Revista Mexicana de Neurociencia

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Revista Mexicana de Neurociencia >Year 2017, Issue 1

Gracia F, Parajeles VA, Panday A, Guirado-Romero AE, Molina KB, Treviño-Frenk I
Multiple Sclerosis in Central America and the Caribbean: Current Status and Care Recommendations
Rev Mex Neuroci 2017; 18 (1)

Language: Español
References: 53
Page: 76-88
PDF: 204.96 Kb.

Full text


Background: Multiple Sclerosis (MS) is a very serious, highly debilitating and costly disease. The medical management of MS is complex and in regions and countries with relatively limited health care systems and reduced financial resources, the impact of MS on individuals and society can be alarming.
Method: To better understand the issues related to MS management in Central America and the Caribbean, a group of experts from the Region and nearby countries were assembled to assess the status of MS and provide recommendations to government, organizations and practitioners.
Results: Based on an extensive review of the literature and their personal experiences, the Panel concluded that surveillance and epidemiology efforts within and between each country in Central America and the Caribbean needs substantial improvement and that MS is clearly mis- or undiagnosed to a great extent in the Region. Also, there is a need for comprehensive pharmacovigilance programs, better continuing education programs for clinicians and out-reach to communities, and the development of clinical guidelines relevant to the Region that stress the internationally accepted criteria to diagnosis MS, and its progression and treatment. In addition, the availability and appropriate use of approved medications, and more community-based, publicservice programs focused on MS are also urgently needed.
Conclusions: Medical societies and government should devote more resources toward educating health professionals and the public on all aspects of MS, and government should provide and support all necessary and well-grounded treatments.

Key words: Multiple Sclerosis, treatment, Central America, Caribbean, recommendations.


  1. Hafler DA. Multiple Sclerosis. J Clin Invest. 2004; 113: 788-794.

  2. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000; 343: 938–952.

  3. Belbasis L, Bellou V, Evangelou E, Ioannidis JPA, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic revies and meta-analyses. Lancet Neurol. 2015; 14(3): 263-273.

  4. Browne P, Chandraratna D, Angwood C, et al. Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity. Neurology. 2014; 83(11): 1022-4.

  5. Cristiano E, Rojas JI, Romano M, et al. The epidemiology of multiple sclerosis in Latin America and the Caribbean: a systematic review. Mult Scler. 2013; 19: 844–854.

  6. Gracia F, Castillo LC, Benzadon A, et al. Prevalence and incidence of multiple sclerosis in Panamá (2000–2005). Neuroepidemiology. 2009; 32: 287–293.

  7. Rivera VM. Multiple Sclerosis in Latin America. Neuroepidemiology. 2009; 32: 294-5. doi: 10.1159/000204913.

  8. Cabre P. Signate A, Olindo S, et al. Role of return migration in the emergence of multiple sclerosis in the French West Indies. Brain. 2005; 128: 2899-2910.

  9. Cabrera-Gomez JA, Santana Capote E, Echazabal-Santanta N, et al. Estado actual de la Esclerosis Multiple en Cuba. Rev Neurol. 2000; 31: 482-93.

  10. Melcon MO, Gold L, Carrá A, et al. Argentina Patagonia: Prevalence and clinical features of multiple sclerosis. Mult Scler. 2008; 15: 656–662.

  11. Melcon M, Melcon C, Bartoloni L, et al. Towards establishing MS prevalence in Latin America and the Caribbean. Mult Scler. 2013; 19(2): 145-152.

  12. Simpson S, Jr, Blizzard L, Otahal P, Van der Mei I, Taylor B. Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis. J Neurol Neurosurg Psychiatry. 2011; 82: 1132–1141.

  13. Flores J, Gonzalez S, Morales X, Yescas P, Ochoa A, Corona T. Absence of Multiple Sclerosis and Demyelinating Diseases among Lacandonians, a Pure Amerindian Ethnic Group in Mexico. Mult Scler Int. 2012; 2012:292631.

  14. Aguirre-Cruz L, Flores-Rivera J, De La Cruz-Aguilera DL, Rangel-López E, Corona T. Multiple Sclerosis in Caucasians and Latino Americans. Autoimmunity. 2011; 44(7): 571-5.

  15. Ordoñez G, Romero S, Orozco L, et al. Genomewide admixture study in Mexican Mestizos with multiple sclerosis. Clin Neurol Neursurgery. 2015; 130: 55-60.

  16. Dyment DA, Ebers GC, Sadovnick AD. Genetics of multiple sclerosis. Lancet Neurol. 2004; 3(2): 104- 10.

  17. Dyment DA, Herrera BM, Cader MZ, et al. Complex interactions among MHC haplotypes in multiple sclerosis: susceptibility and resistance. Hum Mol Genet. 2005; 14(4): 2019-26.

  18. Ramagopalan SV, Morris AP, Dyment DA, et al. The Inheritance of Resistance Alleles in Multiples Sclerosis. PLOS Genet. 2007; 3: e150.

  19. Ebers GC, Bulman DE, Sadovnick AD, et al. A population-based twin study in multiple sclerosis. N Engl J Med. 1986; 315: 1638-1642.

  20. Sadovnick AD, Baird PA, Ward RH. Multiple sclerosis: Updated risks for relatives. Am J Med Genet. 1988; 29: 533-541.

  21. Sadovnick AD, Ebers GC, Dyment DA, Risch NJ. Evdience for genetic basis of multiple sclerosis. The Canadian Collaborative Study Group. Lancet. 1996; 347: 1728-1730.

  22. Hawkes CH, Boniface D. Risk associated behavior in premorbid multiple sclerosis: A Case-control study. Mult Scler Relat Disord. 2014; 3(1): 40-47.

  23. Correale J, Farez M. Association between parasite infection and immune responses in multiple sclerosis. Ann Neurol. 2007; 61: 97-108.

  24. Bach, JF. The effect of infections and susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002; 347: 911-920.

  25. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011; 69: 292–302.

  26. Arrambide G, Sastre-Garriga J. Predictive markers of disease evolution after a CIS in everyday practice. J Neurol Sci. 2014; 343: 8-14.

  27. Tintore M, Rovira À, Río J, et al. Defining high, medium and low impact prognostic factors for developing multiple sclerosis. Brain. 2015; 138: 1863-74.

  28. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014; 83(3): 278-86. doi: 10.1212/WNL.0000000000000560.

  29. Carrá A, Macías-Islas MÁ, Gabbai AA, et al. Optimizing outcomes in multiple sclerosis: consensus guidelines for the diagnosis and treatment of multiple sclerosis in Latin America. Ther Adv Neurol Disord. 2011; 4(6): 349-60.

  30. Solomon AJ, Klein EP, Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012; 78: 1986-1991.

  31. Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004; 364(9451): 2106-12.

  32. Laule C, Vavasour IM, Moore GR, Oger J, Li DK, Paty DW. Water content and myelin water fraction in multiple sclerosis. A T2 relaxation study. J Neurol. 2004; 251(3): 284-293.

  33. Freedman MS, Comi F, De Stefano N, et al. Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice. Mult Scler Relat Disord. 2014; 3(2): 147-55.

  34. Leray E, Vukusic S, Debouverie M, et al. Excess Mortality in Patients with Multiple Sclerosis Starts at 20 Years from Clinical Onset: Data from a Large-Scale French Observational Study. PLoS ONE. 2015; 10(7): e0132033. doi:10.1371/journal.pone.0132033.

  35. Correale J, Abad P, Alvarenga R, et al. Management of relapsing-remitting multiple sclerosis in Latin America: Practical recommendations for treatment optimization. J Neurol Sci. 2014; 339(1-2): 196–206.

  36. Rotstein DL, Healy BC, Malik MT, Chitnis T, Weiner HL. Evaluation of no evidence of disease activity in a 7-year longitudinal multiple sclerosis cohort. JAMA Neurol. 2015; 72(2): 152-8.

  37. Stangel M, Penner IK, Kallmann BA, Lukas C, Kieseier BC. Towards the implementation of ‘no evidence of disease activity’ in multiple sclerosis treatment: the multiple sclerosis decision model. Ther Adv Neurol Disord. 2015; 8(1): 3-13.

  38. Rivera VM, Medina MT, Duron RM, Angel-Macias M. Multiple sclerosis care in Latin America. Neurology. 2014; 82(18): 1660-1661.

  39. Freedman MS, Selchen D, Arnold DL, et al. Treatment optimization in MS: Canadian MS Working Group updated recommendations. Can J Neurol Sci. 2013; 40(3): 307-23.

  40. Milo R. Effectiveness of multiple sclerosis treatment with current immunomodulatory drugs. Expert Opin Pharmacother. 2015; 16(5): 659-73.

  41. Damal K, Stoker E, Foley JF. Optimizing therapeutics in the management of patients with multiple sclerosis: a review of drug efficacy, dosing, and mechanisms of action. Biologics. 2013; 7: 247-258.

  42. Jeannin S, Deschamps R, Chausson N, Cabre P. Response to Interferon-Beta Treatment in Afro-Caribbeans with Multiple Sclerosis. Mult Scler Int. 2011; 2011: 950126. doi: 10.1155/2011/950126.

  43. Sormani MP, Rio J, Tintore M, et al. Scoring treatment response in patients with relapsing multiple sclerosis. Mult Scler. 2013; 19(5): 605-12.

  44. Rio J, Comabella M, Montalban X. Predicting responders to therapies for multiple sclerosis. Nat Rev Neurol. 2009; 5(10): 553-560.

  45. Le Page E, Veillard D, Laplaud DA, et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet. 2015 June 26. doi: 10.1016/S0140-6736(15)61137-0.

  46. Bevan C, Gelfand JM. Therapeutic management of severe relapses in multiple sclerosis. Curr Treat Options Neurol. 2015; 17(4): 345. doi: 10.1007/s11940-015-0345-6.

  47. Durelli L, Cocito D, Riccio A, et al. High-dose intravenous methylprednisolone in the treatment of multiple sclerosis: Clinical-immunologic correlations. Neurology. 1986; 36: 238–243.

  48. Gracia F, Armien B. Therapeutic armamentarium and health system coverage of multiple sclerosis in Latin America. Neuroepidemiology. 2012; 38(4): 217-8.

  49. Trisolini M, Honeycutt A, Wiener J, Lesesne S. Global Economic Impact of Multiple Sclerosis. London, UK: Multiple Sclerosis International Federation; 2010.

  50. GDP per capita (current US$). The World Bank Web site. http://data.worldbank.org/indicator/ NY.GDP.PCAP.CD. Accessed August 27, 2015.

  51. Macias-Islas MA, Soria-Cedillo IF, Velazquez-Quintana M, et al. Cost of care according to disease modifying therapy in Mexicans with relapsing-remitting multiple sclerosis. Acta Neurol Belg. 2013; 113: 415-420.

  52. Hartung DM, Bourdette DM, Ahmed SM, Whitham RH. The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail? Neurology. 2015; 84(21): 2185-92.

  53. Harris C. Costello K, Halper J. Consortium of multiple sclerosis centers recommendations for care of those affected by multiple sclerosis. Int J MS Care. 2003; 5(3): 67-68.

>Journals >Revista Mexicana de Neurociencia >Year 2017, Issue 1

· Journal Index 
· Links 

Copyright 2019