Esclerose múltipla critérios objetivos de diagnóstico

Oliveira, Teresinha V.; Carvalho, Rosana M.; Seixas, Ricardo R.; Gorz, Ana M.; Bittencourt, Paulo R. M.

doi:10.1590/S0004-282X1991000100005

Resumos

Foram revisadas vários critérios para o diagnóstico de esclerose múltipla (EM) e aplicados os de Poser e colaboradores (1983) aos 40 pacientes incluídos neste estudo entre 1982 e 1987. Havia 36 (88%) pacientes do sexo feminino e 5 (12%) do sexo masculino, com EM clinicamente definida (85%) e provável (10%) de acordo com Poser et al., assim como 2 pacientes com doença crônica progressiva. A idade no momento do estudo era de 39 ± 11 anos e a de início da doença de 32 ± 10 anos; o tempo de história era de 6 ± 7 anos (médias ± desvios padrão). Como modo de apresentação da doença encontramos distúrbio de marcha em 50%, de visão em 25% e tontura em 10% dos casos. O exame físico no momento do estudo mostrava déficit motor em 92,5%, sensitivo era 67,5%, ocular visual em 65%, bexiga espástica em 35% e distúrbio vestíbulo-cerebelar em 32% dos pacientes. O potencial evocado visual foi anormal em 65% de 31 casos, o auditivo em 23% de 22 casos e o somes-tésico em 80% de 20 casos. Este estudo demonstra que critérios diagnósticos internacionais, especificamente, o de Poser e colaboradores, são aplicáveis no Brasil, contribuindo claramente para o diagnóstico da doença, bem como para estudos epidemiológicos, clínicos e terapêuticos era nosso país.

The frequency of multiple sclerosis in Brasil is assumed to be lower than in some geographically comparable regions, but internationally available objective diagnostic criteria are not generally used. We have reviewed a number of such criteria and applied those of Poser and colleagues to all patients who could be examined specifically for this study; who had been under our care between 1982-87; with clinically satisfactory history, physical exam, ancillary investigations and follow-up; with enough information to warrant immunosuppressive therapy with azathioprine, methyl-prednisolone or cyclophosphamide. There were 35 (88%) females and 5 (12%) males, with clinically definite (85%), probable (10%) disease according to Poser and cols, as well as 2 patients with chronic progressive disease. Age at time of study was 39 ± 11 years, age at onset had been 32 ± 10 years, and length of history was 6 ± 7 years (mean ± sd). Mode of onset was a disturbance of gait in 50%, of vision in 25% and dizziness in 10%. Physical exam at time of study showed motor deficits in 92.5%, sensory in 67.5%, ocular visual in 65%, spastic bladder in 35%, and vestibulocerebellar disturbances in 32%. Visual evoked responses were abnormal in 65% of 31 cases, auditory in 23% of 22 cases, and somatosensory in 80% of 20 cases. This study shows that international diagnostic criteria, specifically those of Poser and colleagues are applicable in Brasil, providing clear guidelines for diagnosis of multiple sclerosis. We suggest objective diagnostic criteria form the backbone of teaching about the disease, at various levels of medical education. Their wide utilization will in due time provide conditions for epidemiological, clinical and therapeutic studies which have not as yet been carried out in this country.

CONTEÚDO CONTENTS

Teresinha V. Oliveira^I; Rosana M. Carvalho^II; Ricardo R. Seixas^III; Ana M. Gorz^IV; Paulo R. M. Bittencourt^V

^IResidente (R4) em Neurologia - Unidade de Neurologia Clínica do Centro-Dia Clínica de Recuperação e do Hospital Nossa Senhora das Graças (Curitiba) e Unidade de Neurofisiologia Clínica do Centro Diagnóstico de Curitiba

^IIAcadêmica Estagiária - Unidade de Neurologia Clínica do Centro-Dia Clínica de Recuperação e do Hospital Nossa Senhora das Graças (Curitiba) e Unidade de Neurofisiologia Clínica do Centro Diagnóstico de Curitiba

^IIINeurofisio-logista Clínico - Unidade de Neurologia Clínica do Centro-Dia Clínica de Recuperação e do Hospital Nossa Senhora das Graças (Curitiba) e Unidade de Neurofisiologia Clínica do Centro Diagnóstico de Curitiba

^IVNeurologista Clínico - Unidade de Neurologia Clínica do Centro-Dia Clínica de Recuperação e do Hospital Nossa Senhora das Graças (Curitiba) e Unidade de Neurofisiologia Clínica do Centro Diagnóstico de Curitiba

^VChefe da Unidade - Unidade de Neurologia Clínica do Centro-Dia Clínica de Recuperação e do Hospital Nossa Senhora das Graças (Curitiba) e Unidade de Neurofisiologia Clínica do Centro Diagnóstico de Curitiba

RESUMO

Foram revisadas vários critérios para o diagnóstico de esclerose múltipla (EM) e aplicados os de Poser e colaboradores (1983) aos 40 pacientes incluídos neste estudo entre 1982 e 1987. Havia 36 (88%) pacientes do sexo feminino e 5 (12%) do sexo masculino, com EM clinicamente definida (85%) e provável (10%) de acordo com Poser et al., assim como 2 pacientes com doença crônica progressiva. A idade no momento do estudo era de 39 ± 11 anos e a de início da doença de 32 ± 10 anos; o tempo de história era de 6 ± 7 anos (médias ± desvios padrão). Como modo de apresentação da doença encontramos distúrbio de marcha em 50%, de visão em 25% e tontura em 10% dos casos. O exame físico no momento do estudo mostrava déficit motor em 92,5%, sensitivo era 67,5%, ocular visual em 65%, bexiga espástica em 35% e distúrbio vestíbulo-cerebelar em 32% dos pacientes. O potencial evocado visual foi anormal em 65% de 31 casos, o auditivo em 23% de 22 casos e o somes-tésico em 80% de 20 casos. Este estudo demonstra que critérios diagnósticos internacionais, especificamente, o de Poser e colaboradores, são aplicáveis no Brasil, contribuindo claramente para o diagnóstico da doença, bem como para estudos epidemiológicos, clínicos e terapêuticos era nosso país.

SUMMARY

The frequency of multiple sclerosis in Brasil is assumed to be lower than in some geographically comparable regions, but internationally available objective diagnostic criteria are not generally used. We have reviewed a number of such criteria and applied those of Poser and colleagues to all patients who could be examined specifically for this study; who had been under our care between 1982-87; with clinically satisfactory history, physical exam, ancillary investigations and follow-up; with enough information to warrant immunosuppressive therapy with azathioprine, methyl-prednisolone or cyclophosphamide. There were 35 (88%) females and 5 (12%) males, with clinically definite (85%), probable (10%) disease according to Poser and cols, as well as 2 patients with chronic progressive disease. Age at time of study was 39 ± 11 years, age at onset had been 32 ± 10 years, and length of history was 6 ± 7 years (mean ± sd). Mode of onset was a disturbance of gait in 50%, of vision in 25% and dizziness in 10%. Physical exam at time of study showed motor deficits in 92.5%, sensory in 67.5%, ocular visual in 65%, spastic bladder in 35%, and vestibulocerebellar disturbances in 32%. Visual evoked responses were abnormal in 65% of 31 cases, auditory in 23% of 22 cases, and somatosensory in 80% of 20 cases. This study shows that international diagnostic criteria, specifically those of Poser and colleagues are applicable in Brasil, providing clear guidelines for diagnosis of multiple sclerosis. We suggest objective diagnostic criteria form the backbone of teaching about the disease, at various levels of medical education. Their wide utilization will in due time provide conditions for epidemiological, clinical and therapeutic studies which have not as yet been carried out in this country.

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Agradecimento - A realização do presente trabalho foi possível devido ao Corpo Clínico do Hospital Nossa Senhora das Graças, em especial do Serviço de Neurocirurgia (Prof. Af-fonso Antoniuk). O trabalho foi realizado com verba própria da Unidade de Neurologia Clínica. A paciência de Vera Lúcia Cunha e Marília Bittencourt no processamento de palavras foi inestimável.

Dr. Paulo R. M. Bittencourt - Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças - Rua Alcides Munhoz 433 - 80510 Curitiba PR - Brasil.

1. Bittencourt PRB, Kendal BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuro-Psiquiat (São Paulo) 1983, 41-171-181.
2. Blaivas JG. Management of bladder dysfunction in multiple sclerosis. Neurology 1980, 30:12-18.
3. Brisman R. Trigeminal neuralgia and multiple sclerosis. Arch Neurol 1987, 44:379-381.
4. Compston A. The modern management of multiple sclerosis. Br J Hosp Med 1986, 36:200-208.
5. Ebers GC. Optic neuritis and multiple sclerosis. Arch Neurol 1985, 42:702-704.
6. Hallpik JF. Clinical aspects of multiple sclerosis. In Hallpike JF, Adams C, Tourtel-lotte WW (eds) : Multiple Sclerosis. London: Chapman and Hall, 1983, p 129-61.
7. Hauser SL, Dawson DM, Lehrich JR, Beal MF, Kevy SV, Weiner HL. Immunosuppression and plasmapheresis in chronic progressive multiple sclerosis. Arch Neurol 1983, 40:687-690.
8. Hershey LA, Gado HM, Troher JL. Computerized tomography in the diagnostic evaluation of multiple sclerosis. Ann Neurol 1979, 5:32-39.
9. Izquierdo G, Hauw JJ, Lyon-Caen O, Marteav R, Escouroller R, Buge. A, Castaigne PC, Lhermitte F. Value of multiple sclerosis diagnostic criteria. Arch Neurol 1985, 42:848-850.
10. Jensen, ES. Multiple sclerosis: correlation of psychiatric admissions to onset of initial symptoms. Acta Neurol Scand 1988, 77:414-417.
11. Joffe RT, Lippert GP, Gray TA, Sawa G, Horvath Z. Mood disorder and multiple sclerosis. Arch Neurol 1987, 44:376-378.
12. Kirshner HS, Tsai Sl, Runge VM, Price AC. Magnetic resonance imaging and other techniques in the diagnosis of multiple sclerosis. Arch Neurol 1985, 42:859-863.
13. Kurtzke JF. Diagnosis and differential diagnosis of multiple sclerosis. Acta Neurol Scand 1970, 46:484-492.
14. Kurtzke JF. Optic neuritis or multiple sclerosis. Arch Neurol 1985, 42:704-710.
15. Kurtzke JF. Multiple sclerosis: what's in a name? Neurology 1988, 38:309-316.
16. Lauer K, Firnhaber W. An evaluation of laboratory investigations in patients with multiple sclerosis. J Chron Dis 1986, 39:767-774.
17. Lukes SA, Crooks LE, Aminoff MJ, Kaufman L, Panitch HS, Mills L, Norman D. Nuclear magnetic resonance imaging in multiple sclerosis Ann Neurol 1983, 13:592-601.
18. Matteson EL, Flagler DG, Mesara BW. IgG synthesis rate in evaluation of multiple sclerosis in a community hospital. Neurology 1987, 37:847-849.
19. Matthews WB. Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psy-chiat 1975, 38:617-623.
20. McDonald, WI. What is multiple sclerosis? Clinical criteria for diagnosis. In Davison AN, Humphrey JH, Liversedge AL, McDonald WI, Porterfield JS (eds): Multiple Sclerosis Research. London: Elsevier, 1975, p 1-8.
21. McDonald WI. Multiple sclerosis: the present position. Acta Neurol Scand 1983, 68: 65-76.
22. McDonald WI. The mystery of the origin of multiple sclerosis. J Neurol Neurosurg Psychiat 1986, 49:113-123.
23. McDonald WI, Halliday AM. Diagnosis and classification of multiple sclerosis. B Med Bull 1977, 33:4-9.
24. McDonald WI, Silberberg DH. The diagnosis of multiple sclerosis. In McDonald WI, Silberberg DH (eds) : Multiple Sclerosis. London: Butterworth, 1986, p 1-9.
25. Miller DH, McDonald WI, Blumhardt LD, du Boulay GH, Halliday AM, Johnson G, Kendall BE, Kingsley DPE, McManus DG, Moseley IF, Rudje P, Sandercock PAG. Magnetic resonance imaging in isolated non-compressive spinal cord syndromes. Ann Neurol 1987, 22:714-724.
26. Müri RM, Melenberg O. The clinical spectrum of internuclear ophthalmoplegia in multiple sclerosis. Arch Neurol 1985, 42:851-855.
27. Ormerod IEC, Miller DH, McDonald WI, du Boulay EPGH, Rudge P, Kendall BE, Moseley IF, Johnson G, Tofts PS, Halliday AM, Bronstein AM, Scaravilli F, Harding AE, Barnes D, Zilkha KJ. The role of NMR imaging in the assesment of multiple sclerosis and isolated neurological lesions. Brain 1987, 110:1579-1616.
28. Poser CM. Diseases of the myelin sheath. In Baker AB, Baker LH (eds) : Clinical Neurology, Vol 2. Philadelphia: Harper & Row. 1981, 1-70.
29. Poser CM. Miller DH, McDonald WI, du Boulay EPGH, Rudge P, Kendall BE, Moseley IF, Johnson G, Tofts PS, Halliday AM, Bronstein AM, Scaravilli F, Harding AE, Barnes D, Zilkha KJ. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13:227-230.
30. Poser CM, Paty DW, Schein berg D, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. A numerical scoring system for the classification of multiple sclerosis. Acta Neurol Scand 1979, 60:100-111.
31. Silberberg GD. Multiple sclerosis-highlights of studies relating to nature and cause. Postgrad Med 1978, 64:107-111.
32. Steiner J, Feir G, Soffer D, Fleet AB, Abramsky O. Chronic progressive myelopathy: its relation to the spinal progressive form of multiple sclerosis. Acta Neurol Scand 1988, 77:152-157.
33. Swash M, Snooks SJ, Chalmers DAK. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987, 44:504-508.
34. Timme W. Multiple sclerosis : historical retrospect. In Woltman HW, Merritt HH, Wortis SB, Hare CC (eds) : Multiple Sclerosis and the Demyelinating Diseases. Baltimore: Williams & Wilkins, 1950, p 3-11.
35. Walton JN. Brain's Diseases of the Nervous System. Oxford: Oxford Univ Press, 1977, p 544-563.
36. Weiner HL, Hafler DA. Multiple sclerosis. In Appel SH (ed): Current Neurology, vol 6. Chicago: Year Book Med Publ, 1986, p 123-151.

Esclerose múltipla critérios objetivos de diagnóstico

Multiple sclerosis: objective criteria of diagnosis.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Mar 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bittencourt PRB, Kendal BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuro-Psiquiat (São Paulo) 1983, 41-171-181.

[2] 2. Blaivas JG. Management of bladder dysfunction in multiple sclerosis. Neurology 1980, 30:12-18.

[3] 3. Brisman R. Trigeminal neuralgia and multiple sclerosis. Arch Neurol 1987, 44:379-381.

[4] 4. Compston A. The modern management of multiple sclerosis. Br J Hosp Med 1986, 36:200-208.

[5] 5. Ebers GC. Optic neuritis and multiple sclerosis. Arch Neurol 1985, 42:702-704.

[6] 6. Hallpik JF. Clinical aspects of multiple sclerosis. In Hallpike JF, Adams C, Tourtel-lotte WW (eds) : Multiple Sclerosis. London: Chapman and Hall, 1983, p 129-61.

[7] 7. Hauser SL, Dawson DM, Lehrich JR, Beal MF, Kevy SV, Weiner HL. Immunosuppression and plasmapheresis in chronic progressive multiple sclerosis. Arch Neurol 1983, 40:687-690.

[8] 8. Hershey LA, Gado HM, Troher JL. Computerized tomography in the diagnostic evaluation of multiple sclerosis. Ann Neurol 1979, 5:32-39.

[9] 9. Izquierdo G, Hauw JJ, Lyon-Caen O, Marteav R, Escouroller R, Buge. A, Castaigne PC, Lhermitte F. Value of multiple sclerosis diagnostic criteria. Arch Neurol 1985, 42:848-850.

[10] 10. Jensen, ES. Multiple sclerosis: correlation of psychiatric admissions to onset of initial symptoms. Acta Neurol Scand 1988, 77:414-417.

[11] 11. Joffe RT, Lippert GP, Gray TA, Sawa G, Horvath Z. Mood disorder and multiple sclerosis. Arch Neurol 1987, 44:376-378.

[12] 12. Kirshner HS, Tsai Sl, Runge VM, Price AC. Magnetic resonance imaging and other techniques in the diagnosis of multiple sclerosis. Arch Neurol 1985, 42:859-863.

[13] 13. Kurtzke JF. Diagnosis and differential diagnosis of multiple sclerosis. Acta Neurol Scand 1970, 46:484-492.

[14] 14. Kurtzke JF. Optic neuritis or multiple sclerosis. Arch Neurol 1985, 42:704-710.

[15] 15. Kurtzke JF. Multiple sclerosis: what's in a name? Neurology 1988, 38:309-316.

[16] 16. Lauer K, Firnhaber W. An evaluation of laboratory investigations in patients with multiple sclerosis. J Chron Dis 1986, 39:767-774.

[17] 17. Lukes SA, Crooks LE, Aminoff MJ, Kaufman L, Panitch HS, Mills L, Norman D. Nuclear magnetic resonance imaging in multiple sclerosis Ann Neurol 1983, 13:592-601.

[18] 18. Matteson EL, Flagler DG, Mesara BW. IgG synthesis rate in evaluation of multiple sclerosis in a community hospital. Neurology 1987, 37:847-849.

[19] 19. Matthews WB. Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psy-chiat 1975, 38:617-623.

[20] 20. McDonald, WI. What is multiple sclerosis? Clinical criteria for diagnosis. In Davison AN, Humphrey JH, Liversedge AL, McDonald WI, Porterfield JS (eds): Multiple Sclerosis Research. London: Elsevier, 1975, p 1-8.

[21] 21. McDonald WI. Multiple sclerosis: the present position. Acta Neurol Scand 1983, 68: 65-76.

[22] 22. McDonald WI. The mystery of the origin of multiple sclerosis. J Neurol Neurosurg Psychiat 1986, 49:113-123.

[23] 23. McDonald WI, Halliday AM. Diagnosis and classification of multiple sclerosis. B Med Bull 1977, 33:4-9.

[24] 24. McDonald WI, Silberberg DH. The diagnosis of multiple sclerosis. In McDonald WI, Silberberg DH (eds) : Multiple Sclerosis. London: Butterworth, 1986, p 1-9.

[25] 25. Miller DH, McDonald WI, Blumhardt LD, du Boulay GH, Halliday AM, Johnson G, Kendall BE, Kingsley DPE, McManus DG, Moseley IF, Rudje P, Sandercock PAG. Magnetic resonance imaging in isolated non-compressive spinal cord syndromes. Ann Neurol 1987, 22:714-724.

[26] 26. Müri RM, Melenberg O. The clinical spectrum of internuclear ophthalmoplegia in multiple sclerosis. Arch Neurol 1985, 42:851-855.

[27] 27. Ormerod IEC, Miller DH, McDonald WI, du Boulay EPGH, Rudge P, Kendall BE, Moseley IF, Johnson G, Tofts PS, Halliday AM, Bronstein AM, Scaravilli F, Harding AE, Barnes D, Zilkha KJ. The role of NMR imaging in the assesment of multiple sclerosis and isolated neurological lesions. Brain 1987, 110:1579-1616.

[28] 28. Poser CM. Diseases of the myelin sheath. In Baker AB, Baker LH (eds) : Clinical Neurology, Vol 2. Philadelphia: Harper & Row. 1981, 1-70.

[29] 29. Poser CM. Miller DH, McDonald WI, du Boulay EPGH, Rudge P, Kendall BE, Moseley IF, Johnson G, Tofts PS, Halliday AM, Bronstein AM, Scaravilli F, Harding AE, Barnes D, Zilkha KJ. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983, 13:227-230.

[30] 30. Poser CM, Paty DW, Schein berg D, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. A numerical scoring system for the classification of multiple sclerosis. Acta Neurol Scand 1979, 60:100-111.

[31] 31. Silberberg GD. Multiple sclerosis-highlights of studies relating to nature and cause. Postgrad Med 1978, 64:107-111.

[32] 32. Steiner J, Feir G, Soffer D, Fleet AB, Abramsky O. Chronic progressive myelopathy: its relation to the spinal progressive form of multiple sclerosis. Acta Neurol Scand 1988, 77:152-157.

[33] 33. Swash M, Snooks SJ, Chalmers DAK. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987, 44:504-508.

[34] 34. Timme W. Multiple sclerosis : historical retrospect. In Woltman HW, Merritt HH, Wortis SB, Hare CC (eds) : Multiple Sclerosis and the Demyelinating Diseases. Baltimore: Williams & Wilkins, 1950, p 3-11.

[35] 35. Walton JN. Brain's Diseases of the Nervous System. Oxford: Oxford Univ Press, 1977, p 544-563.

[36] 36. Weiner HL, Hafler DA. Multiple sclerosis. In Appel SH (ed): Current Neurology, vol 6. Chicago: Year Book Med Publ, 1986, p 123-151.