Clinical Course of Progressive Multiple Sclerosis in Brazilian Patients

Abstract

Objective: To describe the clinical course and outcome of multiple sclerosis with progressive onset in Brazilian patients. A total of 238 medical records were reviewed, 26 cases (10.9%) fulfilled Thompson criteria (2000), and 5.80% classified as primary progressive and 5.04% relapsing progressive according to Lublin and Reingold. Study Population: 19 Caucasians and 7 non-Caucasians; male:female ratio 1.2:1, mean age at onset was 34 ± 7.9 years. Results: Non-Caucasian patients had earlier onset of disease. The most common manifestations at onset were pyramidal and cerebellar (89% and 34.6%). After 11.3 ± 6.35 years of disease more than 50% of the patients had involvement of most of their functional systems. No statistically significant differences were observed between the subgroups. Conclusion: The clinical course and outcome of progressive multiple sclerosis in Brazil, a tropical country with low prevalence, were very similar to those in the multiple sclerosis high prevalence areas.

Potential risk factors for multiple sclerosis in Rio de Janeiro: a case-control study

“…However, during the last 10 years, various case studies have shown that, despite the low prevalence of the disease, the hot climate and racial miscigenation, this illness now appears with clinical manifestations similar to those observed in Western countries [24][25][26] .…”

Different cognitive profiles of Brazilian patients with relapsing-remitting and primary progressive multiple sclerosis

“…The RRMS form affects more women than men, between 20 and 40 years of age. It is characterized by non systematic neurological syndromes, suggesting disseminated inflammatory lesions in the CNS; while the progressive course of multiple sclerosis affects both men and women above 40 years of age 20,21 leading to an insidious and growing motor and sensitive dysfunction on lower limbs -in most of the cases -related to spinal cord commitment 22,23 . Those clinical differences were previously associated to a reduced inflammatory load detected in brain scans of PPMS patients versus the ones with the RRMS form.…”

The reliability of specific primary progressive MS criteria in an ethnically diverse population

“…Demographic and clinical data were obtained from medical records and from the SIAPEM database [26]. Twenty-six cases had been described in a previous study [5]. Further cases were identified and also followed up by one of the authors (CCVF).…”

“…Multiple sclerosis (MS) that is primarily progressive at onset is the second most frequent MS phenotype in Caucasian patients of the northern hemisphere [1], and according to Lublin and Reingold [2] may have two subtypes: primary progressive multiple sclerosis (PPMS), observed in 7-15% of patients, who experience a gradual progression of disability from the onset of disease with no exacerbations; and progressive-relapsing multiple sclerosis (PRMS), which occurs in fewer than 5% and in whom the initial progressive course is later accompanied by one or more relapses [3][4][5].…”

“…The demographic and clinical profile of PPMS is welldefined: the male/female ratio is similar; patients are older at onset of the disease; the majority of patients develop motor deficit related to spinal cord involvement; and there is a high progression rate [3][4][5][6][7][8][9][10][11][12][13]. Furthermore, in PPMS, there are fewer lesions at brain magnetic resonance imaging (MRI) and contrast enhancement is less compared to relapsing-remitting multiple sclerosis (RRMS) [14][15][16], the more common clinical form, which is present in 80% of patients [2].…”