Tratamento das complicações neurológicas da vacinação anti-rábica

Saraiva, Paulo A. P.; Assis, J. Lamartine de

doi:10.1590/S0004-282X1968000400006

Resumos

Os autores estudaram 33 pacientes com complicações neurológicas da vacinação anti-rábica (tipo Fermi modificada) dividindo-os, quanto ao tratamento, em três grupos: a)tratamento sintomático e de manutenção (9 pacientes); b)tratamento igual ao do grupo aacrescido de ACTH e/ou corticosteróides pelas vias oral, muscular ou venosa (15 pacientes); c) tratamento igual ao do grupo aacrescido da administração de acetato de metilprednosolona em suspensão por via intratecal (9 pacientes). Referem os autores um caso com seqüela no grupo a; dois óbitos, um caso com seqüela, 6 melhorados e 6 considerados curados no grupo b;um óbito (acidente com o respirador) e nenhuma outra complicação ou seqüela com os pacientes do grupo c no qual 7 foram considerados curados e um melhorado. A impressão clínica, justificada pela recuperação mais rápida e completa, foi a de que os melhores resultados foram obtidos no grupo c.

Neurological complications in 33 patients following antirabies vaccination (modified Fermi vaccine) were studied. For analysing purposes of the therapeutic effects the patients were divided in three groups: the first group with symptomatic treatment only (9 patients); the second with symptomatic treatment plus intravenous or intramuscular ACTH or corticosteroids (15 patients); the third with symptomatic treatment plus intrathecal methylprednisolone acetate (9 patients). In the first group one of the patients remained with a neurological sequel. In the second group one patient also had a neurological sequel, two died, six improved and six had complete recovery. In the third group a patient died from a respirator accident, one improved and seven had complete recovery. The authors had the clinical impression that the results were considerably better in the third group of cases.

Tratamento das complicações neurológicas da vacinação anti-rábica

Treatment of neurological complications in anti-rabies vaccination

Paulo A. P. Saraiva^I; J. Lamartine de Assis^II

^IMédico assistente do Hospital de Isolamento «Emílio Ribas» e Hospital das Clínicas da Fac. Med. Univ. São Paulo

^IIDocente-Livre de Neurologia da Fac. Med. Univ. São Paulo

RESUMO

Os autores estudaram 33 pacientes com complicações neurológicas da vacinação anti-rábica (tipo Fermi modificada) dividindo-os, quanto ao tratamento, em três grupos: a)tratamento sintomático e de manutenção (9 pacientes); b)tratamento igual ao do grupo aacrescido de ACTH e/ou corticosteróides pelas vias oral, muscular ou venosa (15 pacientes); c) tratamento igual ao do grupo aacrescido da administração de acetato de metilprednosolona em suspensão por via intratecal (9 pacientes).

Referem os autores um caso com seqüela no grupo a; dois óbitos, um caso com seqüela, 6 melhorados e 6 considerados curados no grupo b;um óbito (acidente com o respirador) e nenhuma outra complicação ou seqüela com os pacientes do grupo c no qual 7 foram considerados curados e um melhorado. A impressão clínica, justificada pela recuperação mais rápida e completa, foi a de que os melhores resultados foram obtidos no grupo c.

SUMMARY

Neurological complications in 33 patients following antirabies vaccination (modified Fermi vaccine) were studied. For analysing purposes of the therapeutic effects the patients were divided in three groups: the first group with symptomatic treatment only (9 patients); the second with symptomatic treatment plus intravenous or intramuscular ACTH or corticosteroids (15 patients); the third with symptomatic treatment plus intrathecal methylprednisolone acetate (9 patients).

In the first group one of the patients remained with a neurological sequel. In the second group one patient also had a neurological sequel, two died, six improved and six had complete recovery. In the third group a patient died from a respirator accident, one improved and seven had complete recovery. The authors had the clinical impression that the results were considerably better in the third group of cases.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Clinica Neurológica Faculdade de Medicina Universidade de São Paulo Caixa Postal3461 São Paulo, SP Brasil.

Trabalho apresentado ao III Congresso Brasileiro de Neurologia (Recife, PE 14 a 18 de julho de 1968)

1. BOINES, G. J. a) Remissions in multiple sclerosis following intrathecal methylprednisolone acetate. Delaware St. med. J. 33:230-235, 1961. b) Predictable remissions in multiple sclerosis. Delaware St. med. J.35:200-202, 1963. c) Erratic persistence of intrathecally injected methylpredinosolone acetate. Delaware St. med. J. 36:210-212, 1964.
2. BAKER, A. C. Intrathecal methyilprednisolone for multiple sclerosis: evaluation by a standard neurological rating. Ann. Allergy 25:665-672, 1967.
3. BRANDRIN, M. W.; SMITH, J. W. & FRIEDMAN, R, M. Supression of experimental allergic encephalomyelitis by antimetabolites. Ann. N. Y. Acad. Sci. 122:356-368, 1965.
4. BRIGGS, G. W. & BROWN, M. W. Neurological complications of antirabies vaccine: treatment with corticosteroids. J. Amer. med. Ass. 173:802-804, 1960.
5. BURNS, K. F.; SHELTON, D. F.; LUKEMAN, J. M. & GROGAN, E. W. Cortisone and ACTH impairment of response to rabies vaccine. Publ. Hlth Rep. (Washington) 75:441-445, 1960.
6. BUSKIRK, C. Van; POFFENBARGER, L. A.; CAPRILES, L. F. & IDEA, B. V. Treatment of multiple sclerosis with intrathecal steroids. Neurology (Minneapolis) 14:595-597, 1964.
7. FERRARO, A. & ROIZIN, L. a) Experimental allergic encephalomyelitis during and following cortone acetate treatment. J. Neuropath. 12:373-386, 1953. b) Hyperergic encephalomyelitis following exanthematic diseases, infectious diseases and vaccination. J. Neuropath. 16:423-445, 1957.
8. FISHMAN, R. A. & CHRISTY, N. P. Rate of adrenal cortical steroids following intrathecal injection. Neurology (Minneapolis) 15:1-6, 1965.
9. GAMMON, G. A. & DILWORTH, M. J. Effect of corticotropin on paralysis of experimental allergic encephalomyelitis. Arch. Neurol. Psychiat. (Chicago) 69:649, 1953.
10. GOLDSTEIN, N. P.; McKENZIE, B. F. & McGUCKIN, W. F. Changes in cerebrospinal fluid of patients with multiple sclerosis after treatment with intrathecal methylprednisolone acetate. Proc. Mayo Clin.. 37:657-668, 1962.
11. KULICK, S. A. The clinical use of intrathecal methylprednisolone acetate following lumbar puncture. J. Mt, Sinai Hosp. 32:75-78, 1965.
12. SCHMIDT, E. Erfahrungen mit der intrathecalen Corticosteroidbehandlung der Polysklerose und anderer neurologischer Erkrankungen. Psychiat. Neurol, u. med. Psychol. (Leipzig) 19:152-156, 1967.
13. SEHGAL, A. D. Laboratory studies after intrathecal corticosteroids; determination of corticosteroids in plasma and cerebrospinal fluid. Arch. Neurol. Psychiat. (Chicago) 9:64-68, 1963.

Datas de Publicação

Publicação nesta coleção
13 Maio 2013
Data do Fascículo
Dez 1968

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BOINES, G. J. a) Remissions in multiple sclerosis following intrathecal methylprednisolone acetate. Delaware St. med. J. 33:230-235, 1961. b) Predictable remissions in multiple sclerosis. Delaware St. med. J.35:200-202, 1963. c) Erratic persistence of intrathecally injected methylpredinosolone acetate. Delaware St. med. J. 36:210-212, 1964.

[2] 2. BAKER, A. C. Intrathecal methyilprednisolone for multiple sclerosis: evaluation by a standard neurological rating. Ann. Allergy 25:665-672, 1967.

[3] 3. BRANDRIN, M. W.; SMITH, J. W. & FRIEDMAN, R, M. Supression of experimental allergic encephalomyelitis by antimetabolites. Ann. N. Y. Acad. Sci. 122:356-368, 1965.

[4] 4. BRIGGS, G. W. & BROWN, M. W. Neurological complications of antirabies vaccine: treatment with corticosteroids. J. Amer. med. Ass. 173:802-804, 1960.

[5] 5. BURNS, K. F.; SHELTON, D. F.; LUKEMAN, J. M. & GROGAN, E. W. Cortisone and ACTH impairment of response to rabies vaccine. Publ. Hlth Rep. (Washington) 75:441-445, 1960.

[6] 6. BUSKIRK, C. Van; POFFENBARGER, L. A.; CAPRILES, L. F. & IDEA, B. V. Treatment of multiple sclerosis with intrathecal steroids. Neurology (Minneapolis) 14:595-597, 1964.

[7] 7. FERRARO, A. & ROIZIN, L. a) Experimental allergic encephalomyelitis during and following cortone acetate treatment. J. Neuropath. 12:373-386, 1953. b) Hyperergic encephalomyelitis following exanthematic diseases, infectious diseases and vaccination. J. Neuropath. 16:423-445, 1957.

[8] 8. FISHMAN, R. A. & CHRISTY, N. P. Rate of adrenal cortical steroids following intrathecal injection. Neurology (Minneapolis) 15:1-6, 1965.

[9] 9. GAMMON, G. A. & DILWORTH, M. J. Effect of corticotropin on paralysis of experimental allergic encephalomyelitis. Arch. Neurol. Psychiat. (Chicago) 69:649, 1953.

[10] 10. GOLDSTEIN, N. P.; McKENZIE, B. F. & McGUCKIN, W. F. Changes in cerebrospinal fluid of patients with multiple sclerosis after treatment with intrathecal methylprednisolone acetate. Proc. Mayo Clin.. 37:657-668, 1962.

[11] 11. KULICK, S. A. The clinical use of intrathecal methylprednisolone acetate following lumbar puncture. J. Mt, Sinai Hosp. 32:75-78, 1965.

[12] 12. SCHMIDT, E. Erfahrungen mit der intrathecalen Corticosteroidbehandlung der Polysklerose und anderer neurologischer Erkrankungen. Psychiat. Neurol, u. med. Psychol. (Leipzig) 19:152-156, 1967.

[13] 13. SEHGAL, A. D. Laboratory studies after intrathecal corticosteroids; determination of corticosteroids in plasma and cerebrospinal fluid. Arch. Neurol. Psychiat. (Chicago) 9:64-68, 1963.