Risco de conversão de neurite óptica desmielinizante isolada em esclerose múltipla em amostra de população brasileira

• Ano de defesa: 2013
• Autor(a) principal: Cristiane Franklin Rocha
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Taxa de conversão; Fatores preditivos; Neurite óptica desmielinizante; Esclerose múltipla; População brasileira; Brasil; Mielite/diagnóstico; Estudos retrospectivos; Acuidade visual; Neurite óptica; Doenças desmielinizantes; População; Oftalmologia; Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central
• Link de acesso: http://hdl.handle.net/1843/BUBD-9FVESL

Demyelinating optic neuritis (DON) is a subacute inflammatory disease of the optic nerve that often causes visual loss in frequent association with eye pain. Although DON is usually associated with recovery of the visual function, it may be the first manifestation of multiple sclerosis (MS). The risk of conversion to MS is strongly related to the findings of brain magnetic resonance imaging (MRI) at the time of the optic neuritis onset. Different conversion rates and factors that influence that risk have been determined in different countries. The present study shows the risk of MS developing after DON and its predictive factors in a Brazilian cohort during a follow-up as long as 30 years. Objective: To study the risk of MS developing in patients with isolated DON and its predictive factors in a sample of the Brazilian population. Methods: A retrospective review of the history, ophthalmological and neurological examination of patients with the initial diagnosis of isolated DON seen at CIEM MS Research Center and the Department of Neuro-Ophthalmology, São Geraldo Hospital of the Federal University of Minas Gerais between 1976 and 2011 was conducted. The diagnosis of MS was considered according to both Posers and McDonald (2005) criteria. Predictive factors were analyzed. Results: Out of 163 patients with DON, 79 were selected (56 females and 23 males; 56 whites, 19 blacks and four mulattos). The follow-up ranged from six months to 30 years (median 4.4 years). In 36 patients baseline brain MRI was abnormal. Different forms of treatment of the DON did not modify the visual recovery. Nine patients developed CDMS (Posers criteria) within 6 months, 14 within 1 year, 16 within two years, 17 within five years and 19 within 10 and 15 years of follow-up. The 15-year conversion rate was 24%. On the other hand, using McDonalds 2005 criteria, 20 patients developed MS within 6 months, 27 within 1 year, 30 within 2 years, 34 within 5 years, 38 within 10 years and 39 within 15 years. The 15-year conversion rate was 65%. The cumulative rate was highest in the first five years after the DON onset. Positive predictive factors included mild visual loss at the onset, decreased color vision, retrobulbar involvement and the number of lesions on brain MRI at baseline. Conclusion: The risk of MS developing in patients with isolated DON in the Brazilian population is similar to that described in other Western population if McDonalds 2005 diagnostic criteria are employed. The number of lesions on baseline brain MRI is the main positive predictive factor for conversion.