Ánalise da neurite óptica desmielinizante isolada como manifestaçãoinicial da esclerose múltipla através do banco de dados do ComitêBrasileiro de Tratamento e Pesquisa da Esclerose Múltipla: características clínicas e prognósticas

Abstract

Optic neuritis is an inflammatory condition of one or both optic nerves with demyelinating, autoimmune or infectious etiology. Demyelinating optic neuritis is the most common cause of transitory visual loss in young adults. It is also one of the most frequent initial symptom of multiple sclerosis in about 15 to 20% of the cases, and during its course this symptom can be seen in over half of the cases. Our objective was to describe clinical and demographic variables of a patients sample with clinically definite multiple sclerosis after an initial episode of isolated demyelinating optic neuritis. This study also aims to determine if clinical variables (such as gender, color, age at onset, initial course of the disease, overall course of multiple sclerosis, interval between the first and second relapse) significantly influence the time from the onset ofthe disease to the assignment of a disability score of 6. This study was conducted retrospectively using the Brazilian Committee of Treatment and Research in Multiple Sclerosis database, which consisted of collaborative data from five multiple sclerosis centers. The database was developed in 2005, and it stored the data recorded via a standardized, two-page entry form, which was completed by neurologists who followedmultiple sclerosis patients in different centers. Of the 1030 patients with clinically definite multiple sclerosis, 174 (17%) had optic neuritis as the initial manifestation of the disease. The duration of multiple sclerosis was 12.0 ± 8.4 years (mean ± SD). About 90% of the Abstractpatients had the onset of the disease before the age of 40.The mean of age at onset of multiple sclerosis was 27.8 years old. In most cases, optic neuritis occurred in adults between the ages of 20 and 39 years and was more common in females (80%) and whites (77%). Twelve patients (7%) showed familiar history of multiple sclerosis. About 96% of the patients showed relapsing-remitting initial course of multiple sclerosis.The mean time for transition from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis was 11 years (mean). The mean time between the first and second relapse was 34.5 months. The mean of relapses during the first five yearsof the disease in patients with was 2.79. In the last visit, 53.5% of the patients couldwalk without aid; 33% showed severe disability; 8% were making use of wheelchairbound and 5.5% were restricted to bed. Two patients (1%) had died from multiple sclerosis related causes. In the group of 174 patients, the median time from the onset of the disease to the assignment of a score of 4 on the Kurtzke Expanded Disability Status Scale was 14 years (95 percent confidence interval, 12.1 - 15.8). The median time from the onset of the disease to the assignment of a score of 6 on the Kurtzke Expanded Disability Status Scale was 21 years (95 percent confidence interval,17.7 - 24.2). The median time from the onset of the disease to the assignment of a score of 7 on the Kurtzke Expanded Disability Status Scale was 30 years. A relapsingremitting overall course of multiple sclerosis and low age at onset indicated favorableoutcome in terms of the assignment of a disability score of 6.