ABSTRACT
ABSTRACT Multiple sclerosis (MS) may present with a cognitive impairment as disabling as the physical disabilities. Therefore, routine cognitive evaluation is pivotal. Valid and reliable neuropsychological tests are essential in follow-up and to define future therapeutic interventions. Objectives To investigate the correlation between the disabilities of MS patients and their cognitive impairment assessed by the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Methods Forty patients with definitive diagnoses of MS were selected. The correlation coefficient (r) between the Expanded Disability Status Scale (EDSS) and the neuropsychological tests of BICAMS were calculated. Results The correlation was clinically substantial and significant with r = 0.55 (p < 0.01) in the Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) in the Brief Visuospacial Memory Test (BVMT) and 0.40 (p < 0.05) in the California Verbal Learning Test (CVLT). Conclusion BICAMS has easy and satisfactory application and evaluation for routine visits and presents a significant correlation with the EDSS. Its use may be indicated for screening and monitoring of cognitive impairment in patients with MS.
RESUMO A esclerose múltipla (EM) pode apresentar um déficit cognitivo (DC) tão devastador quanto suas debilidades físicas. Uma avaliação cognitiva rotineira é essencial e testes neuropsicológicos (TNs) validados e confiáveis são fundamentais no acompanhamento e definição de futuras intervenções terapêuticas. Objetivos Investigar a correlação entre o estado de incapacidade física de pacientes com EM e o comprometimento cognitivo, avaliado pelo Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Métodos Foram calculados coeficientes de correlação (r) entre a Expanded Disability Status Scale (EDSS) e resultados dos testes do BICAMS em quarenta pacientes com diagnóstico definitivo de EM. Resultados A correlação foi clinicamente substancial e significativa, com r = 0.55 (p < 0.01, no Symbol Digit Modalities Test (SDMT), 0.54 (p < 0.01) no Brief Visuospacial Memory Test (BVMT) e 0.40 (p < 0.05) no California Verbal Learning Test (CVLT). Conclusão O BICAMS é de fácil e satisfatória aplicação e avaliação em visitas de rotina e apresenta uma correlação significativa com a EDSS. Seu uso pode ser indicado como rotina no acompanhamento do (DC) em portadores de EM.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Young Adult , Brief Psychiatric Rating Scale/standards , Cognition Disorders/psychology , Multiple Sclerosis, Relapsing-Remitting/psychology , Disability Evaluation , Brazil , Cognition Disorders/diagnosis , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Educational Status , Language , Neuropsychological Tests/standardsABSTRACT
INTRODUCCIÓN: La Esclerosis Múltiple es una enfermedad crónica desmielinizante, de etiología desconocida, que afecta al sistema nervioso central. Aqueja principalmente a mujeres entre 20 y 40 años, siendo una de las principales causas de discapacidad en población joven. Ocurre por un proceso inflamatorio autoinmune en la sustancia blanca del sistema nervioso central, generando lesiones desmielinizantes que son causantes de la sintomatología. Su forma de presentación clínica es variable, siendo la más frecuente la forma Remitente Recurrente, que se caracteriza por recuperaciones entre los episodios de reagudización, que en la mayoría de los casos con son completas. PRESENTACIÓN DEL CASO: Paciente de 21 años, sexo femenino, con diagnóstico de esclerosis múltiple remitente recurrente, que en control médico, luego de seis meses desde confirmado el diagnóstico e iniciado el tratamiento con Interferón beta 1a y estando asintomática, presenta remielinización total de todas las lesiones objetivado a través una resonancia nuclear magnética sin hallazgos patológicos. DISCUSIÓN: La remielinización de las lesiones, causante de la remisión de los síntomas, suele ser parcial y con mielina más delgada, la que se identifica en la resonancia nuclear magnética como placas de sombra. La remielinización total de todas las lesiones del sistema nervioso central ha sido escasamente descrita, presentándose sólo en un 2,6 por ciento de los pacientes, y plantea la presencia de factores intrínsecos aún desconocidos involucrados en la capacidad de regeneración de la mielina a nivel central, abriendo una nueva línea investigativa.
INTRODUCTION: Multiple Sclerosis is a chronic demyelinating disease, with unknown etiology, that affect the central nervous system. Mainly affects women between 20 and 40 years old, and is one of the most important causes of young people disability. It happens because an autoimmune inflammatory process in the white matters at the central nervous system, producing demyelinating lesions that causes the symptoms. The clinical presentation is changeable, the most frequent is the relapsing remitting form, it is marked by periods of improvement between worsening ones, which in most cases is not complete. CASE REPORT: Female, 21 years old, with the diagnoses of relapsing-remitting multiple sclerosis, that in a medical control, after six months since the diagnosis confirmation and the beginning of the treatment with interferon beta 1a and without symptoms, has a total remyelination of the injuries at the central nervous system, without pathological evidence at the magnetic resonance imaging. DISCUSSION: The remyelination of the injuries, that cause the remission of the symptoms, is usually partial with lower quality myelin, which is thinner and is identify by magnetic resonance imaging as shadow plaques. The total remyelination of all the injuries at the central nervous system is scantily reported, only in 2.6 percent of the patients, and propose that inherent factors are involve at the myelin regeneration process, opening a new investigative line.
Subject(s)
Humans , Adult , Female , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Immunosuppressive Agents/therapeutic use , Interferon-beta/therapeutic use , Demyelinating Autoimmune Diseases, CNS , Paresthesia , Treatment OutcomeSubject(s)
Humans , Male , Female , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Magnetic Resonance ImagingABSTRACT
OBJECTIVE: To determine the difference of mean apparent diffusion coefficients (ADC) among different patterns of focal multiple sclerosis (MS) lesions, to compare mean lesion ADC between 2 clinical subgroups and to correlate mean lesion ADC with disability. MATERIAL AND METHOD: Thirty seven patients (26 with relapsing-remitting multiple sclerosis (MS) and 11 with secondary-progressive MS) underwent both conventional and diffusion-weighted MR imaging of the brain. After creating ADC maps, region identification was done by using b = 0 images and T2-weighted images. ADC values were measured for MS lesions and (NAWM). RESULTS: A total of 288 lesions were identified on the images. The mean ADC for the lesions was significantly higher than that of NAWM Hypointense T1 lesions (n = 221) had a significantly higher mean ADC than isointense T1 lesions (n = 67) in both nonenhancing lesions (n = 250) and enhancing lesions (n = 38). The enhanced rim of ring-enhancing lesions (n = 18) had lower ADC than the central nonenhanced portions. Confluent lesions (n = 62) had a substantially higher mean ADC than discrete lesion (n = 226). Mean lesion ADC of secondary progressive MS was significantly higher than relapsing remitting MS. No correlation between mean lesion ADC and (EDSS) score was found CONCLUSION: Quantitative diffusion-weighted imaging is useful to elucidate the heterogeneous pathological substrate of MS in different patterns of MS lesions, to differentiate 2 major clinical subgroups.
Subject(s)
Adolescent , Adult , Age Factors , Cohort Studies , Confidence Intervals , Diffusion Magnetic Resonance Imaging/methods , Disability Evaluation , Disease Progression , Echo-Planar Imaging/methods , Female , Follow-Up Studies , Gadolinium DTPA/diagnosis , Humans , Male , Middle Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis, Chronic Progressive/diagnosis , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Sex Factors , Statistics, NonparametricABSTRACT
A esclerose múltipla é uma das causas mais comuns de incapacidade neurológica crônica em adultos jovens. Avaliamos, através de estudo retrospectivo, características epidemiológicas, formas de apresentação, manifestações clínicas, evolução e o grau de incapacitação física da esclerose múltipla em 302 pacientes. A média da idade dos pacientes foi 37,7 anos e a relação entre os gêneros foi 3,13F:1M. A média da idade no início da doença foi 29,6 anos. Duzentos e oitenta e três pacientes eram brancos (94 por cento), 15 negros (5 por cento) e 4 amarelos (1 por cento). Duzentos e vinte pacientes (72 por cento) apresentaram forma clínica tipo remitente-recorrente. Oitenta e dois pacientes (28 por cento) apresentaram a forma progressiva (50 por cento forma secundária e 50 por cento forma primariamente progressiva). Os sintomas iniciais mais comuns foram sensitivos (31,7 por cento) e ópticos (26,8 por cento).Em relação aos sintomas evolutivos predominavam os sintomas piramidais (72,5 por cento) e os medulares (64,9 por cento). A média do escore do EDSS final foi 3,37 e a do NRS foi 85,17. O índice anual de surtos foi 0,45. Nossos achados coincidem com os da literatura mundial, e ressaltam que 60 pacientes (19,8 por cento) apresentavam esclerose múltipla de forma benigna de valor prognóstico.