Corticotrofina e cortiomdes em neurologia: avaliação critica dos resultados em 518 pacientes hospitalizados

Assis, J. Lamartine de; Tetner, Jayme

doi:10.1590/S0004-282X1968000400001

Resumos

Com base no tratamento pela corticotrofina e corticóides de 518 pacientes internados no período de 1952 e 1967, os autores fazem a avaliação crítica dos resultados dessa terapêutica em diversas afecções do sistema nervoso. São as seguintes as afecções estudadas: moléstias desmielinizantes, polirradiculoneurite ,coréia aguda, mielose funicular, hipsarritmia, miastenia grave, polimiosite, neurotuberculose e neurocisticercose. Os medicamentos empregados foram o ACTH ou corticotrofina pelas vias venosa ou intramuscular, e a cortisona e derivados pelas vias oral ou parenteral. O uso de derivados da cortisona, especialmente o acetato de metilprednisolona, pela via intratecal constituirá objeto de outro estudo. Os resultados do tratamento hormonal foram analisados sob os aspectos curativo e preventivo. Neste último aspecto a análise se restringiu à prevenção de seqüelas nos casos de neurotuberculose e neurocisticercose. A avaliação dos efeitos terapêuticos obedeceu a critério clínico e, quando necessário, ficou subordinada ao estudo evolutivo dos exames complementares. Foram referidos apenas os resultados imediatos, observados pela condição de alta dos pacientes. Desse estudo os autores concluem: 1. A corticotrofina e/ou corticóides são empregados com resultados favoráveis no tratamento de diversas moléstias do sistema nervoso, tanto como terapêutica curativa como preventiva. 2. Os resultados em geral são de avaliação difícil e estão na dependência da natureza e caráter evolutivo da afecção e da época em que o tratamento é instituído relativamente ao início da sintomatologia. 3. Em relação ao tratamento curativo, as afecções agudas de natureza imunalérgica ou os surtos das neuropatías de evolução cíclica e as suscetíveis de agravação progressiva com manifestações paroxísticas foram as que melhor responderam à terapêutica hormonal. Certas moléstias que costumam evoluir com fases de agravação e cuja natureza parece estar ligada a fatores imunológicos, também responderam de modo favorável ao emprego do ACTH e/ou corticóides. 4. Conseqüentemente, melhores efeitos foram obtidos na coréia aguda, polirradiculoneurite, complicações neurológicas das vacinações, da coqueluche, da parotidite epidêmica e de febres eruptivas, nas crises paroxísticas e disritmia cerebral da hipsarritmia e na miastenia grave. Em ordem decrescente quanto aos benefícios proporcionados pela terapêutica hormonal, estão a esclerose múltipla e outras desmielinizações primárias. O número pequeno de casos não permitiu conclusão quanto à polimiosite. É de notar que, em relação às desmielinizações primárias, os melhores resultados foram obtidos quando o tratamento era aplicado no combate aos primeiros surtos de agravação da moléstia tornando-se menos eficiente nos surtos ulteriores. A mielose funicular foi a neuropatía que menos se beneficiou com o emprego isolado dos glicocorticóides. 5. Na meningencefalite tuberculosa subaguda ou crônica os resultados em geral não foram bons, porém nos casos recentes a associação da medicação específica ao ACTH ou corticóides, foi benéfica, tanto como terapêutica curativa como na prevenção de aderências pia-aracnóideas. 6. Na neurocisticercose os resultados de modo geral foram favoráveis, justificando amplamente o emprego dos hormônios glicocorticóides como terapêutica preventiva no sentido de limitar a formação de aderências. Usados com critério e com as necessárias precauções, o ACTH e os corticóides acarretaram índice significativamente baixo de complicações que, no entanto, foram quase sempre muito graves. 8. Com essas restrições a terapêutica hormonal constitui arma preciosa no arsenal terapêutico da Neurologia. Mesmo nos casos menos favoráveis, freqüentemente esses hormônios representam o único recurso disponível e o pouco que se obtiver será suficiente para justificar o seu emprego. Em certos casos de evolução dramática o uso do ACTH e/ou corticóides torna-se quase imperativo.

Based on the treatment with corticotrofin and corticosteroids of 518 patients admited at the "Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo", in the period of 1952 to 1967, the authors performed a critical evaluation of the results obtained in several diseases of the nervous system: demyelinating diseases, polyradiculitis (Landry-Guillain-Barré syndrome), Sydenham's chorea, sabacute combined degeneration, hypsarrhytmia, myasthenia gravis, polymiositis, tuberculous meningitis and neurocysticercosis. ACTH or corticotrofin were employed intravenously or intramuscularly and the steroids were given orally or parenterally. The results with adrenal steroids or ACTH treatment were analysed under the treatment and preventive aspects. Concerning this aspect the analysis hás been limited, to tuberculous meningitis and neurocistycercosis cases. The evaluation of the therapeutic effects was based on clinical criterion and, when necessary, has been subordinated to an evolutive study concerning complementary examinations. Only immediate results based on general conditions of the patients at hospitalar discharge were reported. The authors conclude: 1. The corticotrofin and/or corticosteroids are used with favorable results in the treatment of several nervous system diseases as a therapeutic method as well as prophylactically. 2. Generally the results are difficult to evaluate and some times they depend on the nature and evolution of the disease and also on the period in which the treatment was established. 3. Regarding the therapeutic methods, the acute immunoallergic diseases or neuropathies with cyclical evolution those with a tendency to a progressive worsening and those with paroxystic manifestations responded in a better way to hormonal therapy. Some diseases which use to have an evolution with exacerbations and whose nature seems to be related to immunological factors also responded in a favorable way to ACTH and/or corticosteroids. 4. Consequently, better results were obtained in Sydenham's chorea, polyradiculitis, neurological complications of vaccination, in whooping-cough, epidemic parotiditis and eruptive fevers, in paroxysm crisis and cerebral dysrhytmia of hypsarrhytmia and in myasthenia gravis. In decreasing order regarding hormonal therapeutic benefits the authors point out multiple sclerosis and other primary demyelinating diseases. The small number of cases has not allowed a definite conclusion regarding polymiositis. Concerning primary demyelinating diseases the best results have been obtained when the treatment was employed during the first acute demyelinizating period of the disease, becoming less efficient on further exacerbations. Subacute combined degenation has been the neuropathy with less benefits regarding the hormonal treatment. 5. In sub-acute or chronic meningitis there were no good apparent results, but in recent cases in which the specific medication has been associated to ACTH or corticosteroids the effect has been excellent. 6. In neurocysticercosis the results generally have been favorable, justifying extensive use of hormones as preventive therapeutic in this disease. 7. With a criterious use and necessary precaution ACTH and corticosteroids have a significative low incidence of complications that, however, have been always severe. 8. With those restrictions, the treatment by hormones constitutes a precious weapon in neurological therapy. Even in those unfavorable cases, frequently the hormones represent the only available method and even the minor results obtained will justify its use. In some cases of dramatic evolution the use of ACTH and/or corticosteroids becomes almost imperative.

Corticotrofina e cortiomdes em neurologia. Avaliação critica dos resultados em 518 pacientes hospitalizados

Corticotropin and corticosteroids in Neurology. Critical evaluation of the results in 518 patients

J. Lamartine de Assis^I; Jayme Tetner^II

^IDocente-Livre; Clinica Neurológica do Hospital das Clínicas da FMUSP (Prof. Adherbal Tolosa)

^IIMédico-adido; Trabalho da Clinica Neurológica do Hospital das Clínicas da FMUSP (Prof. Adherbal Tolosa)

RESUMO

Com base no tratamento pela corticotrofina e corticóides de 518 pacientes internados no período de 1952 e 1967, os autores fazem a avaliação crítica dos resultados dessa terapêutica em diversas afecções do sistema nervoso.

São as seguintes as afecções estudadas: moléstias desmielinizantes, polirradiculoneurite ,coréia aguda, mielose funicular, hipsarritmia, miastenia grave, polimiosite, neurotuberculose e neurocisticercose.

Os medicamentos empregados foram o ACTH ou corticotrofina pelas vias venosa ou intramuscular, e a cortisona e derivados pelas vias oral ou parenteral. O uso de derivados da cortisona, especialmente o acetato de metilprednisolona, pela via intratecal constituirá objeto de outro estudo.

Os resultados do tratamento hormonal foram analisados sob os aspectos curativo e preventivo. Neste último aspecto a análise se restringiu à prevenção de seqüelas nos casos de neurotuberculose e neurocisticercose.

A avaliação dos efeitos terapêuticos obedeceu a critério clínico e, quando necessário, ficou subordinada ao estudo evolutivo dos exames complementares. Foram referidos apenas os resultados imediatos, observados pela condição de alta dos pacientes.

Desse estudo os autores concluem:

1. A corticotrofina e/ou corticóides são empregados com resultados favoráveis no tratamento de diversas moléstias do sistema nervoso, tanto como terapêutica curativa como preventiva.

2. Os resultados em geral são de avaliação difícil e estão na dependência da natureza e caráter evolutivo da afecção e da época em que o tratamento é instituído relativamente ao início da sintomatologia.

3. Em relação ao tratamento curativo, as afecções agudas de natureza imunalérgica ou os surtos das neuropatías de evolução cíclica e as suscetíveis de agravação progressiva com manifestações paroxísticas foram as que melhor responderam à terapêutica hormonal. Certas moléstias que costumam evoluir com fases de agravação e cuja natureza parece estar ligada a fatores imunológicos, também responderam de modo favorável ao emprego do ACTH e/ou corticóides.

4. Conseqüentemente, melhores efeitos foram obtidos na coréia aguda, polirradiculoneurite, complicações neurológicas das vacinações, da coqueluche, da parotidite epidêmica e de febres eruptivas, nas crises paroxísticas e disritmia cerebral da hipsarritmia e na miastenia grave. Em ordem decrescente quanto aos benefícios proporcionados pela terapêutica hormonal, estão a esclerose múltipla e outras desmielinizações primárias. O número pequeno de casos não permitiu conclusão quanto à polimiosite. É de notar que, em relação às desmielinizações primárias, os melhores resultados foram obtidos quando o tratamento era aplicado no combate aos primeiros surtos de agravação da moléstia tornando-se menos eficiente nos surtos ulteriores. A mielose funicular foi a neuropatía que menos se beneficiou com o emprego isolado dos glicocorticóides.

5. Na meningencefalite tuberculosa subaguda ou crônica os resultados em geral não foram bons, porém nos casos recentes a associação da medicação específica ao ACTH ou corticóides, foi benéfica, tanto como terapêutica curativa como na prevenção de aderências pia-aracnóideas.

6. Na neurocisticercose os resultados de modo geral foram favoráveis, justificando amplamente o emprego dos hormônios glicocorticóides como terapêutica preventiva no sentido de limitar a formação de aderências.

Usados com critério e com as necessárias precauções, o ACTH e os corticóides acarretaram índice significativamente baixo de complicações que, no entanto, foram quase sempre muito graves.

8. Com essas restrições a terapêutica hormonal constitui arma preciosa no arsenal terapêutico da Neurologia. Mesmo nos casos menos favoráveis, freqüentemente esses hormônios representam o único recurso disponível e o pouco que se obtiver será suficiente para justificar o seu emprego. Em certos casos de evolução dramática o uso do ACTH e/ou corticóides torna-se quase imperativo.

SUMMARY

Based on the treatment with corticotrofin and corticosteroids of 518 patients admited at the "Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo", in the period of 1952 to 1967, the authors performed a critical evaluation of the results obtained in several diseases of the nervous system: demyelinating diseases, polyradiculitis (Landry-Guillain-Barré syndrome), Sydenham's chorea, sabacute combined degeneration, hypsarrhytmia, myasthenia gravis, polymiositis, tuberculous meningitis and neurocysticercosis. ACTH or corticotrofin were employed intravenously or intramuscularly and the steroids were given orally or parenterally.

The results with adrenal steroids or ACTH treatment were analysed under the treatment and preventive aspects. Concerning this aspect the analysis hás been limited, to tuberculous meningitis and neurocistycercosis cases.

The evaluation of the therapeutic effects was based on clinical criterion and, when necessary, has been subordinated to an evolutive study concerning complementary examinations. Only immediate results based on general conditions of the patients at hospitalar discharge were reported.

The authors conclude:

1. The corticotrofin and/or corticosteroids are used with favorable results in the treatment of several nervous system diseases as a therapeutic method as well as prophylactically.

2. Generally the results are difficult to evaluate and some times they depend on the nature and evolution of the disease and also on the period in which the treatment was established.

3. Regarding the therapeutic methods, the acute immunoallergic diseases or neuropathies with cyclical evolution those with a tendency to a progressive worsening and those with paroxystic manifestations responded in a better way to hormonal therapy. Some diseases which use to have an evolution with exacerbations and whose nature seems to be related to immunological factors also responded in a favorable way to ACTH and/or corticosteroids.

4. Consequently, better results were obtained in Sydenham's chorea, polyradiculitis, neurological complications of vaccination, in whooping-cough, epidemic parotiditis and eruptive fevers, in paroxysm crisis and cerebral dysrhytmia of hypsarrhytmia and in myasthenia gravis. In decreasing order regarding hormonal therapeutic benefits the authors point out multiple sclerosis and other primary demyelinating diseases. The small number of cases has not allowed a definite conclusion regarding polymiositis. Concerning primary demyelinating diseases the best results have been obtained when the treatment was employed during the first acute demyelinizating period of the disease, becoming less efficient on further exacerbations. Subacute combined degenation has been the neuropathy with less benefits regarding the hormonal treatment.

5. In sub-acute or chronic meningitis there were no good apparent results, but in recent cases in which the specific medication has been associated to ACTH or corticosteroids the effect has been excellent.

6. In neurocysticercosis the results generally have been favorable, justifying extensive use of hormones as preventive therapeutic in this disease.

7. With a criterious use and necessary precaution ACTH and corticosteroids have a significative low incidence of complications that, however, have been always severe.

8. With those restrictions, the treatment by hormones constitutes a precious weapon in neurological therapy. Even in those unfavorable cases, frequently the hormones represent the only available method and even the minor results obtained will justify its use. In some cases of dramatic evolution the use of ACTH and/or corticosteroids becomes almost imperative.

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Clinica Neurológica Faculdade de Medicina da Universidade de São Paulo Caixa Postal 3461 São Paulo, SP Brasil.

Trabalho da Clinica Neurológica do Hospital das Clínicas da FMUSP (Prof. Adherbal Tolosa), apresentado ao III Congresso Brasileiro de Neurologia (Recife, PE 14 a 18 de julho de 1968)

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Datas de Publicação

Publicação nesta coleção
13 Maio 2013
Data do Fascículo
Dez 1968

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Corticotrofina e cortiomdes em neurologia: avaliação critica dos resultados em 518 pacientes hospitalizados

Corticotropin and corticosteroids in Neurology: critical evaluation of the results in 518 patients

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