The profile of patients followed at the Neuroimmunology Clinic at UNIFESP: 20 years analysis

Abstract

Multiple sclerosis (MS) and neuromyelitis optica (NMO) are the most important and common inflammatory autoimmune diseases that affect the central nervous system (CNS) and can lead to sustained neurologic disability and financial burden for the society 1,2 . Both diseases can cause visual impairment, pyramidal deficits, sensation loss, neuropathic pain, coordination problems, gait impairment and cognitive problems (more MS than NMO). While MS has a Conclusion:We identified that 15% of patients seen have NMO. As patients with NMO have a more severe disease than MS, this data may be important for planning local health care policies.Keywords: multiple sclerosis, neuromyelitis optica, epidemiology, Sao Paulo. RESUMOObjetivo: Descrever a casuística de pacientes atendidos no setor de Neuroimunologia da Universidade Federal de São Paulo (UNIFESP) de 1994 a 2013. Método: Analisamos o diagnóstico final de todos os pacientes atendidos de 1999 a 2013, sendo o diagnóstico revisado na última consulta e estabelecido de acordo com os critérios específicos para cada doença. O volume de atendimentos clínicos e não clínicos (relatórios e receitas) foram contabilizados para avaliar a carga de trabalho da equipe. Resultados: 1.599 pacientes foram avaliados: 816 com esclerose múltipla (EM), 172 com síndromes clínicas isoladas, 178 com neuromielite óptica (NMO), 216 com outras doenças desmielinizantes, 20 com doenças metabólicas, 42 com doenças vasculares e 155 com outros diagnósticos ou diagnósticos indefinidos. Identificamos uma média de 219 consultas e 65 solicitações de relatórios por mês. Conclusão: Identificamos que 15% dos pacientes atendidos tem NMO. Por ser uma doença mais incapacitante que a EM estes dados podem ser importantes para o planejamento de políticas de saúde locais.Palavras-chave: esclerose múltipla, neuromielite óptica, epidemiologia, São Paulo.

Justification for conducting neurological clinical trials as part of patient care within private practice

“…SHE has repeatedly confirmed benefit, over cost but with monoclonal antibody remedies it is becoming more difficult to attract some trials to private practice, as they may necessitate admission to academic units . This may dictate a wider review of research and clinical trials in private neurological practice, especially for treatment directed towards intervention in de novo diagnoses, for which private practice remains optimal . This may necessitate sponsors considering private hospitals or infusion centres for the infusion, in conjunction with private clinics, and the patient monitored in the clinic during the trial.…”

“…Clinical trials and medical research are usually conducted in large academic institutions . Patients in these centres are often refractory and unsuitable for monotherapy for de novo diagnoses, while private clinics attract such patients . Excluding these sites may delay recruitment for such studies .…”

Why this is not multiple sclerosis: a case based approach

“…The Neuroimmunology Clinic of the Universidade Federal de São Paulo (UNIFESP) is a public tertiary care center focused on caring for patients with multiple sclerosis and other demyelinating diseases, established in 1994, and located at Hospital São Paulo 14 . From 1994 to 2014 the clinic has evaluated 1.599 patients, including 988 with MS and 116 with neuromyelitis optica; the remaining 495 patients (31% of all) harbored an alternative diagnosis.…”

“…From 1994 to 2014 the clinic has evaluated 1.599 patients, including 988 with MS and 116 with neuromyelitis optica; the remaining 495 patients (31% of all) harbored an alternative diagnosis. This last group comprises patients with vascular disease of the CNS, metabolic disorders, non-demyelinating inflammatory disease, infectious diseases, systemic clinical diseases, psychiatric or psychogenic disorders and functional symptoms 14 , that were first diagnosed or suspected to have MS and sent for our evaluation and follow-up. Some of these patients had obvious signs and symptoms against MS, but some demanded extra investigation to have a final and proper diagnosis established 12,13,14 .…”

“…This last group comprises patients with vascular disease of the CNS, metabolic disorders, non-demyelinating inflammatory disease, infectious diseases, systemic clinical diseases, psychiatric or psychogenic disorders and functional symptoms 14 , that were first diagnosed or suspected to have MS and sent for our evaluation and follow-up. Some of these patients had obvious signs and symptoms against MS, but some demanded extra investigation to have a final and proper diagnosis established 12,13,14 . We selected patients sent for evaluation and follow up at the clinic with a previously stated diagnosis of MS, which were reviewed by the staff and had an alternative final diagnosis and the exclusion of MS as the cause of their signs and symptoms, seen consecutively from 2010 to 2013.…”