Browsing by Author "Ciampi, Ethel"

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    Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study
    (2016) Bertoglio, J. C.; Baumgartner, M.; Palma Vásquez, Ramón Eduardo; Ciampi, Ethel; Cárcamo, Claudia; Cáceres, D. D.; Acosta-Jamett, G.; Hancke, J. L.; Burgos, R. A.
    Abstract Background Andrographis paniculata (A. paniculata), a medicinal plant, has shown anti-inflammatory, neuroprotective and antifibrotic effects in animal models as well as clinical efficacy in different studies, including an anti-fatigue effect in autoimmune diseases such as rheumatoid arthritis. In multiple sclerosis (MS), fatigue is rated as one of the most common and disabling symptoms. In the present trial, we investigated the effect of A. paniculata on relapse rate and fatigue in relapsing-remitting MS (RRMS) patients receiving interferon beta. Methods A randomised double-blind placebo-controlled trial assessed the effects of 170 mg of A. paniculata dried extract tablet b.i.d. p.o. on relapse rate and fatigue using the Fatigue Severity Scores (FSS) over 12 months in RRMS patients receiving interferon. The Expanded Disability Status Scale (EDSS) score, inflammatory parameters and radiological findings were also investigated. Twenty-five patients were enrolled, and twenty-two patients were ultimately analysed and randomised to the active or placebo group. Results Patients treated with A. paniculata showed a significant reduction in their FSS score as compared to the placebo, equivalent to a 44 % reduction at 12 months. No statistically significant differences were observed for relapse rate, EDSS or inflammatory parameters, with a trend in reducing new lesions among the A. paniculata group. One patient in the A. paniculata group presented with a mild and transient skin rash, which was alleviated with anti-histamine treatment for three weeks. Conclusion A. paniculata was well tolerated in patients and no changes in clinical parameters were observed. A. paniculata significantly reduces fatigue in patients with RRMS receiving interferon beta in comparison to placebo and only interferon beta treatment. Trial registration ClinicalTrials.gov Identifier: NCT02280876 ; Trial registration date: 20.10.2014.
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    Coronavirus disease 2019 in Latin American patients with multiple sclerosis
    (ELSEVIER SCI LTD, 2021) Fragoso, Yara D.; Schiavetti, Irene; Carmisciano, Luca; Ponzano, Marta; Steinberg, Judith; Trevino Frenk, Irene; Ciampi, Ethel; Vecino, Maria Cecilia A.; Correa, Edgar P.; Carcamo Rodriguez Claudia Andrea; Gomes, Sidney; Pimentel, Maria Lucia V.; Santos, Gutemberg A. C.; Vrech, Carlos; Winckler, Thereza C. A.; Sormani, Maria Pia
    Patients with multiple sclerosis (MS) who present coronavirus disease 2019 (COVID-19) are of particular interest to neurologists. These patients have a neuroimmune disease and receive immunomodulatory or immunosuppressive therapies in the long-term. We present here data from 73 patients with MS and a confirmed diagnosis of COVID-19 from five Latin American countries. Fifteen patients (20.5%) were hospitalized and two patients died. The use of anti-CD20 therapies was the only risk factor associated to hospitalization and death. Despite the small sample size, this study highlights the awareness regarding therapeutic options for MS during the pandemic.
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    Corpus callosum atrophy and post-surgical seizures in temporal lobe epilepsy associated with hippocampal sclerosis
    (2018) Uribe-San-Martin, Reinaldo; Ciampi, Ethel; Di Giacomo, Roberta; Vasquez, Macarena; Carcamo, Claudia; Godoy F., Jaime; Lo Russo, Giorgio; Tassi, Laura
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    COVID-19 in MS and NMOSD: a multicentric online national survey in Chile
    (2020) Ciampi, Ethel; Uribe-San-Martín, Reinaldo; Soler, Bernardita; Fernández, Ramiro; García, Pía; Navarrete-Asenjo, Claudio; Tirapegui, José Miguel; Torres, Rubén; Polanco, Juan; Suárez, Felipe; Cuello, María José; Cárcamo, Claudia
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    COVID-19 pandemic: the experience of a multiple sclerosis centre in Chile
    (2020) Ciampi, Ethel; Uribe-San-Martin, Reinaldo; Cárcamo, Claudia
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    Diagnostic MRI Score to Differentiate Susac Syndrome from Primary Angiitis of the Central Nervous System and Multiple Sclerosis
    (2024) Marrodan, Mariano; Calandri, Ismael L.; Bocancea, Diana I.; Ysrraelit, Maria C.; Figueroa, Enrique Gomez; Paez, Montserrat Masso; Flores, Jose D. J.; Rojas, Juan I.; Ciampi, Ethel; Ioli, Pablo; Zanga, Gisela; Ardohain, Carolina; Fracaro, Maria E.; Amaya, Mariela; Tkachuk, Veronica; Fernandez, Victoria C.; Jose, Gustavo; Silva, Emanuel; Luetic, Geraldine; Contentti, Edgar Carnero; Kohler, Eduardo; Cassara, Fatima Pagani; Moran, Dolores; Seimandi, Carla; Paviolo, Juan P.; D'elio, Brenda; Da Prat, Gustavo; Gatto, Emilia; Cristiano, Edgardo; Lereis, Virginia Pujol; Ameriso, Sebastian F.; Fiol, Marcela P.; Correale, Jorge
    Objective: Susac syndrome (SuS), multiple sclerosis (MS), and primary angiitis of the central nervous system (PACNS) present diagnostic challenges due to overlapping clinical features. We aimed to enhance diagnostic precision by developing the SPAMS (SuS, PACNS, MS) score, a practical radiological tool. Methods: This multicenter study included 99 patients (43 SuS, 37 MS, 19 PACNS) from South American countries. Relevant MRI features were identified through an elastic-net model determined key variables. Results: The SPAMS score assigned 2 points for snowball lesions, 1 point for spokes-like lesions, or if there are more than 4 lesions in the corpus callosum, corpus callosum involvement, or cerebellar involvement. It subtracted 1 point if gadolinium-enhancing lesions or 4 points if Dawson's fingers are present. Bootstrapping validated the optimal cutoff at 2 points, exhibiting a diagnostic performance of area under the curve = 0.931, sensitivity = 88%, specificity = 89%, positive predictive value = 88%, negative predictive value = 89%, and accuracy = 88%. Interpretation: When specific MRI findings coexisted, the SPAMS score differentiated SuS from MS and PACNS. Access to MRI and standard protocol sequences makes it a valuable tool for timely diagnosis and treatment, potentially preventing disability progression and severe clinical outcomes.
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    Efficacy of andrographolide in not active progressive multiple sclerosis: a prospective exploratory double-blind, parallel-group, randomized, placebo-controlled trial
    (2020) Ciampi, Ethel; Uribe-San-Martin, Reinaldo.; Cárcamo Rodríguez, Claudia Andrea; Cruz, Juan Pablo; Reyes, Ana.; Reyes, Diego.; Pinto, Carmen.; Vásquez Torres, Macarena.; Burgos, Rafael A.; Hancke, Juan.
    Abstract Background Multiple sclerosis (MS) is a chronic immune mediated disease and the progressive phase appears to have significant neurodegenerative mechanisms. The classification of the course of progressive MS (PMS) has been re-organized into categories of active vs. not active inflammatory disease and the presence vs. absence of gradual disease progression. Clinical trial experience to date in PMS with anti-inflammatory medications has shown limited effect. Andrographolide is a new class of anti-inflammatory agent, that has been proposed as a potential drug for autoimmune disorders, including MS. In the present trial, we perform an exploratory pilot study on the efficacy and safety of andrographolide (AP) compared to placebo in not active PMS. Methods A pilot clinical trial using 140 mg oral AP or placebo twice daily for 24 months in patients with not active primary or secondary progressive MS was conducted. The primary efficacy endpoint was the mean percentage brain volume change (mPBVC). Secondary efficacy endpoints included 3-month confirmed disability progression (3-CDP) and mean EDSS change. Results Forty-four patients were randomized: 23 were assigned to the AP group, and 21 were assigned to the placebo group. The median baseline EDSS of both groups was 6.0. Annualized mPBVC was − 0.679% for the AP group and − 1.069% for the placebo group (mean difference: -0.39; 95% CI [− 0.836–0.055], p = 0.08, relative reduction: 36.5%). In the AP group, 30% had 3-CDP compared to 41% in the placebo group (HR: 0.596; 95% CI [0.200–1.777], p = 0.06). The mean EDSS change was − 0.025 in the AP group and + 0.352 in the placebo group (mean difference: 0.63, p = 0.042). Adverse events related to AP were mild rash and dysgeusia. Conclusions AP was well tolerated and showed a potential effect in reducing brain atrophy and disability progression, that need to be further evaluated in a larger clinical trial. Trial registration ClinicalTrials.gov NCT02273635 retrospectively registered on October 24th, 2014.
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    Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings
    (2021) Uribe San Martin, Reinaldo; Di Giacomo, Roberta; Mai, Roberto; Gozzo, Francesca; Pelliccia, Veronica; Mariani, Valeria; Cardinale, Francesco; Ciampi, Ethel; Onofrj, Marco; Tassi, Laura
    BACKGROUND: Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery. OBJECTIVE: To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy. METHODS: We selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed. RESULTS: A total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients. CONCLUSION: The degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.
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    Galectin-8 as an immunosuppressor in experimental autoimmune encephalomyelitis and a target of human early prognostic antibodies in multiple sclerosis
    (2017) Pardo, Evelyn; Cárcamo, Claudia; Uribe-San Martín, Reinaldo; Ciampi, Ethel; Segovia-Miranda, Fabián; Curkovic-Peña, Cristobal; Montecino, Fabián; Holmes, Christopher; Tichauer, Juan Enrique; Acuña, Eric; Osorio-Barrios, Francisco; Castro, Marjorie; Cortes, Priscilla; Oyanadel, Claudia; Valenzuela, David M.; Pacheco, Rodrigo; Naves, Rodrigo; Soza, Andrea; González, Alfonso
    Galectin-8 (Gal-8) is a member of a glycan-binding protein family that regulates the immune system, among other functions, and is a target of antibodies in autoimmune disorders. However, its role in multiple sclerosis (MS), an autoimmune inflammatory disease of the central nervous system (CNS), remains unknown. We study the consequences of Gal-8 silencing on lymphocyte subpopulations and the development of experimental autoimmune encephalitis (EAE), to then assess the presence and clinical meaning of anti-Gal-8 antibodies in MS patients. Lgals8/Lac-Z knock-in mice lacking Gal-8 expression have higher polarization toward Th17 cells accompanied with decreased CCR6+ and higher CXCR3+ regulatory T cells (Tregs) frequency. These conditions result in exacerbated MOG35-55 peptide-induced EAE. Gal-8 eliminates activated Th17 but not Th1 cells by apoptosis and ameliorates EAE in C57BL/6 wild-type mice. β-gal histochemistry reflecting the activity of the Gal-8 promoter revealed Gal-8 expression in a wide range of CNS regions, including high expression in the choroid-plexus. Accordingly, we detected Gal-8 in human cerebrospinal fluid, suggesting a role in the CNS immune-surveillance circuit. In addition, we show that MS patients generate function-blocking anti-Gal-8 antibodies with pathogenic potential. Such antibodies block cell adhesion and Gal-8-induced Th17 apoptosis. Furthermore, circulating anti-Gal-8 antibodies associate with relapsing-remitting MS (RRMS), and not with progressive MS phenotypes, predicting clinical disability at diagnosis within the first year of follow-up. Our results reveal that Gal-8 has an immunosuppressive protective role against autoimmune CNS inflammation, modulating the balance of Th17 and Th1 polarization and their respective Tregs. Such a role can be counteracted during RRMS by anti-Gal-8 antibodies, worsening disease prognosis. Even though anti-Gal-8 antibodies are not specific for MS, our results suggest that they could be a potential early severity biomarker in RRMS.
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    In Reply: Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings
    (2021) Uribe San Martin, Reinaldo; Di Giacomo, Roberta; Mai, Roberto; Gozzo, Francesca; Pelliccia, Veronica; Mariani, Valeria; Cardinale, Francesco; Ciampi, Ethel; Onofrj, Marco; Tassi, Laura
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    Occurrence of area postrema syndrome during follow-up: phenotype and influence over NMOSD activity in LATAM in real-world settings
    (2024) Pestchanker, Claudia; Cortez, Brenda Bertado; Peixoto, Marco A. Lana; Gortari, Jose Ignacio; Suarez, Sheila Castro; Zamalloa, Cesar Caparo; Galiana, Graciana; Penalver, Francisco; Marques, Vanesa Daccach; Messias, Katharina; Galleguillos, Lorna; Garcia, Fernando; Rojas, Juan I.; Patrucco, Liliana; Cristiano, Edgardo; Tkachuk, Veronica; Liwacki, Susana; Correale, Jorge; Marrodan, Mariano; Ysraelit, Maria C.; Vrech, Carlos; Deri, Norma; Leguizamon, Felisa; Tavolini, Dario; Mainella, Carolina; Zanga, Gisela; Serena, Marina Alonso; Ciampi, Ethel; Soares Neto, Herval Ribeiro; Lopez, Pablo; Contentti, Edgar Carnero
    IntroductionWe aimed to assess the frequency, duration, and severity of area postrema syndrome (APS) during follow-up in neuromyelitis optica spectrum disorder (NMOSD) patients, as well as its association with inflammatory activity and prognostic factors of APS severity in a real-world setting.MethodsWe conducted a retrospective study on a cohort of Latin American (LATAM) NMOSD patients who had experienced APS during their follow-up. Patients from Mexico, Peru, Brazil, Colombia, Panama, Chile and Argentina patients who met 2015 NMOSD criteria were included. We evaluated data on symptom type (nausea, vomiting and/or hiccups), frequency, duration, severity (measured by APS severity scale), association with other NMOSD core relapses, and acute treatments (symptomatic and immunotherapy or plasmapheresis). Logistic regression was conducted to evaluate factors associated with APS severity (vs. mild-moderate).ResultsOut of 631 NMOSD patients, 116 (18.3%) developed APS during their follow-up. The most common APS phenotype was severe. Inflammatory activity (i.e., relapses) significantly decreased after the onset of APS. Half of the patients experienced isolated APS with a median duration of 10 days, and the most frequently used acute treatment was IV steroids. All three symptoms were present in 44.6% of the patients. APS symptoms resolved following immunotherapy. Logistic regression did not identify independent factors associated with the severity of APS.ConclusionsOur findings indicate that 18.3% of NMOSD patients developed APS during the follow-up period, with most patients fulfilling criteria for severe APS. The inflammatory activity decreased after the onset of APS compared to the previous year.
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    Oftalmoparesia dolorosa episódica asociada a rinosinusitis aguda recurrente: Un caso de síndrome de Tolosa Hunt
    (2015) Perelli S, J.; Vergara V, M.; Ciampi, Ethel; Cabezón A, R.; Uribe S, R.
    Tolosa Hunt Syndrome is the idiopathic inflammation of cavernous sinus, characterized by one or more episodes of unilateral orbital pain followed by ophtalmoparesis (III, IV o VI nerve palsy) and sometimes the affection of maxillary branch of the trigeminal nerve. We describe the case of a 27 years old man with episodes of painful right ophtalmoparesis associated with acute rhinosinusitis. On high resolution MRI there was inflammation of the III, IV, V2 and VI right nerves with gadolinium enhancement. We propose the THS diagnosis exacerbated by rhinosinusitis and started on chronic steroid therapy.
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    Practical issues concerning the use of Magnetic Resonance Imaging in Multiple Sclerosis in Latin America: discussion from 16 centres on behalf of the Foro Latam EM Study Group
    (Elsevier B.V., 2022) Ciampi, Ethel; Guerra-Posada, Carolina; Treviño-Frenk, Irene; Cortes-Enriquez, Fernando; Correa-Díaz, Edgar Patricio; Steinberg, Judith; Fragoso, Yara; Garcia Bonitto, Juan; Macias, Miguel Angel; Novarro, Nelson; Carra, Adriana; Vizcarra, Darwin; Vrech, Carlos; Cárcamo Rodríguez, Claudia Andrea
    MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis have been recently published, and they have been fundamental for improving patient care. Implementation of these and previous MAGNIMS recommendations have not been established in many countries. Addressing the local limitations behind these difficulties is needed. A panel of 14 MS neurologists from 16 different reference centres from Chile, Argentina, Mexico, Colombia, Ecuador, Panamá, Perú and Brazil met to discuss the current situation regarding the use of MRI in MS including a) Access and availability, b) Standardized acquisition protocols and reports, and c) Multicentric research potential.
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    Pregnancy outcomes in women with Multiple Sclerosis
    (2021) Soler León, Bernardita María; Ciampi, Ethel; Uribe San Martín, Reinaldo; Keller K.; Astudillo M.; Charaf V.; Reyes A.; Vergara E.; Cárcamo Rodríguez, Claudia Andrea
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    Prevalence of comorbidities in Multiple Sclerosis and impact on physical disability according to disease phenotypes
    (2020) Ciampi, Ethel; Uribe San Martín, Reinaldo; Soler León, Bernardita María; Molnar, Karolyn; Reyes Placencia, Diego Armando; Keller Matamala, Karina Pascale; Cárcamo Rodríguez, Claudia Andrea
    Background: Comorbidities are prevalent among Multiple Sclerosis (MS) patients. Few studies have characterized their prevalence and impact in Latin American populations.Objective: We aim to assess the prevalence of comorbidities and their impact on the risk of physical disability across different MS phenotypes.Methods: Cross-sectional multicenter study of patients under regular clinical care at the Programa de Esclerosis Múltiple UC and Hospital Dr. Sótero del Río in Chile. Prevalence of comorbidities was estimated from the retrospective assessment of electronic medical charts. Disease phenotypes were categorized into two groups: clinically isolated syndrome/relapsing-remitting (inflammatory group) and primary/secondary progressive MS patients (progressive group). A multivariable analysis using binary logistic regression for assessing the risk of EDSS ≥ 6.0 in each group was performed.Results: A total of 453 patients was included, 71% female, mean age at onset 31 years, mean disease duration 10 years, and median EDSS 2.0 (range 0–10). In the whole sample, most prevalent comorbidities were ever-smoking (42.2%), depression/anxiety (34.9%), thyroid disease (15.7%), hypertension (11.3%) and insulin resistance/type 2 diabetes mellitus (11.0%). When assessing the risk of EDSS ≥ 6, in the inflammatory group (N = 366), age at onset (OR 1.06, 95%CI(1.02–1.11), p = 0.008), disease duration (OR 1.06, 95%CI(1.00–1.12), p = 0.039) and epilepsy comorbidity (OR 5.36, 95%CI(1.33–21.5), p = 0.018) were associated with a higher risk of disability. In the progressive group (N = 87), disease duration was a risk factor (OR 1.08 95%CI(1.02–1.16), p = 0.014), while shorter diagnostic delay (OR 0.91 95%CI(0.85–0.99), p = 0.025) and insulin resistance/type 2 diabetes mellitus comorbidity were protective factors (OR 0.18 95%CI(0.04–0.83), p = 0.028), 72% of these patients were receiving metformin.Conclusions: Comorbidities are common across different MS disease phenotypes. Epilepsy seems particularly related with a higher risk of physical disability in relapsing-remitting patients, while the role of insulin resistance/type 2 diabetes mellitus or the impact of metformin use as a protective factor should be further studied. Prospective and larger studies are still needed in order to assess the real impact of comorbidities and their management in MS outcomes.
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    Prevalence of epilepsy in a cohort of patients with multiple sclerosis
    (2014) Uribe San Martín, Reinaldo; Ciampi, Ethel; Suárez Hernández, F.; Vasquez Torres, M.; Godoy F., Jaime; Cárcamo Rodríguez, Claudia Andrea
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    Refractory epilepsy associated with anti-ribosomal P antibodies successfully treated with topiramate
    (2020) Uribe San Martín, Reinaldo; Ciampi, Ethel; Cruz, Juan Pablo; Vásquez, M.; Cárcamo Rodríguez, Claudia Andrea
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    Relationship between Social Cognition and traditional cognitive impairment in Progressive Multiple Sclerosis and possible implicated neuroanatomical regions
    (2018) Ciampi, Ethel; Uribe San Martín, Reinaldo; Vásquez, M.; Ruiz-Tagle, A.; Labbé Atenas, Tomás; Cruz, J. P.; Lillo, P.; Slachevsky, A.; Reyesk, D.; Reyes, A.; Cárcamo Rodríguez, Claudia Andrea