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Article ; Online: Hypophosphatemia as a possible biomarker for epileptic seizures at the emergency department.

Coutinho, Maria P / Faustino, Patrícia / Ladeira, Filipa / Leitão, Lia

2023 Volume 111, Page(s) 42–44

Abstract: Introduction: Hypophosphatemia seems to be temporally associated with seizures, despite not being considered a trigger. We aimed to evaluate hypophosphatemia as a biomarker for seizures.: Methods: Retrospective study, including all consecutive ... ...

Abstract	Introduction: Hypophosphatemia seems to be temporally associated with seizures, despite not being considered a trigger. We aimed to evaluate hypophosphatemia as a biomarker for seizures. Methods: Retrospective study, including all consecutive patients admitted at our central hospital's emergency department from 01/01-31/03/2021, screened as "altered consciousness/syncope" or "seizures", with available phosphate levels. Results: 277 patients included, mostly male (61.7%), mean age 64.3 years. Final diagnosis was "seizure" in 34.7% and "other diagnosis" in 65.3%. Patients with seizures were younger (p<0.001), had more frequent epilepsy (p<0.001) and alcoholism (p=0.01). Patients with other diagnosis had more often renal failure (p<0.001) and statin (p=0.02) or diuretic (p=0.003) therapy. Time to blood collection (from the event and from admission) was similar between groups. Patients with seizures had lower mean phosphate levels and more frequent hypophosphatemia (<2.4mg/dL) (p<0.001). Mean CK levels were similar in both groups (p=0.25). HyperCK (>200U/L) was more frequent in the seizure group (p=0.04). Odds ratio (OR) of hypophosphatemia for seizures was 4.330 (CI 95% 2.170-8.640, p<0.001), persisting after correction for confounders. OR of hyperCK was 1.890 (CI 95% 1.060-3.371, p=0.03), losing significance when adjusted. Sensitivity was low for both. Hypophosphatemia was more specific (91.2% vs 79.9%). Conclusions: Our findings support hypophosphatemia as a seizure biomarker. More studies are needed.
Language	English
Publishing date	2023-07-17
Publishing country	England
Document type	Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2023.07.012
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Article ; Online: Outcomes in Guillain-Barré Syndrome following a second therapeutic cycle - A single-centre retrospective observational study.

Faustino, Patrícia / Coutinho, Maria / Brum, Marisa / Medeiros, Luísa / Ladeira, Filipa

Journal of the neurological sciences

2022 Volume 441, Page(s) 120368

Abstract: Introduction: The treatment of Guillain-Barré Syndrome (GBS) with intravenous immunoglobulin (IVIg) or plasma exchange (PE) reduces time to clinical recovery. Although sometimes used in clinical practice, the benefit of a second treatment cycle is of ... ...

Abstract	Introduction: The treatment of Guillain-Barré Syndrome (GBS) with intravenous immunoglobulin (IVIg) or plasma exchange (PE) reduces time to clinical recovery. Although sometimes used in clinical practice, the benefit of a second treatment cycle is of unproven benefit. Aims: Our aim was to compare GBS prognosis in patients treated with one or two cycles of IVIg or PE. Methods: We selected patients with electrophysiological studies compatible with acute inflammatory demyelinating polyneuropathy or acute motor-sensory axonal neuropathy, from January 2018 to December 2020 in our hospital. Our primary outcome was any improvement in the Guillain-Barré Syndrome Disability Score (GBS-DS) at a mean of twelve weeks. We compared patients treated with one or two treatment cycles with a binary regression. Results: We included twenty-six patients, 65.4% with the classical presentation and 30.8% were treated with two cycles. Patients treated with two cycles presented a higher basal GBS-DS (median 4; IQR 1-5) compared with the group of patients treated with one cycle (median 3; IQR 1-5), p = 0.01. The remaining basal characteristics were similar between groups. The two-cycle treatment regimen did not associate with an improvement in GBS-DS (OR 0.28, 95% CI 0.03-2.35, p = 0.24). Likewise there was no benefit in the need for intensive care unit (OR 2.0, 95% CI 0.37-10.92, p = 0.42) or mechanical invasive ventilation (OR 10.2, 95% CI 0.86-120.96, p = 0.66). Discussion: Our analysis reinforces the recent literature data regarding the absence of benefit of two treatment cycles in patients with GBS.
MeSH term(s)	Guillain-Barre Syndrome/drug therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Plasma Exchange ; Plasmapheresis ; Prognosis
Chemical Substances	Immunoglobulins, Intravenous
Language	English
Publishing date	2022-07-29
Publishing country	Netherlands
Document type	Journal Article ; Observational Study
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2022.120368
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Article ; Online: Nivolumab-induced seronegative encephalitis.

Cabral, Gonçalo / Ladeira, Filipa / Gil, Nuno

Journal of neuroimmunology

2020 Volume 347, Page(s) 577350

Abstract: Immune checkpoint inhibitors (ICIs) have emerged as a new therapeutic tool for numerous types of cancer. Neurological complications have been reported in 1% of patients who have undergone checkpoint inhibition therapy. ICIs-induced encephalitides occur ... ...

Abstract	Immune checkpoint inhibitors (ICIs) have emerged as a new therapeutic tool for numerous types of cancer. Neurological complications have been reported in 1% of patients who have undergone checkpoint inhibition therapy. ICIs-induced encephalitides occur in 0.1-0.2% of patients within weeks after ICIs initiation; are usually seronegative and have nonspecific changes on imaging, CSF and electroencephalogram (EEG) studies. Early recognition and prompt treatment are important to prevent significant morbidity and mortality. We present a case of nivolumab-induced encephalitis with very subtle clinical symptoms and full recovery following ICIs suspension and steroids.
MeSH term(s)	Aged ; Encephalitis/blood ; Encephalitis/chemically induced ; Encephalitis/diagnostic imaging ; Female ; Humans ; Immune Checkpoint Inhibitors/adverse effects ; Nivolumab/adverse effects
Chemical Substances	Immune Checkpoint Inhibitors ; Nivolumab (31YO63LBSN)
Language	English
Publishing date	2020-08-03
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	8335-5
ISSN	1872-8421 ; 0165-5728
ISSN (online)	1872-8421
ISSN	0165-5728
DOI	10.1016/j.jneuroim.2020.577350
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Article ; Online: HBV and VZV seroprotection loss in MS patients under DMT.

Ladeira, Filipa / Oliveira, Tiago / Soares, Mafalda / Araujo, Cristina / Sousa, Ana / Brum, Marisa / Sequeira, João / Capela, Carlos

Multiple sclerosis and related disorders

2022 Volume 70, Page(s) 104490

Abstract: Background: Strategies recommended to decrease the risk of infection associated with the use of multiple sclerosis disease-modifying treatments include screening and immunization against common viral infections such as varicella-zoster (VZV) and ... ...

Abstract	Background: Strategies recommended to decrease the risk of infection associated with the use of multiple sclerosis disease-modifying treatments include screening and immunization against common viral infections such as varicella-zoster (VZV) and hepatitis B (HBV). However, the data concerning the durability of those vaccine responses and the need for re-test is scarce. Objectives: We aimed to evaluate HBV and VZV seroprotection loss in MS patients under DMT. Methods: We conducted a cohort study including patients with basal seroprotective titers against HBV/VZV viruses and a subsequent serology performed at least 3 months apart. We evaluated predictors of seroprotection loss through a binary regression. Results: HBV seroprotection loss occurred in one-fifth of patients in a median interval of 21.3 months. Anti-CD20 treatment (OR 8.559 95%CI 3.467- 21.130, p < 000.1), age at last serology higher or equal to 55 years (OR 7.506, 95% CI 2.473-22.786, p < 0.001) and basal HBsAb titer (OR 0.992, 95%CI 0.987 -0.996, p=0.001) increase the risk of seroprotection loss. VZV seroprotection loss occurred rarely in a median interval of 21.3 months. We could not identify any factor associated with an increased risk of VZV seroprotection loss. Conclusions: Anti-CD20 drugs are associated with a loss of seroprotection against HBV in a short-interval follow-up.
MeSH term(s)	Humans ; Hepatitis B virus ; Hepatitis B Vaccines/therapeutic use ; Cohort Studies ; Hepatitis B/drug therapy ; Hepatitis B/prevention & control ; Hepatitis B Antibodies
Chemical Substances	Hepatitis B Vaccines ; Hepatitis B Antibodies
Language	English
Publishing date	2022-12-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2022.104490
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Article ; Online: Acute-onset chronic inflammatory demyelinating polyneuropathy with anti-neurofascin-155 antibodies and bilateral facial nerve enhancement.

Caetano, André / Ladeira, Filipa / Fernandes, Marco / Pires, Pedro / Medeiros, Elmira

Journal of neuroimmunology

2019 Volume 336, Page(s) 577026

Abstract: A 26-year-old female presented with acute onset distal paraparesis, upper limb tremor and bilateral facial palsy. Neurophysiology revealed a sensorimotor demyelinating polyneuropathy and lumbar puncture revealed an albuminocytologic dissociation. ... ...

Abstract	A 26-year-old female presented with acute onset distal paraparesis, upper limb tremor and bilateral facial palsy. Neurophysiology revealed a sensorimotor demyelinating polyneuropathy and lumbar puncture revealed an albuminocytologic dissociation. Neuroaxis MRI revealed bilateral facial nerve and cauda equina enhancement. Initially diagnosed as Guillain-Barré Syndrome, poor response to intravenous immunoglobulin, persistent deterioration, anti-neurofascin-155 antibodies and clinical response to steroid therapy led to diagnosis of acute-onset chronic inflammatory demyelinating polyneuropathy (CIDP). CIDP patients with anti-neurofascin-155 antibodies are younger, with distal predominant weakness, tremor, and poor response to intravenous immunoglobulin. Up to 16% can present acutely, however bilateral facial weakness is rare.
MeSH term(s)	Adult ; Autoantibodies/blood ; Cell Adhesion Molecules/blood ; Facial Nerve/diagnostic imaging ; Female ; Humans ; Nerve Growth Factors/blood ; Neural Conduction/physiology ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/blood ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnostic imaging
Chemical Substances	Autoantibodies ; Cell Adhesion Molecules ; NFASC protein, human ; Nerve Growth Factors
Language	English
Publishing date	2019-08-21
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	8335-5
ISSN	1872-8421 ; 0165-5728
ISSN (online)	1872-8421
ISSN	0165-5728
DOI	10.1016/j.jneuroim.2019.577026
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Article ; Online: Safety and Effectiveness of Cladribine in Multiple Sclerosis: Real-World Clinical Experience From 5 Tertiary Hospitals in Portugal.

Santos, Mónica / Sequeira, João / Abreu, Pedro / Guerreiro, Rui / Santos, Mariana / Ferreira, João / Brum, Marisa / Ladeira, Filipa / Leitão, Lia / Dias, Rafael / Sá, Maria José / Salgado, Vasco / Capela, Carlos / de Sá, João

Clinical neuropharmacology

2023 Volume 46, Issue 3, Page(s) 105–111

Abstract: Objectives: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe for very active multiple sclerosis (MS) with relapses. Aims were to assess the safety and effectiveness of cladribine in real-world setting, during ...

Abstract	Objectives: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe for very active multiple sclerosis (MS) with relapses. Aims were to assess the safety and effectiveness of cladribine in real-world setting, during treatment follow-up. Methods: This was a multicentric, longitudinal, observational study with retrospective and prospective data collection of clinical, laboratory, and imaging data. This interim analysis reports data from July 1, 2018 (study onset), to March 31, 2021. Results: A total of 182 patients were enrolled: 68.7% were female; mean age at onset was 30.1 ± 10.0 years, and mean age at first cycle of cladribine treatment was 41.1 ± 12.1; 88.5% were diagnosed with relapse-remitting MS and 11.5% with secondary progressive MS. Mean disease duration at cladribine start was 8.9 ± 7.7 years. Most patients (86.1%) were not naive, and median number of previous disease-modifying therapies was 2 (interquartile range, 1-3). At 12 months, we observed no significant Expanded Disability Status Scale score worsening ( P = 0.843, Mann-Whitney U test) and a significantly lower annualized relapse rate (0.9 at baseline to 0.2; 78% reduction). Cladribine treatment discontinuation was registered in 8% of patients, mainly (69.2%) due to disease activity persistence. Most frequent adverse reactions were lymphocytopenia (55%), infections (25.2%), and fatigue (10.7%). Serious adverse effects were reported in 3.3%. No patient has discontinued cladribine treatment because of adverse effects. Conclusion: Our study confirms the clinical efficacy and the safety profile of cladribine for treating MS patients with a long-term active disease in the real-world setting. Our data contribute to the body of knowledge of the clinical management of MS patients and the improvement of related clinical outcomes.
MeSH term(s)	Humans ; Female ; Male ; Cladribine/adverse effects ; Multiple Sclerosis/drug therapy ; Immunosuppressive Agents/adverse effects ; Portugal/epidemiology ; Retrospective Studies ; Tertiary Care Centers ; Drug-Related Side Effects and Adverse Reactions ; Recurrence ; Multiple Sclerosis, Relapsing-Remitting/drug therapy
Chemical Substances	Cladribine (47M74X9YT5) ; Immunosuppressive Agents
Language	English
Publishing date	2023-04-11
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	199293-4
ISSN	1537-162X ; 0362-5664
ISSN (online)	1537-162X
ISSN	0362-5664
DOI	10.1097/WNF.0000000000000552
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Article ; Online: The Influence of Menopause in Multiple Sclerosis Course: A Longitudinal Cohort Study.

Ladeira, Filipa / Salavisa, Manuel / Caetano, André / Barbosa, Raquel / Sá, Francisca / Correia, Ana Sofia

European neurology

2019 Volume 80, Issue 3-4, Page(s) 223–227

Abstract: Background: Hormonal variations are known to influence the course of multiple sclerosis (MS).: Objectives: We aimed to evaluate the impact of menopause in MS course, including disease activity and disability progression.: Methods: We conducted a ... ...

Abstract	Background: Hormonal variations are known to influence the course of multiple sclerosis (MS). Objectives: We aimed to evaluate the impact of menopause in MS course, including disease activity and disability progression. Methods: We conducted a retrospective longitudinal cohort study including all women, older than 44, post-menopausal, with a diagnosis of MS at least 1 year before menopause. We evaluated the impact of menopause in MS course comparing clinical and radiologic outcomes within 5 years before and after menopause. We repeated the analysis in subgroups of patients without disease-modifying treatment (DMT) change or co-morbidities diagnosed during the observation period, considering that those factors might also impact MS outcomes. Results: Thirty-seven women, with a mean age at the time of menopause of 49.8 (±4.06) years were included in the analysis. Within 5 years following menopause, we observed a decrease in the annualized relapse rate (0.37 ± 0.35 pre-menopause vs. 0.08 ± 0.18 post-menopause, p < 0.001) compared with the same period before menopause, while the EDSS progression rate remained stable (0.13 ± 0.24 EDSS point/year pre-menopausal vs. 0.13 ± 0.18 post-menopause, p = 0.935). EDSS progression events frequency was similar before and after the menopause (37.8 vs. 48.6%, respectively, p = 0.424). These observations persisted in patients' subgroups without DMT switch or co-morbidities. Conclusions: Following menopause, we observed a reduction in the relapse rate, but the disability progression continued at a similar rate, compared to the pre-menopausal period. These observations persisted in the subgroup of patients without changes in DMT or co-morbidities diagnosed during the observation period.
MeSH term(s)	Adult ; Cohort Studies ; Disease Progression ; Female ; Humans ; Longitudinal Studies ; Menopause ; Middle Aged ; Multiple Sclerosis ; Postmenopause ; Premenopause ; Recurrence ; Retrospective Studies
Language	English
Publishing date	2019-01-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	209426-5
ISSN	1421-9913 ; 0014-3022
ISSN (online)	1421-9913
ISSN	0014-3022
DOI	10.1159/000496374
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Article ; Online: Probable REM-Sleep Behavior Disorder and Dysautonomic Symptoms in Essential Tremor.

Barbosa, Raquel / Mendonça, Marcelo / Ladeira, Filipa / Miguel, Rita / Bugalho, Paulo

Tremor and other hyperkinetic movements (New York, N.Y.)

2017 Volume 7, Page(s) 522

Abstract: Background: Non-motor symptoms can be present in essential tremor (ET). We intend to assess the frequency of rapid eye movement (REM) sleep behavior disorder (RBD) and dysautonomic symptoms in ET patients and evaluate the differences between patients ... ...

Abstract	Background: Non-motor symptoms can be present in essential tremor (ET). We intend to assess the frequency of rapid eye movement (REM) sleep behavior disorder (RBD) and dysautonomic symptoms in ET patients and evaluate the differences between patients with ET and RBD (ET-RBD and ET without RBD [ET-nonRBD]). Methods: All ET patients were contacted by telephone. Autonomic symptoms were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) questionnaire, and RBD symptoms with the RBD screening questionnaire (RBDSQ) using ≥5 as a cut-off for probable RBD (pRBD). Results: From 92 ET patients contacted, 53 (55% female) were included. The mean age at assessment was 73.6±19 years, and the average disease duration was 19.9±17.3 years. Fourteen patients (26.4%) had pRBD and 52 (98.1%) reported at least one autonomic symptom, the most prevalent being urinary symptoms (96%). The ET-RBD group had higher SCOPA-total and thermoregulatory scores than ET-nonRBD patients (13.9±9.6 vs. 7.7±5.1, p=0.017 and 2.5±2.0 vs. 0.9±1.6, p=0.001). There were no other differences between groups. Discussion: Our results suggest that pRBD is common in ET, and its presence is associated with dysautonomic symptoms. As these symptoms are known to be prodromal symptoms of Parkinson's disease (PD), we question if this patient subgroup has a higher risk of developing a synucleinopathy.
MeSH term(s)	Aged ; Cohort Studies ; Essential Tremor/complications ; Essential Tremor/physiopathology ; Female ; Humans ; Male ; Primary Dysautonomias/complications ; Primary Dysautonomias/physiopathology ; REM Sleep Behavior Disorder/complications ; REM Sleep Behavior Disorder/physiopathology
Language	English
Publishing date	2017-12-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2674453-3
ISSN	2160-8288 ; 2160-8288
ISSN (online)	2160-8288
ISSN	2160-8288
DOI	10.7916/D8Z61VW5
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Article ; Online: Capsular warning syndrome: The role of blood pressure.

Ladeira, Filipa / Barbosa, Raquel / Calado, Sofia / Viana-Baptista, Miguel

Journal of the neurological sciences

2017 Volume 381, Page(s) 20–21

MeSH term(s)	Aged ; Aged, 80 and over ; Blood Pressure ; Female ; Hospitalization ; Humans ; Ischemic Attack, Transient/physiopathology ; Ischemic Attack, Transient/therapy ; Male ; Middle Aged ; Retrospective Studies ; Stroke, Lacunar/physiopathology ; Stroke, Lacunar/therapy ; Syndrome
Language	English
Publishing date	2017-08-09
Publishing country	Netherlands
Document type	Letter
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2017.08.008
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Article ; Online: Obstructive Sleep Apnea and Other Vascular Risk factors' Impact on Non-Motor Symptoms in Parkinson's Disease.

Meira, Bruna / Fernandes, Marco / Salavisa, Manuel / Saraiva, Marlene / Conceição, Laurete / Borbinha, Cláudia / Ladeira, Filipa / Marto, João Pedro / Barbosa, Raquel / Mendonça, Marcelo / Bugalho, Paulo

Movement disorders clinical practice

2022 Volume 9, Issue 6, Page(s) 785–798

Abstract: Background: Previous studies revealed an association between vascular comorbidities and obstructive sleep apnea (OSA) and the severity of motor and cognitive symptoms in Parkinson's disease (PD). However, there is a lack of studies assessing the entire ... ...

Abstract	Background: Previous studies revealed an association between vascular comorbidities and obstructive sleep apnea (OSA) and the severity of motor and cognitive symptoms in Parkinson's disease (PD). However, there is a lack of studies assessing the entire spectrum of non-motor symptoms (NMS). Objective: To investigate the relationship between vascular comorbidities and NMS in PD patients. Methods: Patients were assessed at baseline and 4 years later with the Non-Motor Symptom Assessment Scale, Parkinson's Psychosis Questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment, and Apathy scale. After tetrachoric correlation matrix, we conducted linear regression models (adjusted for age, gender, disease duration, and UPDRS-III) to investigate the relationship between vascular comorbidities and NMS. Results: In 73 PD patients, (mean disease duration 7.1 [5.3]), 57% had hypertension, 44% body mass index >25, 44% elevated cholesterol, 15% diabetes mellitus, 15% OSA, 14% cigarette-smoking history, 8% prior stroke, and 8% coronary disease. Cognition, psychotic symptoms, apathy, urinary function, and miscellaneous domains significantly worsened at the 4-year follow-up. OSA was significantly associated with higher severity of hallucinations/illusions at baseline and with a more severe deterioration of attention/memory, psychotic symptoms, and apathetic mood at the 4-year follow-up. At baseline, but not at follow-up, hypertension was negatively associated with miscellaneous domain scores and coronary disease with autonomic function scores (gastrointestinal tract and urinary function domains). Conclusion: Among PD-associated comorbidities, OSA was the main factor of decline. In addition to cognitive impairment, OSA might also potentially worsen psychotic symptoms and apathy. Treatment of OSA could be a strategy to improve these important NMS.
Language	English
Publishing date	2022-07-06
Publishing country	United States
Document type	Journal Article
ISSN	2330-1619
ISSN (online)	2330-1619
DOI	10.1002/mdc3.13504
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