Esclerose múltipla de início tardio: análise de uma coorte retrospectiva
Ano de defesa: | 2015 |
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Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Universidade Federal de São Paulo (UNIFESP)
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Programa de Pós-Graduação: |
Não Informado pela instituição
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Departamento: |
Não Informado pela instituição
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País: |
Não Informado pela instituição
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Palavras-chave em Português: | |
Link de acesso: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3248075 http://repositorio.unifesp.br/handle/11600/48433 |
Resumo: | Multiple Sclerosis (MS) is an inflammatory autoimmune disease of the central nervous system that leads to demielinization, axonal loss and nerve degeneration. It affects predominantly young adults, between 20 and 40 years of age. Late Onset Multiple Sclerosis (LOMS) is when the first symptom starts at 50 and plus years of age, and represents 4,5% of patients with MS. Usually its initial presentation is monosymptomatic, with a motor or cerebellar symptom and the most common clinical course is primary progressive. Vascular disease of the central nervous system and cervical spondylotic myelopathy are the main differential diagnosis due to a higher prevalence at this age. There is scanty literature concerning the epidemiology and clinical features of LOMS, which makes studying this population very important. The purpose of this study is to describe the demographic, clinical and laboratorial characteristics of patients with LOMS followed at MS center of the Neurology Department of the Federal University of São Paulo, The LOMS frequency was 4,18%, with a female to male ratio of 2,1:1. Median age at onset was 54 years and the predominant disease course was primary progressive (64,3%). The prevailing symptoms were motor (54,8%) and cerebellar (29%); 54,5% of patients had positive oligoclonal bands and 83,3% had altered visual evoked potential. The main differential diagnoses in our series were neuromyelitis optica, cerebrovascular disease and transverse myelitis of other etiologies. Patients with LOMS reached the disability landmarks of EDSS 3, 6 and 7 in the following proportion and time: EDSS 3,0, 77,42% of patients in 3,7 years; EDSS 6,0, 58,06% in 5,1 years and EDSS 7,0, 32,26% in 5,7 years. The comparative analysis with a matched control group of patients with regular MS showed that the progression index of the primary progressive form was higher in patients with LOMS (0,55 vs 0,74). Also, the late onset together with a progressive course were predictors of reaching earlier the EDSS 3,0 (p=0,001) and 6,0 (p=0,002). ! ! 85! In conclusion, LOMS is not rare among MS patients, and the clinical characteristics of both adult and late onset patients are similar. The LOMS group with primary progressive form reaches the disability milestones at shorter time. |