[Multiple sclerosis: descriptive study of its clinical forms in 302 cases]

Motor symptoms and the quality of life of relapsing-remitting multiple sclerosis patients in a specialized center in South of Brazil

BACKGROUND

Spasticity, fatigue, muscle weakness and changes in gait are some of the main motor symptoms of Multiple Sclerosis (MS). These changes can interfere with the patients' quality of life.

OBJECTIVE

To characterize the motor and quality of life symptoms in patients with relapsing-remitting Multiple Sclerosis at a specialized center.

METHODS

Fifty five patients at the Neuroimmunology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre were evaluated for fatigue (Fatigue Severity Scale - FSS), walking ability (Functional Ambulation Categories - FAC), impact of MS on walking (Multiple Sclerosis Walking Scale-12 - MSWS-12), walking speed (10-Meter Walk Test - 10MWT and the Times 25-foot Walk test - T25FW), functional independence (Barthel Index - BI), functional mobility (Timed Up and Go - TUG), and quality of life (Multiple Sclerosis Impact Scale - MSIS-29).

RESULTS

The patients were mostly women (69.1%), with average age of 43.3 (±12.1) years old, with time since diagnosis of 8.2 (±5.3) years, and EDSS average of 4.3 (±1.3). On the BI, the mean was 96.6 (±5.7) points and 80% of the patients had FAC 5. At MSIS-29, patients had a higher average score on the psychological scale (19.5±26.7) than on the physical scale (10.2±23.6). Most patients (69.1%) presented fatigue.

CONCLUSION

The patients had preserved functional independence and functional walking ability and presence of fatigue. There was minimal impact of MS on patients' quality of life.

Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis

BACKGROUND

Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear.

OBJECTIVE

The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms.

METHODS

This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores.

RESULTS

The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = -0.06, p < 0.001). Neither presentation was associated with changes in relapse risk.

CONCLUSION

Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.

Multiple sclerosis epidemiology in Latin America: An updated survey

Novel epidemiological data have appeared in recent years in Latin America (LATAM). The objective of this study was to perform an updated systematic review of the epidemiology of the disease reported in LATAM.

Definition, prevalence and predictive factors of benign multiple sclerosis

Background

Multiple sclerosis (MS) is characterized by a great inter-individual variability in disease course and severity. Some patients experience a rather mild course, controversially called 'benign MS' (BMS). The usefulness of this entity in clinical practice remains unclear.

Methods

We performed a literature search in PubMed, Web of Science and Cochrane Library databases from November 1980 to December 2015, using the following key words: benign multiple sclerosis, diagnosis, imaging, prognosis, predictive, natural history and predefined inclusion criteria.

Results

Our search yielded 26 publications. Most definitions were based on the Expanded Disease Status Scale (EDSS), which is heavily weighted towards physical disability. Between 30 and 80% of relapsing-remitting MS patients have EDSS < 3 or 4 at 10 years after onset. Having only one relapse in the first 5 years and EDSS ≤ 2 at 5 years or EDSS ≤ 3 at 10 years appears to be predictive for a prolonged benign disease course, without protecting against disease progression at a later stage. Evidence on the predictive value of MRI parameters remains limited.

Conclusions

Current BMS definitions have some predictive value for future physical disability, but do not take into account the age at EDSS and the potentially disrupting effects of non-EDSS symptoms and cognitive impairment. It appears to correspond to mild RRMS in the first decades and its prevalence varies. Since early and accurate prediction of BMS is not yet possible, the clinical relevance is limited. Research approaches are suggested.

Assessment of patients with multiple sclerosis according to tests of the Multiple Sclerosis Functional Composite

Abstract Introduction: The Multiple Sclerosis Functional Composite (MSFC) is a scale that evaluates the functional and cognitive aspects of patients with multiple sclerosis (MS). Objective: To compare the performance of individuals with the relapsing-remitting form of MS (RRMS) with a group of healthy subjects using the MSFC. Methods: Twenty subjects were investigated in this study, consisting of 10 patients with clinical diagnosis of RRMS and 10 controls with similar gender and age to the group with the disease. The three tests that comprise the MSFC were used for the evaluation of gait, upper limb motor function and cognition (memory and processing speed). Student's t-test was used to assess data with normal distribution and data with skewed distribution were evaluated using the Mann-Whitney test. Results: The results showed that the patients with RRMS took longer to perform the locomotion test (6.91 ± 2.35) compared to the control group (5.16 ± 1.28). The MS group (22.06 ± 5.44) also showed greater difficulty in performing a task with the dominant upper limb compared to the healthy subjects (17.79 ± 2.96). No statistically significant difference was found between the groups in the performance of cognitive tasks (p = .65). Conclusion: The use of the MSFC tests proved valuable for measuring possible motor and cognitive impairments in patients with RRMS. Thus, it is suggested that this scale is adopted in clinical practice, improving therapies for the treatment of MS patients and thereby providing them a better quality of life.

Relato de Experiência em Acompanhamento Cognitivo com um Paciente com Esclerose Múltipla

A Esclerose Múltipla (EM) é uma doença crônica e autoimune, caracterizada por desmielinização, inflamação e neurodegeneração do Sistema Nervoso Central. Entre 30 e 50% dos indivíduos com EM apresentam comprometimento cognitivo. O processo de reabilitação cognitiva visa capacitar o paciente a conviver, reduzir e/ou superar os déficits cognitivos decorrentes da doença. Este trabalho relata a experiência de uma estagiária de Psicologia ao participar de um projeto de extensão universitária de acompanhamento cognitivo a um paciente com EM. Inicialmente o paciente foi submetido à avaliação neuropsicológica, identificando funções cognitivas preservadas e déficits. Foram observados déficits na recordação tardia, compreensão léxica, compreensão aritmética e aprendizagem numérica. Posteriormente, o paciente recebeu acompanhamento cognitivo semanal pelo período de seis meses. Após o período do acompanhamento, foi feita a reavaliação neuropsicológica. Observou-se melhora significativa na capacidade de recordação tardia e na aprendizagem aritmética, que deixaram de consistir em déficits. Além disso, houve abrandamento do déficit na compreensão aritmética. Os demais resultados permaneceram sem alterações. O trabalho mostra o impacto positivo que o acompanhamento cognitivo pode trazer ao paciente com EM e como a experiência de extensão pode auxiliar na formação dos estudantes de Psicologia.

Serum uric acid level in patients with relapsing-remitting multiple sclerosis

Uric acid (UA) is a hydrophilic antioxidant product associated with multiple sclerosis (MS). We conducted a randomized case-control study to evaluate the serum level of UA in different phases of MS in comparison with levels in a healthy control population. Serum UA was checked in 130 patients with relapsing-remitting MS (85 patients in remitting and 45 patients in relapsing phase) and 50 age-matched controls using a quantitative enzyme-linked immunosorbent assay (ELISA). The mean concentrations of UA in serum was 6.41(±3.18)mg/dL in patients with remitting MS, 4.76(±1.66)mg/dL in patients with relapsing MS and 6.33(±2.94)mg/dL in controls. There was a significant difference between mean UA concentration in relapsing MS and remitting MS (p<0.001), and between patients with relapsing MS and controls (p=0.002); however, the difference between levels for patients in the remitting phase of MS and the control group was not significant (p=0.87). It seems probable that UA has a role in the prevention of disease activity in MS.

The epidemiology of multiple sclerosis in Latin America and the Caribbean: a systematic review

The incidence and prevalence of multiple sclerosis (MS) varies geographically as shown through extensive epidemiological studies performed mainly in developed countries. Nonetheless, scant data is available in Latin America and the Caribbean (LAC). The objective of this review is to assess epidemiological data of MS in LAC. We conducted a systematic review of published articles and gray literature from January 1995 to May 2011. Twenty-two studies met the inclusion criteria after full-text review. Incidence data were found in only three studies and ranged from 0.3 to 1.9 annual cases per 100,000 person-years. Prevalence was reported in 10 studies and ranged from 0.83 to 21.5 cases per 100,000 inhabitants. The most prevalent subtype of MS was the relapsing–remitting form (48% to 91% of the series). No data about mortality were found. This study showed low frequency for MS in LAC compared with North American and European countries. The role of environmental and genetic factors should be well studied, providing new insights about its etiology.

Prevalence of epilepsy in a case series of multiple sclerosis patients

OBJECTIVE

The prevalence of epilepsy in multiple sclerosis (MS) patients has been a subject of interest for some years. The objectives of this study were to describe the clinical, radiological and electroencephalographic characteristics of epileptic seizures and to calculate the prevalence of epilepsy in a case series of MS patients.

METHOD

Medical charts of MS patients were reviewed and patients who had suffered epileptic seizures were identified.

RESULTS

Of 160 cases analyzed, 5 had suffered epileptic seizures and one had comorbid mesial hippocampal sclerosis, confirmed by magnetic resonance imaging in a patient with complex partial seizures that began fifteen years prior to her diagnosis of MS. In the other four patients, seizures occurred both during the acute phase of the disease and in the chronic phase.

CONCLUSION

The prevalence of epileptic seizures in MS patients in this study was 2.5%, similar to that found in other studies.

The prevalence of multiple sclerosis in central Italy

Background: The prevalence of multiple sclerosis varies considerably throughout the world.

Objective: To better define the prevalence of MS in central Italy.

Methods: This is a population-based study conducted in the province of Frosinone, which is situated in the Lazio region, central Italy. The selected prevalence day was 1 January 2007. A total of 467 patients, with a definite diagnosis of multiple sclerosis, were considered for crude, age- and sex-specific prevalence estimation.

Results: The overall crude prevalence rate was 95.0 cases per 100,000 (95% confidence interval (CI) 86.6—104.0). A significantly higher prevalence rate was recorded in females (134.9, 95% CI 121.0—150.1) than in males (53.3, 95% CI 44.4—63.3) ( p = 0.001). Age-specific prevalence peaked in the 25—34 year, 35—44 year and 45—54 year age groups; moreover, it was found to increase up to the 35—44 year age group in males and the 45—54 year age group in females, decreasing thereafter. The female to male ratio was 2.6.

Conclusions: The results confirm that MS occurs more frequently in central Italy than might be expected on the basis of the geographic-related distribution model, thus supporting the view that this is a high-risk area for the disease.

Validation of the "Six Step Spot Test" for gait among patients with multiple sclerosis in Brazil

The clinical manifestations of multiple sclerosis (MS) are variable among patients, and the course of disease is not linear. Different symptoms are presented, with gradual accumulation of disability. These variations are difficult to quantify in clinical practice, and several studies have attempted to create instruments capable of measuring these disabilities. The Six Step Spot Test (SSST) was developed for quantitative evaluation of the lower limbs (LL) over time. Performance in this test reflects the complexity of sensory-motor function, including LL strength, spasticity, coordination and balance, going beyond vision and cognition. The aim of the present study was to validate the SSST in a population of MS patients in Brazil. This prospective study included 75 patients with MS, with EDSS 0 to 6.5 in the study group. Ninety-one healthy subjects were randomly selected for the control group. The results showed that the groups were similar, and that the SSST is a reliable and reproducible test. According to the statistical analysis on the data in this study, the SSST is a valid, reliable and reproducible tool for use in the Brazilian MS patient population.

Expressão do complexo de histocompatilidade principal de classe I (MHC I) no sistema nervoso central: plasticidade sináptica e regeneração

Foi demonstrado recentemente que o complexo de histocompatibilidade principal de classe I (MHC I), expresso no sistema nervoso central (SNC), não funciona somente como molécula com papel imunológico, mas também como parte de um mecanismo envolvido na plasticidade sináptica. A expressão de MHC I interfere na intensidade e seletividade da retração de sinapses em contato com neurônios que sofreram lesão e também influencia a reatividade das células gliais próximas a esses neurônios. A intensidade do rearranjo sináptico e resposta glial após lesão, ligadas à expressão de MHC I no SNC, repercute em diferenças na capacidade regenerativa e recuperação funcional em linhagens de camundongos isogênicos. Dessa forma, os novos aspectos sobre a função do MHC I no SNC direcionam futuras pesquisas no sentido de buscar o envolvimento do MHC I em doenças neurológicas e também o desenvolvimento de novas estratégias terapêuticas.

Effect of thalidomide and pentoxifylline on experimental autoimmune encephalomyelitis (EAE)

BACKGROUND

Autoimmune encephalomyelitis (EAE) in Lewis rats is a classical experimental model of demyelinating inflammatory disease of the central nervous system. EAE is widely accepted for study of immune-inflammatory mechanisms in the CNS related to multiple sclerosis (MS) due to similar clinical evolution.

OBJECTIVES

In the present study we investigated the effects of Thalidomide and pentoxifylline during EAE development in Lewis rats.

METHODS

EAE was induced in Lewis rats and treatment with Thalidomide or pentoxifylline was performed. Clinical evaluation was carried out daily. Histopathological analysis of the brain tissue and spinal cord was performed. Griess method was used for determination of NO serum levels. TNF-alpha and IFN-gamma serum levels were investigated using ELISA method.

RESULTS

Thalidomide and pentoxifylline treatment is associated with significant reduction of neuroinflammation in CNS. Serum levels of NO, IFN-gamma and TNF-alpha showed a marked reduction. Such findings were correlated with improvement of clinical symptoms, particularly in thalidomide treated rats.

CONCLUSIONS

Taken together the data suggested that thalidomide and pentoxifylline may be therapeutic options for the treatment of MS, however further experiments must be performed to investigate this hypothesis.

Multiple sclerosis outcome and morbi-mortality of a Brazilian cohort patients

We studied the clinical and evolution characteristics of multiple sclerosis (MS) patients followed since the onset of HUCFF/UFRJ in 1978. The diagnosis of MS was based on Poser's et al. and MC Donald's et al. criteria. From 188 patients, 122 were included. Eighty-five were females. The mean age onset was 32.2 years-old (range 6.0 to 61.0±10.3), mainly Caucasians (82/67%). The relapsing-remitting course (MSRR) was more frequent (106/86.8%). Monosymptomatic onset was significantly more frequent in Caucasians than in Afro-Brazilians (p<0.05). Seventeen patients had benign form of MS and these patients presented association with MSRR when compared with severe form (p=0.01). The mortality rate was 2.12% (4 patients died). This study was similar to other Brazilian series with regard to sex and age, and lack of correlation between EDSS and number of relapses; it confirmed south-southeast African-descendants gradient distribution and association between first mono-symptomatic relapses and Caucasian; we found lower frequency of benign forms.

Esclerose múltipla: estudo de pacientes com a forma surto-remissão cadastrados na Secretaria de Estado da Saúde de Minas Gerais

Esclerose múltipla é uma doença crônica, inflamatória e desmielinizante do sistema nervoso central. O tratamento preconizado para a forma surto-remissão é com imunomoduladores, fornecidos em Belo Horizonte pela Secretaria de Estado da Saúde de Minas Gerais (SES/MG). Analisamos os dados de 283 pacientes inscritos no Programa de Medicamentos Excepcionais (imunomoduladores) da SES/MG no período de maio a outubro de 2004. Houve predomínio do sexo feminino (3,7:1) e a idade média dos pacientes foi 38,4±10,7 anos, com as primeiras manifestações clínicas ocorridas aos 29,7±10,2 anos. Os sintomas iniciais foram: sensitivos (46,4%), visuais (33,1%), síndrome de tronco cerebral/cerebelo (30,1%) e motores (25,9%). Os sintomas observados em surtos subseqüentes foram motores (22,3%), síndromes de tronco cerebral/cerebelo (18,9%), visuais (18,9%) e sensitivos (9,6%). Em 234 RM de encéfalo e 109 RM da medula espinhal existiam lesões desmielinizantes em 97,4% e 85,3% respectivamente. Comparamos nossos achados com outras séries descritas na literatura brasileira.

Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care

OBJECTIVE

The Chalder Fatigue Questionnaire (CFQ) is an instrument used to measure physical and mental fatigue. We translated and adapted the questionnaire and tested its reliability and validity in a Brazilian primary care setting.

METHOD

A pilot study with 204 consecutive primary care attenders in Sao Paulo, Brazil, verified the internal consistency and factor structure of the questionnaire. After some modifications through a rigorous translation, back-translation, and cross-cultural adaptation procedure, a validation study was conducted with 304 attenders, who also completed the fatigue section of the Revised Clinical Interview Schedule (CIS-R).

RESULTS

The internal consistency of the Brazilian CFQ slightly improved from the pilot to the validation study: Cronbach's alpha from .86 to .88. The two-factor structure (physical and mental fatigue) also improved. According to the receiver operating curve analysis with the fatigue section of the CIS-R as the standard criterion, 3/4 was chosen as the cutoff for Brazilian primary care (sensitivity 69.1% and specificity 79.4%).

CONCLUSION

The Brazilian CFQ had good reliability and validity. The cutoff was determined as 3/4 and the factor structure of the English CFQ was closely reproduced.

Clinical and epidemiological profile of multiple sclerosis in a reference center in the State of Bahia, Brazil

Multiple sclerosis (MS) is an autoimmune, demyelinating and degenerative disease that affects the central nervous system. Its prevalence and clinical aspects vary according to the continent considered, being more frequent in Caucasians and young individuals aged 20 to 40 years. Epidemiological data from Brazil show that prevalence is variable, being more frequent in the Southern and Southeastern areas of the country, rather than in the Northern and Northeastern areas. The purpose of this paper is to describe MS clinical and epidemiological features in the State of Bahia, in the Brazilian Northeastern region. Thus, we held a cross-sectional study over the period from February to May, 2005, in the Multiple Sclerosis Patient Support Center ("Núcleo de Apoio aos Pacientes com Esclerose Múltipla") of Bahia, which included all patients with a diagnosis of MS seen over this period of time. A total of 121 patients were investigated, being 80.2% females (female:male ratio=4:1), with higher frequency in mulatto individuals (64%), and the relapsing-remitting type (91.3%). Most patients (68.7%) had mild MS, and blacks were prone to worse prognosis compared to other patients.

Características clínicas e epidemiológicas de 20 pacientes portadores de esclerose múltipla acompanhados em Cuiabá - Mato Grosso

A esclerose múltipla é uma doença imunomediada do sistema nervoso central com ampla variação nos seus aspectos clínicos. No Brasil, aspectos étnicos e demográficos demonstram estas variações, como observado em várias casuísticas brasileiras. O presente estudo retrospectivo consta da análise descritiva dos aspectos clínicos e epidemiológicos de 20 casos de esclerose múltipla acompanhados em Cuiabá, cidade situada na região centro-oeste do Brasil. Os pacientes foram diagnosticados no período entre 1998 e 2005 no ambulatório de Neurologia do CRIDAC. Houve predomínio no sexo feminino (75%), sendo observada significativa incidência sobre a etnia negra (20%). A média do EDSS inicial/final foi 1,85/3,9. A forma evolutiva mais comum foi a remitente-recorrente (75%), com 55% do total de pacientes sendo naturais de Mato Grosso. Os sintomas piramidais (90%), cerebelares (60%) e visuais (25%) foram os mais freqüentemente observados. Todos os pacientes estavam em uso de imunomoduladores ou imunossupressores.

Prevalence of multiple sclerosis in Isfahan, Iran

BACKGROUND

The prevalence of multiple sclerosis (MS) shows considerable variability all over the world. According to Kurtzke, Iran is considered to have a low prevalence.

OBJECTIVE

To estimate the period prevalence and risk factors of MS in Isfahan, central part of Iran.

METHODS

A cross-sectional case register study conducted between 2004 and 2005. In the province of Isfahan, Iran, all patients known to have definite MS during 2004 and 2005, being alive and resident within Isfahan as well as being a member of the Isfahan MS Association were included in the study. Demographic and case-related information was recorded. 1,391 definite MS patients (308 men and 1,083 women) from the Isfahan MS Association, Iran, have been identified. The disease was confirmed using clinical information and MRI findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. Population data were obtained from the year 1999 Iran Census. The mean (SD) age of the participants was 32.5 (9.3) years with a mean (SD) duration of the disease of 6.4 (5.1) years for men and 6.9 (5.3) years for women.

RESULTS

The period prevalence of MS was 35.5 per 100,000 [95% confidence interval (CI) 33.6-37.3] in a population of 3,923,255, with a higher rate in women than men [54.5 (95% CI: 51.1-57.8) for women and 14.9 (95% CI: 13.3-16.6) for men]. The female/male ratio was 3.6 (95% CI: 3.2-4.1). The direct age-adjusted period prevalence was 59.5 per 100,000 (95% CI: 44.8-75.2) for women and 17.0 per 100,000 (95% CI: 8.9-25.1) for men. MS rates were highest among 30- to 39-year-olds and decreased with increasing age. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.1% (95% CI: 48.4-53.7) and 47.0% (95% CI: 44.4-49.7), respectively.

CONCLUSION

Isfahan could be considered as an area with a medium to high risk of MS. This is in sharp contrast with the gradient hypothesis.

Clinical Course of Progressive Multiple Sclerosis in Brazilian Patients

OBJECTIVE

To describe the clinical course and outcome of multiple sclerosis with progressive onset in Brazilian patients. A total of 238 medical records were reviewed, 26 cases (10.9%) fulfilled Thompson criteria (2000), and 5.80% classified as primary progressive and 5.04% relapsing progressive according to Lublin and Reingold.

STUDY POPULATION

19 Caucasians and 7 non-Caucasians; male:female ratio 1.2:1, mean age at onset was 34 +/- 7.9 years.

RESULTS

Non-Caucasian patients had earlier onset of disease. The most common manifestations at onset were pyramidal and cerebellar (89% and 34.6%). After 11.3 +/- 6.35 years of disease more than 50% of the patients had involvement of most of their functional systems. No statistically significant differences were observed between the subgroups.

CONCLUSION

The clinical course and outcome of progressive multiple sclerosis in Brazil, a tropical country with low prevalence, were very similar to those in the multiple sclerosis high prevalence areas.

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

OBJETIVE: to register multiple sclerosis (MS) patients residing in the coastal region of the State of São Paulo (CEREM Litoral Paulista). METHOD: Individual interviews with identified cases of MS. RESULTS: 81 individuals with diagnosis of MS agreed to come for registration (62 females [76.5%], 19 males [23.5%]). 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 relapsing/remitting form of MS. 81.5% of all patients were undergoing treatment 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.

[Ethical issues in multiple sclerosis under physicians and patients point of view]

Multiple sclerosis (MS) is a neurologic disorder that mostly affects young adults and can usually evolute to physical disability. Thus, caring patients with MS brings many ethic questions for the physician.

OBJECTIVE

To identify physicians and patients' perceptions about the illness and so improve doctor-patient relationship.

METHOD

It was made two different questionnaires, one for patients and another for physicians, 103 patients and 44 physicians answered them.

RESULTS

96.1% of patients knew their diagnosis, all others would like to know it. From those, 74.7% thought that that way it was disclosured was correct and 90.9% said that the doctor should tell us it. The worst symptoms described were fatigue (29.1%) and motor deficits (28.1%). By other side, 68% of patients told they suffered because of the illness. The most important reason for doctors to tell the diagnosis to the patients was to improve adherence to treatment (56.8%). A familiar present at this moment was demanded for 54.6% of doctors. When asked about orientations in a pregnancy, 50% of physicians did not answer correctly. Finally, 50% of physicians were against complementary and alternative therapies.

CONCLUSION

Patients want to know their diagnosis and doctors should tell them in the most adequate moment and give more information. A debate about palliative care is also necessary.

Epidemiologia de 118 casos de esclerose múltipla com seguimento de 15 anos no centro de referência do Hospital da Restauração de Pernambuco

A prevalência de esclerose múltipla (EM) varia consideravelmente no mundo. De acordo com Kurtzke, a América do Sul é considerada região de baixa prevalência (menor que 5 casos:100000 habitantes). OBJETIVO: Descrever a epidemiologia da EM em centro de referência, comparando-a aos achados de oito serviços nacionais. MÉTODO: Através de estudo de incidência, descritivo, prospectivo, longitudinal, foram analisados dados de 118 pacientes, atendidos no Centro de Referência para Atenção ao Paciente Portador de Doença Desmielinizante do Hospital da Restauração - Recife - PE - Brasil (CRAPPDD-HR), entre janeiro de 1987 e março de 2002, com diagnóstico de EM, segundo critérios de Poser. RESULTADOS: Os pacientes foram acompanhados por um a 15 anos. Noventa e cinco (80,5%) pacientes estavam em tratamento específico com imunomoduladores. A prevalência foi igual a 1,36:100000 habitantes. Identificaram-se: predomínio da etnia parda (110 casos, 93,2%); 82 (82,2%) casos clinicamente definidos, 15 (12,7%) laboratorialmente definidos e 6 (5,1%) clinicamente prováveis; número máximo de surtos igual a 46; maior número de casos com EDSS leve, assim como um a 10 anos de doença na forma surto/remissão (SR). A razão de gênero dos 83 casos da forma SR se equivaleu à geral (4,1:1), contudo na forma SR com progressão secundária houve predomínio duas vezes maior para o sexo feminino e na forma primariamente progressiva, 5,5 vezes maior para o sexo masculino. CONCLUSÃO: Apesar da presente pesquisa ter se assemelhado aos oito estudos utilizados para comparação, as diferenças constatadas irão requerer novas pesquisas e novas abordagens.

Multiple sclerosis: report on 200 cases from Iran

Clinical findings of 200 patients in Iran with definite multiple sclerosis (MS) according to Poser et al.'s criteria and positive findings on magnetic resonance imaging (MRI) have been reviewed. The clinical course was relapsing-remitting (RR) for 88%, primary progressive (PP) for 7% and secondary progressive (SP) for 5% of cases. The mean age of onset was 27 +/- 7.4 years for the whole group and 37.1 +/- 8.8 years for PPMS. The gender ratio was 2.5:1 female:male. Involvement of the pyramidal system was the most common mode of presentation. Five per cent of patients had positive family history for the disease, 14% of patients had benign MS and 12% with disease duration longer than five years had an Expanded Disability Status Scale < or = 2. The optico-spinal form was not a common form of presentation in the group.

[Box and block test of manual dexterity in normal subjects and in patients with multiple sclerosis]

Recently new disease-modifying treatments for multiple sclerosis (MS) were introduced which can change the natural course of the disease. In clinical trials with these new agents the Expanded Disability Status Scale (EDSS) is often used as a primary outcome instrument to measure neurological impairment and disability. A number of limitations have been identified when using the EDSS, some of wich are because the EDSS is an ordinal scale that is heavily biased to locomotor function. In this study we applied the box and block test of manual dexterity in normal subjects and relapsing-remitting MS patients. The results were that 64.8% of the female and 80.7% of the male patients had significant changes on this task compared with normal subjects, and as this test is easily applied and is sensitive in detecting upper extremity functional ability, we recommend its use in clinical trials to evaluate new drugs in MS patients.

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

We reviewed the clinical and laboratory findings of 200 patients in Curitiba, Southern Brazil (25 degrees 25'40" S; 49 degrees 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 African-Brazilian, 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 > or = 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