RENATA BARBOSA PAOLILO

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Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 16
  • article 3 Citação(ões) na Scopus
    Asymptomatic MRI lesions in pediatric-onset AQP4-IgG positive NMOSD
    (2022) PAOLILO, Renata Barbosa; RIMKUS, Carolina de Medeiros; PAZ, Jose Albino da; APOSTOLOS-PEREIRA, Samira Luisa; CALLEGARO, Dagoberto; SATO, Douglas Kazutoshi
    Background and purpose: Around 5% of all Neuromyelitis Optica Spectrum Disorders (NMOSD) cases start before 18 years of age. Clinical and radiological manifestations of AQP4-IgG positive NMOSD were revised in 2015, and the importance of neuroimaging in the diagnosis is well recognized. Neuroimaging findings in pediatric-onset NMOSD were scarcely described, and longitudinal evaluation of NMOSD lesions was only accessed in a few adult-onset cohorts. Methods: This study evaluated brain, spinal cord, and optic nerve MRI of sixteen pediatric-onset AQP4-IgG positive NMOSD through a qualitative evaluation of lesion evolution. Lesions were classified as symptomatic or asymptomatic in acute or chronic phase (> 30 days from last attack) MRI.Results: Seventy MRI scans and 54 subsequent exams were evaluated. Most NMOSD lesions (74.5%) reduced, remained stable, or developed atrophy/cavitation. New brain lesions or enlargement of existing brain lesions were found in two patients (12.5%) without any clinical symptom and in five patients (31.2%) in the course of an attack from other topography (optic neuritis or acute myelitis). One patient (6.3%) presented an asymptomatic spinal cord lesion irrespective of clinical manifestation. No asymptomatic lesion was described in optic nerve MRI. In acute phase exams, longitudinally extensive transverse myelitis (13/19 vs 8/24; p = 0.033), cervical myelitis (15/19 vs 10/24, p = 0.028), lumbar myelitis (5/19 vs 0/24; p = 0.012), and a higher number of segments [median 8 (range 4-17) vs 3.5 (range 1-14); p = 0.003] were affected.Conclusions: Asymptomatic brain and spinal cord lesions can occur in pediatric-onset NMOSD, especially in the course of acute optic neuritis or myelitis. More longitudinal studies are necessary to guide recommendations on neuroimaging frequency in pediatric patients with AQP4-IgG NMOSD.
  • article 1 Citação(ões) na Scopus
    Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach
    (2022) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; FEO, Lucas Bueno; SILVA, Guilherme Diogo; DISSEROL, Caio Cesar Diniz; PAOLILO, Renata Barbosa; LARA, Amanda Nazareth; TONACIO, Adriana Coracini; MENDES, Maria Fernanda; PEREIRA, Samira Luisa Apostolos; CALLEGARO, Dagoberto
    Background Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. Objective To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. Methods Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. Conclusion We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.
  • conferenceObject
    Neuroimaging profile in pediatric Neuromyelitis Optica Spectrum Disorders (NMOSD)
    (2017) PAOLILO, R.; RIMKUS, C. D. M.; PAZ, J. A.; APOSTOLOS-PEREIRA, S. L.; ARAUJO, A. L. P. C.; GOMES, A. B.; VENTURA, L. M. Gomes De Brito; PITOMBEIRA, M. S.; MATOS, A. D. M. B.; REED, U. C.; CALLEGARO, D.; SATO, D. K.
  • conferenceObject
    Pediatric acquired demyelination syndromes profile in a Brazilian center
    (2018) PAOLILO, R. B.; PAZ, J. A. da; APOSTOLOS-PEREIRA, S. L.; ARAUJO, A. L. C.; RIMKUS, C. M.; CALLEGARO, D.; SATO, D. K.
  • article 28 Citação(ões) na Scopus
    Acute Disseminated Encephalomyelitis: Current Perspectives
    (2020) PAOLILO, Renata Barbosa; DEIVA, Kumaran; NEUTEBOOM, Rinze; ROSTASY, Kevin; LIM, Ming
    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated central nervous system (CNS) disorder, characterized by polyfocal symptoms, encephalopathy and typical magnetic resonance imaging (MRI) findings, that especially affects young children. Advances in understanding CNS neuroimmune disorders as well as the association of myelin oligodendrocyte glycoprotein antibody (MOG-Ab) with both monophasic and recurrent forms of ADEM have led to new insights into its definition, management and outcome. In this review, we aim to provide an update based on current epidemiologic, clinical, radiological and immunopathological aspects and clinical outcome of ADEM.
  • article 0 Citação(ões) na Scopus
    COVID-19 in children and adolescents with neuroimmunological disorders
    (2023) PESSOA, Ingrid Lacerda; PAOLILO, Renata Barbosa; PAZ, Jose Albino da
  • article 6 Citação(ões) na Scopus
    Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system
    (2021) BECKER, Jefferson; FERREIRA, Lis Campos; DAMASCENO, Alfredo; BICHUETTI, Denis Bernardi; CHRISTO, Paulo Pereira; CALLEGARO, Dagoberto; PEIXOTO, Marco Aurelio Lana; SOUSA, Nise Alessandra de Carvalho; ALMEIDA, Sergio Monteiro de; ADONI, Tarso; SANTIAGO-AMARAL, Juliana; JUNQUEIRA, Thiago; PEREIRA, Samira Luisa Apostolos; GOMES, Ana Beatriz Ayroza Galvao Ribeiro; PITOMBEIRA, Milena; PAOLILO, Renata Barbosa; GRZESIUK, Anderson Kuntz; PICCOLO, Ana Claudia; ALMEIDA, Jose Arthur Costa D.; GOMES NETO, Antonio Pereira; OLIVEIRA, Augusto Cesar Penalva de; OLIVEIRA, Bianca Santos de; TAUIL, Carlos Bernardo; VASCONCELOS, Claudia Ferreira; KAIMEN-MACIEL, Damacio; VARELA, Daniel; DINIZ, Denise Sisterolli; OLIVEIRA, Enedina Maria Lobato De; MALFETANO, Fabiola Rachid; BORGES, Fernando Elias; FIGUEIRA, Fernando Faria Andrade; GONDIM, Francisco de Assis Aquino; PASSOS, Giordani Rodrigues dos; SILVA, Guilherme Diogo; OLIVAL, Guilherme Sciascia Do; SANTOS, Gutemberg Augusto Cruz dos; RUOCCO, Heloisa Helena; SATO, Henry Koiti; SOARES NETO, Herval Ribeiro; CALIA, Leandro Cortoni; GONCALVES, Marcus Vinicius Magno; VECINO, Maria Cecilia Aragon De; PIMENTEL, Maria Lucia Vellutini; RIBEIRO, Marlise de Castro; BOAVENTURA, Mateus; PAROLIN, Monica Koncke Fiuza; MELO, Renata Brant de Souza; LAZARO, Robson; THOMAZ, Rodrigo Barbosa; KLEINPAUL, Rodrigo; DIAS, Ronaldo Maciel; GOMES, Sidney; LUCATTO, Simone Abrante; ALVES-LEON, Soniza Vieira; FUKUDA, Thiago; RIBEIRO, Taysa Alexandrino Gonsalves Jube; WINCKLER, Thereza Cristina D'avila; FRAGOSO, Yara Dadalti; NASCIMENTO, Osvaldo Jose Moreira do; FERREIRA, Maria Lucia Brito; MENDES, Maria Fernanda; BRUM, Doralina Guimaraes; GLEHN, Felipe Von
    The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases.The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.
  • article 36 Citação(ões) na Scopus
    Treatment and outcome of aquaporin-4 antibody-positive NMOSD: A multinational pediatric study
    (2020) PAOLILO, Renata Barbosa; HACOHEN, Yael; YAZBECK, Elise; ARMANGUE, Thais; BRUIJSTENS, Arlette; LECHNER, Christian; APOSTOLOS-PEREIRA, Samira Luisa; MARTYNENKO, Yana; BREU, Markus; RIMKUS, Carolina de Medeiros; WASSMER, Evangeline; BAUMANN, Matthias; PAPETTI, Laura; CAPOBIANCO, Marco; KORNEK, Barbara; ROSTASY, Kevin; PAZ, Jose Albino da; CICCARELLI, Olga; LIM, Ming; SAIZ, Albert; NEUTEBOOM, Rinze; MARIGNIER, Romain; HEMINGWAY, Cheryl; SATO, Douglas Kazutoshi; DEIVA, Kumaran
    Objective To describe the clinical phenotypes, treatment response, and outcome of children with antibodies against aquaporin-4 (AQP4-Ab) neuromyelitis optica spectrum disorder (NMOSD). Methods Retrospective, multicenter, and multinational study of patients with AQP4-Ab NMOSD aged <18 years at disease onset from a center in Brazil and 13 European centers. Data on demographics, clinical findings, and laboratory results were analyzed; calculation of annualized relapse rates (ARRs) pre- and on-treatment with disease-modifying therapies (DMTs) and of ORs for predictors of poor outcome was performed. Results A total of 67 children were identified. At last follow-up (median 4 years, interquartile range 2-10 years), 37/67(57.8%) were found to have permanent disability. A more severe disease course was seen in the non-White ethnicity with both a shorter time to first relapse (p = 0.049) and a worse Expanded Disability Status Scale score at last follow-up (p = 0.008). The median ARR on treatment was 0.18 on azathioprine (n = 39, range 0-4), 0 on mycophenolate mofetil (n = 18, range 0-3), and 0 on rituximab (n = 29, range 0-2). No patient treated with rituximab as first-line therapy relapsed. Optic neuritis at onset was associated with a poor visual outcome below 20/200 (OR 8.669, 95% CI 1.764-42.616, p = 0.008), and a younger age at onset was associated with cognitive impairment (OR 0.786, 95% CI 0.644-0.959, p = 0.018). Conclusions AQP4-Ab NMOSD in children is an aggressive disease with permanent disabilities observed in over half the cohort. All DMTs were associated with a reduction of ARR. First-line rituximab prevented further clinical relapses. International consensus on treatment protocols for children is required to reduce heterogeneity of treatment regimens used worldwide. Classification of evidence This study provides Class IV evidence that for children with AQP4-Ab NMOSD, all DMTs, particularly first-line rituximab, reduced the ARR and prevented further clinical relapses.
  • conferenceObject
    Anti-AQP4 antibodies positive neuromyelitis optica syndrome in children : an European-Brazilian collaborative study
    (2019) PAOLILO, R. B.; YAZBECK, E.; HACOHEN, Y.; BRUIJSTENS, A.; LECHNER, C.; ARMANGUE, T.; SAIZ, A.; PEREIRA, S. L. Apostolos; MARTYNENKO, Y.; BREU, M.; RIMKUS, C. D. M.; WASSMER, E.; BAUMANN, M.; PAPETTI, L.; CAPOBIANCO, M.; AUBART, M.; ROSTASY, K.; PAZ, J. A. D.; NEUTEBOON, R.; HINTZEN, R.; LIM, M.; MARIGNIER, R.; HEMINGWAY, C.; SATO, D. K.; DEIVA, K.
  • conferenceObject
    Five-year follow-up of pediatric onset Neuromyelitis Optica Spectrum Disorders (NMOSD)
    (2017) PAOLILO, R. B.; PAZ, J. A.; APOSTOLOS-PEREIRA, S. L.; RIMKUS, C. D. M.; ARAUJO, A. L. P. C.; VENTURA, L. M. G. D. B.; PITOMBEIRA, M. S.; GOMES, A. B.; MATOS, A. D. M. B.; TORRETTA, P. H. B.; REED, U. C.; CALLEGARO, D.; SATO, D. K.