Ton, Alyne Mendonça Marques; Vasconcelos, Claudia Cristina Ferreira; Alvarenga, Regina Maria Papais

doi:10.1590/0004-282X20170043

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REVIEW • Arq. Neuro-Psiquiatr. 75 (6) • Jun 2017 • https://doi.org/10.1590/0004-282X20170043 copiar

A esclerose múltipla benigna: aspectos cognitivos e de neuroimagem

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

A existência real de uma forma benigna da esclerose múltipla (EMB) é um tema controverso. Ampliar o número de publicações que abordam os aspectos gerais do subtipo da doença, tais como os critérios de definição utilizados, análise de prevalência e da presença de marcadores clínicos e de neuroimagem. Foi realizada uma revisão sistemática dos dados publicados até outubro de 2015, relativa à EMB. Os dados encontrados foram dicotomizados em gráficos e, posteriormente, analisados. Foram analisados 31 artigos publicados. A frequência estimada EMB oscila entre 6% a 73%. O comprometimento cognitivo foi reconhecido em 17–47% dos sujeitos, apresentando correlação significativa com os aspectos de neuroimagem, como a atrofia cerebral global, aumento do volume lesional em T2 e atrofia regional da substância cinzenta. Os critérios atualmente utilizados superestimam a freqüência de EMB, e, por essa razão, destaca-se a importância da validação dos métodos de diagnóstico praticados.

esclerose múltipla; cognição; neuroimagem

Author	Year	Population (n)	Country	Definition	Frequency (%)	Frequency after

						5 years (%)	10 years (%)	20 years (%)
Hawkins & Mc Donell²	1999	131	Ireland	3	19.90	-	9.30	-
Thompson et al.³	1986	240	Ireland	3	42.00	-	-	-
Pittock et al.⁴	2004	162	Ireland	4	30.24	-	20.93	-
Glad et al.⁵	2010	138	Norway	2	14.50	-	-	-
				3	26.30	-	-	-
				4	40.80	-	-	-
McAlpine⁷	1954	241	London	1	32.36	25.72	-	-
Costelloe et al.¹¹	2008	355	Ireland	-	14.32	-	-	11.00
Correale et al.¹³	2012	342	Argentina	3	12.50	-	-	-
Sayao et al.²⁸	2007	169	England	3	-	-	-	52.10
Leray et al.²⁹	2013	374	France	2	57.70	-	12.01	2.63
Leray et al.²⁹	2013	374	France	3	73.90	-	18.53	5.03

Author	Year	Population (n)	Cognitive impairment (%)	Cognitive assessment
Pagani et al.⁶	2008	60 BMS	20	Nonspecified neuropsychological tests exploring memory, attention and frontal lobe cognitive domains
		35 SPMS
		21 healthy volunteers
Correale et al.¹³	2012	47 BMS	47	Neuropsychological battery containing PASAT- 3 seconds, DST, 7/24 SPART, WCST and VFD.
Correale et al.¹³	2012	299 NBMS	47
Bester et al.¹⁵	2013	26 BMS	38	Neuropsychological battery containing VFT, CVLT-II, SDMT, PASAT-3 seconds, D-KEFS and CWIT.
Bester et al.¹⁵	2013	24 healthy volunteers	38
Rovaris et a.l¹⁶	2008	62 BMS	19	Neuropsychological battery containing PASAT, TMT, CST, SST, DST, WLT, ROCF-recall, Token Test, VFT and WCST.
		32 SPMS
		19 healthy volunteers
Amato et al.¹⁷	2008	47 BMS	23	SRT, 10/36 SRT, PASAT, SDMT and WLG.
Mesaros et al.¹⁹	2009	54 BMS	17	Neuropsychological battery containg PASAT, TMT, AMT, DSP, SST, CST, WLG, ROCF-recall, Raven Test, Token Test, WCST and ROCF-copy.
Amato et al.²⁷	2006	163 BMS	45	SRT, 10/36 SRT, PASAT, SDMT, WLG and Stroop Test.
Amato et al.²⁷	2006	111 healthy volunteers	45	SRT, 10/36 SRT, PASAT, SDMT, WLG and Stroop Test.

Author	Year	Population (n)	Country	Neuroimages findings
Filippi et al.²¹	1995	13 BMS	Italy	Lower lesional charge (p = 0.03)
Filippi et al.²¹	1995	13 SPMS	Italy	-
De Stefano et al.²³	2008	50 BMS	Italy	Lesional and perilesional inferior MTr to the healthy controls (p < 0.0001) and bigger than the patients with RRMS
		50 RRMS		NAWM of MTr and cortical similar to the controls (p > 0.05) and bigger than the patients with RRMS (p < 0.0001)
		32 healthy volunteers		-
Gauthier et al.²⁴	2006	39 BMS	USA	Lower rate of brain atrophy (p = 0.02)
Gauthier et al.²⁴	2006	40 RRMS	USA	-
Strasser-Fuchs et al.²⁵	2007	13 BMS	England	No differences in relation to the lesional charge in T2 (p = 0.19)
Strasser-Fuchs et al.²⁵	2007	15 SPMS	England	-
Calabrese et al.³²	2009	48 BMS	Italy	Inferior number of intracortical lesions (p < 0.001)
Calabrese et al.³²	2009	96 RRMS	Italy	-

Author	Year	Population (n)	Country	Cognition and neuroimages
Pagani et al.⁶	2008	60 BMS	Italy	There’s no difference between the grey matter atrophy level and the patients with, or without, cognitive loss
		35 SPMS		-
		21 healthy volunteers		-
Carreole et al.¹³	2012	47 BMS	Argentina	BMS patients without a cognitive loss present less progression in the lesional charge related to others
Carreole et al.¹³	2012	299 BMS	Argentina	When compared to BMS patients with cognitive loss, there’s no difference
Rovaris et al.¹⁶	2008	62 BMS	London	BMS patients without a cognitive commitment were associated with a less lesional charge in T2 (p = 0.03), normalized brain volume (p = 0.006) and diffusion average of inferior grey matter in relation to SPMS controls (p = 0.03).
		32 SPMS		BMS patients without a cognitive commitment did not show differences in neuroimaging related to others
		19 healthy volunteers		-
Amato et al.¹⁷	2008	47 BMS	Italy	The cognitive commitment was associated with an increase in lesional charge in T1 (p = 0.001) and T2 (0.05).
Amato et al.¹⁷	2008		Italy	BMS patients with cognitive commitment presented with a pronounced cortical atrophy (p = 0.005) and a reduction of cortical MTr (p = 0.02)
Mesaros et al.¹⁹	2009	54 BMS	Italy	The cognitive commitment was associated with a greater lesional charge in the corpus callosum (p = 0.02) and diffusion average of superior NAWM to others (P = 0.02)
Bester et al.³²	2013	26 BMS	USA	The cognitive commitment was associated with an increase of lesional volume in T2 in the anterior thalamus region (p < 0.001)

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[1] Correspondence: Alyne Mendonça Marques Ton; Departamento de Neurologia da UNIRIO; Rua Mariz e Barros, 775; 20270-004 Rio de Janeiro RJ, Brasil; E-mail: lyne_msv@hotmail.com