Epidemiology of accidental tetanus in Brazil from 2009-2019

Background: Accidental tetanus is an infectious disease caused by acute intoxication from Clostridium tetani’s exotoxin. Manifestations include intermittent tonic spasms due to central nervous system’s hyperexcitability. Objectives: To estimate the lethality rate and describe the epidemiological profile of patients diagnosed with accidental tetanus in Brazil. Design and setting: Ecological descriptive study developed at Federal University of Fronteira Sul, Passo Fundo, Brazil. Methods: The data was obtained from the Notifiable Diseases Information System (SINAN). All cases confirmed in Brazil from 2009 to 2019 were included. Variables sex, skin color, age group, outcome and region of notification were selected. Descriptive statistics were used based on absolute (n) and relative (%) frequencies and the lethality rate was calculated. Results: 2,969 cases were included, with a 34% decrease from 2009 to 2019. The majority were male (85.3%), brown people (51%), age group of 40-59 years (39.9%) and in the northeast region (33.3%). Cure was seen in 52.5% and the lethality rate was 32.3%. Conclusions: Though cases reduced, accidental tetanus still is a public health issue because of its high lethality rate. Immunization, offered by the Brazilian public health system, can prevent it, indicating the necessity to increase immunization rates.

Symmetry of ictal slow waves may predict the outcomes of corpus callosotomy for epileptic spasms

We aimed to analyse the ictal electrographic changes on scalp electroencephalography (EEG), focusing on high-voltage slow waves (HVSs) in children with epileptic spasms (ES) and tonic spasms (TS) and then identified factors associated with corpus callosotomy (CC) outcomes. We enrolled 17 patients with ES/TS who underwent CC before 20 years of age. Post-CC Engel’s classification was as follows: I in 7 patients, II in 2, III in 4, and IV in 4. Welch’s t-test was used to analyse the correlation between ictal HVSs and CC outcomes based on the following three symmetrical indices: (1) negative peak delay: interhemispheric delay between negative peaks; (2) amplitude ratio: interhemispheric ratio of amplitude values for the highest positive peaks; and (3) duration ratio: interhemispheric ratio of slow wave duration. Ages at CC ranged from 17–237 months. Four to 15 ictal EEGs were analysed for each patient. The negative peak delay, amplitude ratio and duration ratio ranged from 0–530 ms, 1.00–7.40 and 1.00–2.74, respectively. The negative peak delay, amplitude ratio and duration ratio were significantly higher in the seizure residual group (p = 0.017, <0.001, <0.001, respectively). Symmetry of ictal HVSs may predict favourable outcomes following CC for ES/TS.

FEATURES OF PAIN SYNDROME IN PATIENTS WITH MULTIPLE SCLEROSIS

The data of 61 medical cards of patients with multiple sclerosis has been analyzed. 47,54% of patients reported pain as a symptom of multiple sclerosis, following types of pain were observed: neuropathic pain (оngoing extremity pain, Lhermitte's phenomenon), nociceptive pain (headache, back pain) and mixed pain (painful tonic spasms, spasticity pain). Only 17,24% of patients received therapy to treat pain.

FEATURES OF PAIN SYNDROME IN PATIENTS WITH MULTIPLE SCLEROSIS

The data of 61 medical cards of patients with multiple sclerosis has been analyzed. 47,54% of patients reported pain as a symptom of multiple sclerosis, following types of pain were observed: neuropathic pain (оngoing extremity pain, Lhermitte's phenomenon), nociceptive pain (headache, back pain) and mixed pain (painful tonic spasms, spasticity pain). Only 17,24% of patients received therapy to treat pain.

Movement disorders in early MS and related diseases

BackgroundLittle is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS) and related demyelinating diseases. We conducted a prospective study to fill this knowledge gap.MethodsA consecutive patient sample was recruited from the MS clinic within a 1-year-period. Patients diagnosed over 5 years before the study start date were excluded. Each eligible patient was interviewed by a movement disorder neurologist who conducted a standardized movement disorder survey and a focused examination. Each patient was followed prospectively for 1–4 follow-up visits. Movement disorders identified on examination were video-recorded and videos were independently rated by a separate blinded movement expert.ResultsSixty patients were included (56.6% female, mean age 38.3 ± 12.7 years). Eighty percent reported one or more movement disorders on the survey and 38.3% had positive findings on examination. After excluding incidental movement disorders (e.g., essential tremor), 58.3% were thought to have demyelination-related movement disorders. The most common movement disorders in a descending order were restless legs syndrome, tremor, tonic spasms, myoclonus, focal dystonia, spontaneous clonus, fasciculations, pseudoathetosis, hyperekplexia, and hemifacial spasm. The movement disorder started 5 months following a relapse on average but in 8 patients it was the presenting symptom of a new relapse or the disease itself. The majority of movement disorders occurred secondary to spinal (85.7%) or cerebellar/brainstem lesions (34.2%). Spinal cord demyelination was the only statistically significant predictor of demyelination-related movement disorders.ConclusionMovement disorders are more common than previously thought even in early MS. They typically begin a few months after spinal or brainstem/cerebellar relapses but may occasionally be the presenting symptom of a relapse.