21^st World Congress on Neurology and Therapeutics March 15-17, 2018 London, UK

Anita Phung is currently a General Practice Specialist Trainee at King’s College Hospital, London, UK and Mathew Vithayathil is currently a Core Medical Trainee at Addenbrooke’s Hospital, Cambridge, UK

Statin use is highly prevalent. Common adverse effects on the musculoskeletal system are well documented. There is less understanding of a rarer phenomenon, statin autoimmune myositis (SAM). We present a near fatal case of SAM after prolonged statin therapy and highlight the key diagnostic tests and immunosuppressant therapies. An 82 year old male was admitted after being found lying on the floor for 36 hours. Prior to falling, he reported four months of gradual weakness affecting his proximal lower limbs and spine. This was preceded by 17 months of atorvastatin use, which was discontinued four months previously due muscle weakness. Creatinine kinase was elevated; needle electromyogram showed necrotizing myopathy and an autoantibody screen was positive for HMG-CoA reductase, consistent with SAM. The patient required intubation and ventilator support for respiratory failure, as well as percutaneous endoscopic gastrostomy (PEG) feeding for severe dysphagia. He was initially commenced on high dose intravenous methylprednisolone, followed by intravenous immunoglobulin, cyclophosphamide and tapering oral steroids. The patient showed a significant response to treatment, being able to self-ventilate, mobilize independently and orally feed without his PEG tube. He was transferred to neurohabilitation and subsequently discharged home. This is the first case to describe effective use of high dose steroids, immunoglobulin and cyclophosphamide for the treatment of near fatal SAM. It is important that clinicians are aware of this significant adverse effect from statins, which can develop after long-term use, so that investigations and treatment are initiated early to prevent progression to debilitating states.

Tatiana Paschoalette Rodrigues Bachur is a Pharmacist, and has completed her Master’s degree in Pathology and is Professor of Medicine Course at the State University of Ceará, Brazil and Collaborator of the group of studies in Neuroinflammation and Neurotoxicology. She has developed studies in Toxicology, Pharmacology and Tropical Diseases and is a Reviewer of scientific journals and a Project Manager

Guillain-Barré syndrome (GBS) is an autoimmune disease that develops with demyelination and / or degeneration of axons in the peripheral nervous system, and may manifest as a secondary condition to several viral infections. Epidemiological studies have correlated urban arboviruses to GBS, which manifests itself within a few days after the classic clinical manifestations of these viruses. The objective of the study is to make a survey between the association of dengue, zika and chikungunya and GBS. A review was performed on the occurrence of GBS in patients affected by these arboviruses through the search for articles published between the years 2004 to 2017 in the Medline and Lilacs databases. The descriptors used, individually and in combination, were: arboviruses, zika virus, chikungunya fever, dengue, Guillain-Barre Syndrome. Articles were included describing the occurrence of GBS in patients with one of three arboviruses published in English, Portuguese and Spanish. We selected and analyzed 17 articles. The results showed that zika is the infection with the highest prevalence of GBS (incidence of 0.24 per 1000 cases) and dengue with a lower prevalence. Although encephalitis presents as a more frequent neurological complication in chikungunya and dengue, GBS surpasses encephalitis when the three arboviruses are added. It is concluded that arboviruses, especially zika may lead to late neurological manifestations of their classic symptoms, among which in adults, the most common is Guillain-Barré syndrome.

Gislei Frota Aragão, PhD in Pharmacology, Professor of Medicine Course at the State University of Ceará (Brazil) and coordinator of the Group of Studies in Neuroinflammation and Neurotoxicology. He develops studies in Neuropharmacology and Neurotoxicology and is a reviewer of scientific journals and a project manager

Depression is a common illness worldwide, with more than 300 million people affected. Agomelatine is a new antidepressant that has a novel mechanism of action, acting as an agonist for MT1 and MT2melatonergic receptors and as a 5-HT2c receptor antagonist. The safety profile of a drug is directly related to its adverse effects. A literature review on the adverse effects of agomelatine was carried out through the search of scientific articles published between the years 2009 and 2017 in the Medline and Lilacs databases as well in the electronic library ScienceDirect. The descriptors used for the search, individually and in combination, were agomelatine, adverse effects and toxicity. The inclusion criteria were articles on the adverse effects, side effects and toxicity of agomelatine published within the established period, written in English, from which 20 articles were included and analyzed. The results showed that agomelatine can cause serious adverse reactions such as hepatoxicity, reported in 13 articles, as well as a series of mild and moderate events such as somnolence (10), headache (10), nausea (7), fatigue (5), dizziness (5), gastrointestinal symptoms (4), dry mouth (3), diarrhea (3), nasopharyngitis (2), anxiety (2), back pain (1) and changes in the emotional process (1). One selected article reported finding no adverse effects. Thus, although agomelatine has a proven therapeutic effect, it should only be used in patients under strict professional monitoring for its potential adverse effects