT, indicating a role for retrograde degeneration in GM atrophy and suggesting that the extent of brain GM/WM atrophy may be of prognostic relevance in NMOSD
Doutorado
Neurologia
Doutor em Ciências Médicas
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Aulitzky, Anna [Verfasser]. "Klinische Phänotypisierung und genetische Aufarbeitung von Patienten mit Sporadischer Spastischer Paraparese und Familien mit Hereditärer Spastischer Paraparese / Anna Aulitzky". Ulm : Universität Ulm, 2017. http://d-nb.info/112490266X/34.

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Coelho, Juliana Nogueira. "A funcionalidade dos indivíduos com lesão medular de etiologia não-traumática - uma proposta para o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-20072016-113108/.

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Objetivo: Construir e testar a aplicabilidade de um instrumento baseado no Core Set resumido da CIF para lesão medular em indivíduos com etiologia não-traumática. Métodos: Foi realizada uma revisão sistemática para identificarmos as escalas de avaliação funcional que tenham sido aplicadas em indivíduos com paraparesia espástica. Para o desenvolvimento do instrumento utilizamos as descrição das categorias selecionadas para o Core Set resumido de lesão medular traumática crônica e elaboramos perguntas de fácil compreensão e alternativas de respostas descritos com detalhes que satisfizessem os seus qualificadores para guiar a aplicação do instrumento e garantir a reprodutibilidade dos achados. Após esta fase realizamos a aplicação desse instrumento em 40 indivíduos com lesão medular não-traumática (mulheres: 62,5%, média de idade: 44 ± 16 anos). A prevalência de incapacidade em cada uma das categorias da CIF foi definida pela proporção de indivíduos com os qualificadores de 1 a 4. Resultados: Na revisão sistemática identificamos 10 instrumentos de avaliação funcional a usados para paraparesia espástica, dos quais somente a Escala de Osame e a SCIM-III podem ser consideradas específicas para a nossa amostra. Dentre estes instrumentos de avaliação a MIF apresentou maior número de categorias da CIF, a Escala de Osame e o Rankin apresentaram menores números de categorias da CIF e o DEFU-QV foi a escala que continha mais categorias exclusivas. Desenvolvemos um instrumento baseado no Core Set resumido da CIF para lesão medular traumática crônica, contendo 43 perguntas com subitens. O instrumento foi considerado bom e de fácil uso pelos avaliadores, levando em média 45 minutos de aplicação. Os dados foram correlacionados com a Escala de Disfunção Motora Osame (0 - 13 pontos), que foi dicotomizada em dois grupos leve (0 a 4 pontos) e grave (>= 5) para análise. A pontuação média na Escala de Osame foi 5,4 ± 2,2, a SCIM-III apresentou a pontuação média de 83,0 ± 13,0. Indivíduos do grupo grave apresentaram maior frequência de deficiências quando avaliados pelo Core Set de lesão medular, principalmente: funções sexuais, neuromusculoesqueléticas, defecação e dor. A medula espinhal foi a Estrutura do Corpo citada com maior frequência. Nas categorias de Atividades e Participação: todos os indivíduos apresentaram deficiência na utilização de transporte, bem como dificuldade para o uso da mão e do braço, andar, dirigir, deslocar-se, realizar rotina diária, trabalho e lazer. As principais barreiras identificadas referiram-se a condições de ambientes internos e externos, enquanto os principais facilitadores foram os produtos para uso pessoal na vida diária, seguido daqueles usados para mobilidade e transporte pessoal em ambientes interno e externo, família imediata e profissionais de saúde. Conclusão: O instrumento desenvolvido propõe uma forma de aplicar o Core Set de lesão medular crônica. É de fácil compreensão e aplicação pelos profissionais que o utilizaram e foi capaz de diferenciar os indivíduos mais gravemente incapacitados. Tem vantagem de identificar e ponderar o impacto dos Fatores Ambientais
Objective: Building and test the applicability of an instrument based on the brief ICF Core Set for spinal cord injury in patients with non-traumatic etiology. Methods: A systematic review was performed to identify the functional assessment scales that have been applied in individuals with spastic paraparesis. For the development of this instrument, we used the description of the selected categories for the brief Core Set of chronic traumatic spinal cord injury and easy comprehension questions were elaborated along with choices for answers described with enough details in order to satisfy their qualifiers to guide the application of the instrument and ensure the reproducibility of the findings. After this phase we applied this instrument in 40 patients with non-traumatic spinal cord injury (women: 62.5%; mean age: 44 ± 16 years). The proportion of individuals defined the prevalence of disability in each ICF category with the qualifiers from 1 to 4. Results: The systematic review enabled us to identify 10 functional assessment instruments used for spastic paraparesis, of which only Osame Scale and SCIM-III may be considered specific to the sample used herein. Among these evaluation tools MIF presented a higher number of ICF categories, the Osame Scale and Rankin had lower numbers of ICF categories and DEFU-QOL was the scale which contained more exclusive categories. We have developed a tool based on the brief ICF Core Set for chronic traumatic spinal cord injury, containing 43 questions with sub-items. This instrument was considered good and easy to use by the evaluators, taking an average of 45 minutes of application. The data was correlated with Osame Motor Disability Scale (0 - 13 points), which was dichotomized into two groups: mild (0 to 4 points), and severe (>= 5) for analysis purposes. The average score in Osame Scale was 5.4 ± 2.2, and SCIM-III presented an average of 83.0 ± 13.0. Individuals from the severe group presented a greater frequency of disabilities when evaluated by the Core Set of spinal cord injury, mainly: sexual functions, neuromusculoskeletal, defecation and pain. The spinal cord was the Body Structure most frequently cited. In the categories of Activities and Participation, all of the individuals presented limitation to use transportation as well as the use of hand and arm, walking, driving, moving, carrying out daily routine tasks, work and leisure. The main barriers identified were related to the conditions of internal and external environments, while the main facilitators were the products for personal use in daily life, followed by those used for mobility and personal transport in internal and external environments, immediate family and health professionals. Conclusion: The developed instrument proposes a form to apply the Core Set of chronic spinal cord injury. It is easy to understand and be applied by professionals who used it. Furthermore, it was able to differentiate the individuals more severely disabled. It has the advantage to identify and ponder the impact of environmental factors as well
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Tauil, Carlos Bernardo. ""Ensaio clínico controlado randomizado aberto com metil-prednisolona em portadores de mielopatia associada ao HTLV-1 paraparesia espástica tropical"". Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-13092006-121302/.

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Estudamos a avaliação clínica de longo termo da resposta de pacientes com diagnóstico precoce de HAM/TSP ao tratamento com metil-prednisolona. Objetivamos pesquisar em relação ao tempo de evolução e apresentação da doença a eficácia deste tratamento. Realizamos o acompanhamento dos pacientes utilizando como parâmetros as escalas de critérios clínicos de Osame e Kurtzke e comparamos com um grupo controle que não recebeu este tipo de tratamento.Os pacientes do grupo experimental e do grupo controle que realizaram fisioterapia mantiveram-se estáveis ou obtiveram melhora de alguns sintomas da doença
We studied the long-term clinical response of patients with early diagnoses of HAM/TSP to treatment with methylprednisolone. The aim was to study this treatment in relation to the time of evolution and presentation of the disease and its effectiveness. The patients were followed using the scales of clinical criteria by Osame and Kurtzke, and compared with a control group of patients who did not receive this treatment type. We observed that patients in the experimental group and the control group, having been followed up with physiotherapy, either remained stable or presented improvement for some symptoms of the disease
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Nishimura, Paula Lumi Goulart. "Diretrizes para o design de dispositivo para animais com problemas de locomoção com uso da prototipagem rápida". Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/154153.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Muitas das cadeiras de rodas utilizadas por animais domésticos com problemas locomotores são feitas a partir de materiais improvisados, como canos, rodinhas de brinquedos e diversos materiais reciclados, devido, sobretudo, aos seus baixos custos. Porém, esses aparelhos improvisados podem ter desempenho comprometido e não atenderem às necessidades do animal, até mesmo causarem lesões por não serem devidamente adaptados. Uma das finalidades do Design é solucionar problemas de projeto, como também otimizar o produto e o seu processo de produção, podendo, dessa forma, auxiliar no desenvolvimento de equipamentos para cães com problemas locomotores, cuja área ainda carece de estudos. O objetivo da presente pesquisa foi propor as diretrizes necessárias para a construção de cadeiras de rodas eficientes para cães com problemas de locomoção nos membros pélvicos a partir de tecnologias de Prototipagem Rápida, as quais proporcionam a obtenção de peças com exatidão geométrica ou discrepância desprezível, assegurando maior conforto e melhor funcionalidade, com menores tempo de produção e custos. Esta pesquisa foi dividida em duas fases: (i) pesquisa teórica bibliográfica e (ii) pesquisa prática experimental. Na teórica, foram feitas revisões bibliográficas a respeito dos problemas locomotores em cães e sobre as tecnologias de Prototipagem Rápida, suas aplicações e estado da arte. Já na fase experimental, uma metodologia projetual adaptada de Munari (1981) foi utilizada para confecção e análise de aparelhos existentes, os quais contribuíram para a proposta de um modelo que suprisse as necessidades dos modelos analisados. A cadeira de rodas projetada, embora tenha atendido às principais expectativas, necessitou de alguns ajustes e alterações estruturais, podendo ser considerada um primeiro passo para o desenvolvimento de modelos futuros. Em vista disso, através das informações obtidas na produção desse aparelho, como também os dados coletados a partir dos outros testes e análises, foi possível elencar as diretrizes fundamentais para a produção de cadeiras de rodas eficientes, com peças impressas em 3D, para cães com problemas locomotores nos membros pélvicos.
Many wheelchairs used by domestic animals with locomotion problems are made from improvised materials such as pipes, toy wheels and many recycled materials, due to their low costs. However, these improvised devices can compromise performance and may not attend the needs of the animal, even causing injuries for not being properly adapted. One of Design's purposes is to solve problems within projects, as well as to optimize the product and its production process, and, in this way, to aid in the development of this kind of equipment for dogs with locomotive problems, whose area is still lacking in studies. The present research objective was to propose the necessary guidelines for the construction of efficient wheelchairs for dogs with locomotion problems in the pelvic area using Rapid Prototyping technologies, which provide pieces with geometric accuracy or negligible discrepancy, ensuring greater comfort and better functionality to the dog, with shorter production time and lower costs. This research was divided into two phases: (i) theoretical bibliographic research and (ii) experimental practical research. In the theoretical phase, bibliographical reviews were made regarding the locomotion problems in dogs and about Rapid Prototyping technologies, their applications, and state of the art. In the experimental phase, a design methodology adapted from Munari (1981) was used for the confection and analysis of existing devices, which contributed to the proposal of a model that would attend the needs of the models analyzed. The designed wheelchair, although had met the main expectations, required some adjustments and structural changes, and could be considered a first step for the development of future models. Consequently, through the information obtained in the production of this device, as well as the data collected from the other tests and analyzes, it was possible to list the fundamental guidelines for the production of efficient wheelchairs with 3D printed parts for dogs with locomotion problems in the pelvic area.
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Verkkoniemi, Auli. "Variant Alzheimerś disease with spastic paraparesis : clinical, neuropathological and molcecular genetic characterization". Helsinki : University of Helsinki, 2001. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/verkkoniemi/.

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Libros sobre el tema "Paraparesie"

1

Parker, James N. y Philip M. Parker. The official patient's sourcebook on tropical spastic paraparesis. Editado por Icon Group International Inc. San Diego, Calif: Icon Health Publications, 2002.

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Alleyne, Cargill Herley. Clinical and seroepidemiological case-control study of tropical spastic paraparesis and multiple sclerosis in Barbados. [New Haven: s.n.], 1991.

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Mckhann, Guy Mead. Isolation and characterization of human T-cell lymphotropic virus type-1 from patients with tropical spastic paraparesis. [New Haven: s.n.], 1990.

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Current issues in clinical neurovirology: Pathogenesis, diagnosis and treatment. Philadelphia, Pa: Saunders, 2008.

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Publications, ICON Health. The Official Patient's Sourcebook on Tropical Spastic Paraparesis. Icon Health Publications, 2002.

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Harbourne, George. Genetic linkage studies of autosomal dominant hereditary spastic paraparesis. 1995.

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Miller, Aaron E. y Teresa M. DeAngelis. HTLV Myelopathy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199732920.003.0009.

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Infection due to the human T-lymphocytic 1 (HTLV-1) virus can result in a myelopathy involving the thoracolumbar spinal cord, which typically manifests clinically as a spastic paraparesis—hence its alternative moniker tropical spastic paraparesis. In this chapter, we summarize the diagnostic approach to a patient with a spastic paraparesis and the key points, which assist in narrowing down the lengthy differential diagnosis to HTLV-1.
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Provan, Drew, Trevor Baglin, Inderjeet Dokal y Johannes de Vos. Haematological emergencies. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199683307.003.0013.

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Septic shock/neutropenic fever - Acute transfusion reactions - Delayed transfusion reaction - Post-transfusion purpura - Hypercalcaemia - Hyperviscosity - Disseminated intravascular coagulation - Overdosage of thrombolytic therapy - Heparin overdosage - Heparin-induced thrombocytopenia - Warfarin overdosage - Massive blood transfusion - Paraparesis/spinal collapse - Leucostasis - Thrombotic thrombocytopenic purpura - Sickle crisis
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Provan, Drew, Trevor Baglin, Inderjeet Dokal, Johannes de Vos y Hassan Al-Sader. Haematological emergencies. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199683307.003.0013_update_001.

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Septic shock/neutropenic fever - Acute transfusion reactions - Delayed transfusion reaction - Post-transfusion purpura - Hypercalcaemia - Hyperviscosity - Disseminated intravascular coagulation - Overdosage of thrombolytic therapy - Heparin overdosage - Heparin-induced thrombocytopenia - Warfarin overdosage - Massive blood transfusion - Paraparesis/spinal collapse - Leucostasis - Thrombotic thrombocytopenic purpura - Sickle crisis
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Araujo, Abelardo Q.-C. Neurological Manifestations of the Human T-lymphotropic Virus Type 1. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0161.

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The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects about 20 million individuals worldwide. Its typical neurological presentation is of a chronic, slowly progressive myelopathy named “HTLV-1-associated myelopathy/tropical spastic paraparesis” (HAM/TSP). HAM/TSP emerges as the tip of the iceberg among numerous other neurological clinical syndromes caused by this virus, such as inflammatory myopathies, polyneuropathies, ALS-like syndromes, dysautonomia, etc. HAM/TSP designates a spastic paraparesis with neurogenic bladder, and minor sensory signs. Pathologically, HAM/TSP is characterized initially by perivascular lymphocytic cuffing and mild parenchymal mononuclear infiltrates affecting mainly the thoracic spinal cord. This is followed by gliosis and scarring in later stages. The neuropathogenesis of HTLV-1 is still poorly understood but is apparently immune mediated. The therapy of TSP/HAM remains basically symptomatic.
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Capítulos de libros sobre el tema "Paraparesie"

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Poeck, Klaus. "Chronisch-progrediente Paraparese". En Diagnostische Entscheidungen in der Neurologie, 72–77. Berlin, Heidelberg: Springer Berlin Heidelberg, 1986. http://dx.doi.org/10.1007/978-3-662-06601-0_15.

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Angelini, Corrado. "Spastic Paraparesis Type 4". En Genetic Neuromuscular Disorders, 403–5. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-56454-8_102.

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Angelini, Corrado. "Spastic Paraparesis Type 7". En Genetic Neuromuscular Disorders, 407–10. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-56454-8_103.

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Angelini, Corrado. "Spastic Paraparesis Type 4". En Genetic Neuromuscular Disorders, 355–57. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-07500-6_81.

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Angelini, Corrado. "Spastic Paraparesis Type 7". En Genetic Neuromuscular Disorders, 359–62. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-07500-6_82.

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Poeck, Klaus. "Chronisch-progrediente zentrale Paraparese". En Diagnostische Entscheidungen in der Neurologie, 81–87. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-662-21782-5_15.

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Marsden, Jon, Lisa Bunn, Amanda Denton y Krishnan Padmakumari Sivaraman Nair. "Hereditary Spastic Paraparesis and Other Hereditary Myelopathies". En Neurological Rehabilitation, 235–88. Boca Raton, FL : CRC Press/Taylor & Francis Group, 2018. | Series: Rehabilitation science in practice series: CRC Press, 2018. http://dx.doi.org/10.1201/9781315374369-9.

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Karlstrom, Helena, William S. Brooks, John B. J. Kwok, Jillian J. Kril, Glenda M. Halliday y Peter R. Schofield. "Variable Phenotype of Alzheimer's Disease with Spastic Paraparesis". En Genotype — Proteotype — Phenotype Relationships in Neurodegenerative Diseases, 73–92. Berlin, Heidelberg: Springer Berlin Heidelberg, 2005. http://dx.doi.org/10.1007/3-540-26522-8_7.

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Rowan, Aileen G. y Charles R. M. Bangham. "The Pathogenesis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis". En Neurotropic Viral Infections, 3–20. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-33189-8_1.

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Schönbach, Christian. "Human T-Lymphotropic Virus Type-I-associated Myelopathytropical Spastic Paraparesis". En Encyclopedia of Systems Biology, 928. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-9863-7_753.

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Actas de conferencias sobre el tema "Paraparesie"

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Fragio-Gil, Jorge Juan, Roxana Gonzalez Mazario, Jose Ivorra Cortés, Francisco Miguel Ortiz Sanjuan, Elena Grau García, Cristobal Pávez Perales, Marta De la Rubia Navarro et al. "AB0900 ACUTE PARAPARESIS AS CLINICAL PRESENTATION OF VERTEBRAL OSTEOMYELITIS". En Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.6662.

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Hasenöhrl, T., W. Mayr, M. Dimitrijevic, S. Palma, C. Ambrozy y R. Crevenna. "Neuromuskuläre Elektrostimulation verbessert das Gangbild einer Patientin mit spastischer Paraparese – ein Fallbericht". En Jahrestagung 2018 der Österreichischen Gesellschaft für Physikalische Medizin und Rehabilitation. Georg Thieme Verlag KG, 2018. http://dx.doi.org/10.1055/s-0038-1673269.

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Paiva, Lohanna, Alexandre Zuquete Guarato, Vinicius Sousa y Felipe Chagas Rodrigues de Souza. "DESENVOLVIMENTO DE UMA CADEIRA DE RODAS REGULÁVEL E DE BAIXO CUSTO PARA CÃES COM PARAPARESIA USANDO IMPRESSÃO 3D". En XXVI Congresso Nacional de Estudantes de Engenharia Mecânica. ABCM, 2019. http://dx.doi.org/10.26678/abcm.creem2019.cre2019-0214.

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Leitão, Juliana Rodrigues, Marcelo Candido Portilho Gouveia, Bruno Watanabe Minto y Luis Gustavo Gosuen Gonçalves Dias. "RUPTURA DE BEXIGA URINÁRIA E FRATURA VERTEBRAL EM L5 DECORRENTES DE TRAUMA EM CÃO: RELATO DE CASO". En I Congresso On-line Nacional de Clínica Veterinária de Pequenos Animais. Revista Multidisciplinar em Saúde, 2021. http://dx.doi.org/10.51161/rems/1825.

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Introdução: As fraturas da coluna vertebral são causas potenciais de injúrias da medula espinhal em pequenos animais. Frequentemente, o paciente com trauma toracolombar têm lesões associadas em outros órgãos. Objetivos: Objetivou-se relatar um caso de ruptura da bexiga urinária e fratura completa oblíqua na 5° vértebra lombar e descrever as técnicas cirúrgicas utilizadas. Materiais e métodos: Uma cadela, Shih Tzu, com 5 anos de idade, 5 kg, foi atendido com histórico de trauma há 4 horas pela queda de um botijão de gás cheio na região toracolombar. Paraparesia, disúria, hematúria e dor abdominal eram os sinais clínicos. Ao exame neurológico, a paciente demonstrou dor acentuada na região lombar e propriocepção ausente. O paciente foi submetido ao exame radiográfico da coluna vertebral o qual indicou fratura completa oblíqua na 5° vértebra lombar. Na ultrassonografia abdominal, constatou-se líquido livre na cavidade abdominal. Realizou-se uretrocistografia retrógrada de contraste positivo, confirmando-se a ruptura da vesícula urinária. Optou-se primariamente pela cistorrafia com fio absorvível monofilamentado, padrão contínuo, invaginante Cushing e em 2 planos. Instituiu-se o tratamento clínico para fratura vertebral que incluiu confinamento estrito, imobilização externa e controle da dor (dipirona 25mg/kg SID e tramadol 2 mg/kg SID). Após dois dias, realizou-se laminectomia e estabilização lombar. A fratura em L5 foi reduzida com auxílio de pinça ponta-ponta. Dois parafusos foram colocados tanto na vértebra cranial (L4) quanto caudal (L6) à fratura, com ângulo de 45° de inserção. O cimento ósseo Cimento Ortopédico Veterinário – C-VET foi colocado em torno dos implantes. Efetuou-se o desgaste do processo espinhoso das vértebras L4, L5 e L6. Resultados: No pós-operatório imediato, a paciente foi encaminhada para internação. Foi orientado repouso absoluto por 15 dias. No sétimo dia, o animal deambulava sem dor e urinava normalmente. Após 30 dias, a paciente não apresentava alterações clínicas neurológicas, recebendo alta. Uma intervenção terapêutica rápida limita a extensão da lesão neuronal, favorecendo a recuperação do paciente. Em cães com preservação da percepção de dor profunda, o prognóstico é favorável. Conclusão: Conclui-se que em casos com histórico conhecido de traumatismo vertebral deve-se avaliar o paciente quanto a lesões concorrentes para um resultado pós-cirúrgico satisfatório.
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Ju, Wei, Meili Zhang, Bonita R. Bryant, Jing Chen, John C. Morris, John E. Janik, Thomas A. Waldmann et al. "Abstract 2526: CP690550 inhibits interleukin-2 (IL-2), IL-9 and IL-15 mediated JAK3 activation and proliferation of T cells obtained from patients with HTLV-1-associated adult T cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)". En Proceedings: AACR 101st Annual Meeting 2010‐‐ Apr 17‐21, 2010; Washington, DC. American Association for Cancer Research, 2010. http://dx.doi.org/10.1158/1538-7445.am10-2526.

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Gopan, Gayatri, Geetha Narayanan, Sreejith G. Nair, Prakash Purushothaman, Rona Joseph, Rekha A. Nair y Jagathnath Krishna. "Outcome of Treatment in Elderly Myeloma—A Single-Centre Experience". En Annual Conference of Indian Society of Medical and Paediatric Oncology (ISMPO). Thieme Medical and Scientific Publishers Pvt. Ltd., 2021. http://dx.doi.org/10.1055/s-0041-1735368.

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Abstract Introduction Multiple myeloma (MM) accounts for approximately 1% of all cancers and 10% of all hematologic malignancies. In our institution, we see around 200 patients with myeloma every year. We present our experience with multiple myeloma in the patients aged more than 60 years. Objectives This is a retrospective study of 300 newly diagnosed multiple myeloma patients above 60 years of age treated in the Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India, during the period between 2014 and 2017. The medical records of the patients were studied and following data were collected: demographic and clinical details, diagnostic and staging workup, primary treatment, response assessment, relapse, and survival. Survival was estimated using the Kaplan–Meier method. Results A total of 300 patients were included in the study. The median age was 66 years with a male-to-female ratio of 1.4:1. The common clinical presentations were backache (134), fatigue (49), lower respiratory infection (20), and paraparesis (14). Monoclonal protein was immunoglobulin (Ig)-G in 199 patients (66.6%), IgA in 52 patients (17.4%), IgM in 2 patients, and IgD in 1 patient. Light-chain disease was seen in 42 patients (14%). One hundred and sixty patients (53.5%) had ISS stage III. Only 285 patients received treatment, of which 203 (67.8%) received bortezomib-based regimen, - bortezomib and dexamethasone (BD; 33.4%); bortezomib, lenalidomide, and dexamethasone (BLD; 19.7%); bortezomib, cyclophosphamide, and dexamethasone (VCD; 8.7%); bortezomib, thalidomide, and dexamethasone (BTD; 2.3%); and bortezomib, melphalan, and prednisolone (3.7%). Nonbortezomib-based regimens used were melphalan and prednisolone (MP) alone or with thalidomide or lenalidomide (15%), lenalidomide and dexamethasone (LD; 10.4%), and thalidomide and dexamethasone (TD; 2%). Response assessment was done as per IMWG guidelines. Fifty-seven (26.3%) patients achieved complete response (CR), 94 (43.3%) achieved very good partial response (VGPR), 19 (8.8%) attained partial response (PR), 15 (5.6%) had stable disease, and 46 (15.4%) developed progressive disease. With bortezomib-based regimens, 119 patients (58.3%) achieved CR/VGPR, and with non-bortezomib based regimens, 42 patients (51.2%) achieved CR/VGPR. One hundred and forty-three patients (47.8%) received maintenance therapy of which 79 received maintenance with bortezomib, 49 with lenalidomide, and 15 with thalidomide. The average duration of maintenance was 24 months. Second-line chemotherapy regimens were used in 37 patients. Agents used were MP, LD, TD, and VCD. With second-line treatment, 15 patients achieved VGPR, 10 patients achieved partial response, and 25 patients developed progressive disease. Third-line chemotherapy regimens were used in 22 patients and the regimens used were pomalidomide and dexamethasone, MP, TD, LD, vincristine, doxorubicin, and dexamethasone and carfilzomib and dexamethasone. At a median follow-up of 34 months, the 2-year overall survival (OS) was 68%. The median progression-free survival was 21 months. The 2-year OS for patients receiving initial bortezomib-based regimen was 67.8% and non-bortezomib based regimen was 68% which was similar. Conclusion In this study, CR/VGPR rates and 2-year OS in patients treated with bortezomib and non-bortezomib based regimens were not statistically significant.
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