Esclerose múltipla: estudo clínico de 50 pacientes acompanhados no Ambulatório de Neurologia UNIFESP-EPM

-O b j e c t i v e :65% of all patients were residents of the city of Santos. The mean age of these patients was 43 years (14 to 74 years), and the Expanded Disability Status Scale (EDSS) was ≤ 5.5 in 76.5% of the cases. 82.7% of the assessed patients presented the re l a p s i n g / remitting form of MS. 81.5% of all patients were underg o i n g t reatment with immunomodulators. Conclusion: Due to their clinical profile, patients seem to come to CEREM Litoral Paulista for prescription of immunomodulators. There is a clear need to identify other cases in the region and to allow other forms of treatment to be put into practice.KEY WORDS: multiple sclerosis, immunomodulators, city of Santos.Descrição e características dos 81 pacientes em seguimento no Centro de Referência em Esclero s e Múltipla do litoral paulista. RESUMO -Objetivo: Registrar os pacientes portadores de esclerose múltipla (EM) residentes na região do litoral paulista (CEREM Litoral Paulista). Método: Entrevistas individuais com casos identificados de EM.Resultados: 81 indivíduos com diagnóstico de EM (62 mulheres [76,5%] e 19 homens [23,5%]) concord a r a m em comparecer para re g i s t ro no centro. 65% do grupo total de pacientes eram residentes da cidade de S a n t o s . A idade média destes pacientes era 43 anos (14 a 74 anos), e o Expanded Disability Status Scale (EDSS) foi < 5,5 em 76,5% dos casos. 82,7% dos pacientes registrados apresentava a forma re m i t e n t e -re c o rrente de E M . 81,5% de todos os pacientes estava recebendo tratamento com imunomoduladore s . Conclusão: Pelo perfil clínico, os pacientes parecem vir ao CEREM Litoral Paulista para prescrição de imunomoduladores. Existe uma clara necessidade de identificar outros casos na região e permitir que outras formas de tratamento sejam implantadas.

“…The pre d o m i n a nce of Caucasians affected by the disease in our group seems to be higher than that reported in other Reference Centers in Brazil [7][8][9][10][11][12][13][14] .…”

Section: Discussioncontrasting

confidence: 75%

Description and characteristics of 81 patients attending the Reference Center for Multiple Sclerosis of the coastal region of the state of São Paulo - Brazil

Fragoso

Fiore

2005

“…The MS preferentially affects caucasians, young adults and females 3 . The clinical feature of the disease in the Brazilians is similar to the one described in other countries 4 .…”

supporting

confidence: 75%

Balance Rehabilitation Unit (BRU TM) posturography in relapsing-remitting multiple sclerosis

Kessler

Ganança

et al. 2011

Objective: To evaluate balance control with Balance Rehabilitation Unit (BRU TM ) posturography in patients with multiple sclerosis (MS). Method: A cross controlled study was performed including 39 relapsing-remitting multiple sclerosis patients with scores less than or equal to 4 in the Expanded Disability Status Scale (EDSS), and a homogeneous control group consisting of 65 healthy individuals, matched by the age and gender. The experimental group was distributed according to the EDSS scale scores in 0-2.5 and 3-4. To assess the vestibular system function, the patients underwent a neurotological evaluation, including posturography of the Balance Rehabilitation Unit (BRU TM ). Results: Statistically significant differences were observed when comparing the values of the sway velocity and the ellipse area of the MS 0-2.5 group with the control and the MS 3-4 group with the control. A statistically significant difference was verified between the MS 0-2.5 and the MS 3-4 groups in the condition 3 ellipse area values. Conclusion: The evaluation of the balance control with posturography of Balance Rehabilitation Unit (BRU TM ) enables the identification of abnormalities of the sway velocity and confidential ellipse in patients with relapsing-remitting multiple sclerosis.

“…In terms of clinical presentation, pyramidal findings and optic neuritis occur in approximately equal proportions in all series, except for a much higher frequency of pyramidal syndrome and lower frequency of optic neurits at disease's onset in Oliveira's series 15 . Perhaps their larger number of patients with PP form may partially account for this difference (30% versus 8 to 19% in other series).…”

Section: Discussionmentioning

confidence: 81%

Multiple sclerosis: report on 200 cases from Curitiba, Southern Brazil and comparison with other Brazilian series

Arruda

Scola

Teive

et al. 2001

-We reviewed the clinical and laboratorial findings of 200 patients in Curitiba, Southern Brazil (25°25'40" S; 49°16'23" W-GR), with multiple sclerosis (MS)according to Poser's criteria. The patients were classified as: clinically definite (A1 and A2) -142 patients (71%); laboratory-supported definite -42 patients (21%); and clinically probable -16 patients (8%). Relapsing-remitting (RR) form was the most common clinical presentation, with 182 (91%), followed by primary progressive (PP)(16 cases, 8%), and only 2 cases with secondarily progressive form (SP). Nine women and 7 men totalized the 16 PP cases. The mean age of onset was 32.0±9.9 (median 32 years). The gender ratio was female 1.8:1 male. All patients, except 3 AfricanBrazilian, were white. Seven (3.5%) patients developed a clinical history of Devic´s syndrome. The initial clinical picture included brainstem/cerebellar syndrome in 126 (63%) cases, sensorial findings in 106 (53%)patients, motor (pyramidal) syndrome in 102 (49.5%), and optic neuritis in 79 (39.5%) cases. 122 (61%) patients had a final EDSS score < 3.5; 45 (22.5%) a score between 3.5 and 5.5, and 33 (16.5%) a score ≥ 6.0. There was no significant correlation between the number of relapses or duration of disease with EDSS scores (Spearman's test). Only 14 (7%) of the total number presented the benign form (EDSS< 3.5 after 10 years of disease). We observed a later age of onset and initial clinical findings with higher frequency of brainstem/ cerebellar syndrome and optic neuritis, when compared to other Brazilian and Western series KEY WORDS: multiple sclerosis, clinical forms, Brazilian series, EDSS.Esclerose múltipla: descrição de 200 casos de Curitiba, Paraná e comparação com outras séries brasileiras RESUMO -Os autores analisaram retrospectivamente 200 pacientes portadores de esclerose múltipla de acordo com os critérios de Poser (1983). Cento e quarenta e dois (71%) dos casos possuíam a forma clinicamente definida, 42 (21%) a forma definida laboratorialmente e 16 (8%) a forma clinicamente provável. A forma recorrente-remitente (RR) foi a mais comumente observada (182 casos, 91%), seguida pela forma progressiva primária (PP)(16 casos, 8%), e somente 2 pacientes com a forma secundariamente progressiva. A idade média de início da doença foi 32,0±9,9 anos (mediana 32 anos).A relação entre os gêneros foi mulheres 1,8:1 homens. Todos os pacientes eram da raça branca, com exceção de 3 pacientes afro-brasileiros. Síndrome de Devic ou neuromielite óptica foi observada em 7 (3,5%) pacientes. Síndrome de tronco cerebral/cerebelar foi a forma mais comum de apresentação inicial da doença, com 126 casos (63%), seguido por achados sensoriais (106 casos, 53%), síndrome motora/piramidal (102 casos, 49,5%), e neurite óptica (79 casos, 39,5%). Nesta série, 122 pacientes (61%) possuíam um EDSS final < 3,5; 45 (22,5%) escore entre 3,5 e 5,5 e 33 (16,5%) um escore ≥ 6.0. Não se observou uma correlação entre o número de surtos ou os anos de doença com o escore EDSS (teste de Spearman). Somente 14 paci...