Different cognitive profiles of Brazilian patients with relapsing-remitting and primary progressive multiple sclerosis / Diferentes perfis cognitivos de pacientes brasileiros com esclerose múltipla remitente-recorrente e progressiva primária

Cognitive impairment is a symptom of multiple sclerosis (MS). Different clinical forms of multiple sclerosis have different cognitive profiles, according to findings of previous studies which used extensive batteries of neuropsychological tests. OBJECTIVE: To investigate cognitive profiles of Brazilian patients with relapsing-remitting multiple sclerosis (RRMS) and primary progressive multiple sclerosis (PPMS) by using a brief battery of neuropsychological tests. METHOD: Sixty-six patients, within 18-65 of age and 3-18 years of education, were paired with healthy control subjects, regarding gender, age, and education level. RESULTS: On Symbol Digit Modalities Test and Hooper Visual Organization Test, cognition was affected in 50 percent in RRMS and 69 percent in PPMS. Fluency of "F" was impaired in 24 percent of RRMS and 81 percent of PPMS. Immediate recall was affected in 32 percent of RRMS and in 63 percent of PPMS; whereas late recall, in 46 percent of relapsing-remitting and in 69 percent of primary progressive. CONCLUSION: Cognitive profiles of relapsing-remitting and primary progressive patients are different.

O comprometimento cognitivo é um sintoma da esclerose múltipla (EM). Formas clínicas diferentes da EM apresentam diferentes perfis cognitivos, de acordo com resultados de estudos anteriores que usaram bateria extensa de testes neuropsicológicos. OBJETIVO: Investigar o perfil cognitivo de pacientes com esclerose múltipla remitente-recorrente (EMRR) e esclerose múltipla progressiva primária (EMPP) utilizando uma bateria neuropsicológica breve. MÉTODO: 66 pacientes com idade de 18 a 65 anos, escolaridade 3 a 18 anos, foram pareados a controles por sexo, idade e escolaridade; e avaliados. RESULTADO: No Symbol Digit Modalitie Test e Hooper Visual Organization Test 50 por cento com EMRR e 69 por cento com EMPP apresentaram desempenho comprometido. Na fluência da letra "F" o comprometimento foi de 24 por cento daqueles com EMRR e 81 por cento com EMPP. Na evocação imediata o comprometimento foi de 32 por cento na EMRR e 63 por cento na EMPP e, evocação tardia em 46 por cento na remitente-recorrente e 69 por cento com progressiva primária. CONCLUSÃO: Os perfis cognitivos dos pacientes com esclerose múltipla remitente-recorrente e progressiva primária são diferentes.

Multiple sclerosis outcome and morbi-mortality of a Brazilian cohort patients / Caracteristicas clínico-evolutivas e morbi-mortalidade de uma coorte de pacientes brasileiros com esclerose múltipla

We studied the clinical and evolution characteristics of multiple sclerosis (MS) patients followed since the onset of HUCFF/UFRJ in 1978. The diagnosis of MS was based on Poser's et al. and MC Donald's et al. criteria. From 188 patients, 122 were included. Eighty-five were females. The mean age onset was 32.2 years-old (range 6.0 to 61.0±10.3), mainly Caucasians (82/67 percent). The relapsing-remitting course (MSRR) was more frequent (106/86.8 percent). Monosymptomatic onset was significantly more frequent in Caucasians than in Afro-Brazilians (p<0.05). Seventeen patients had benign form of MS and these patients presented association with MSRR when compared with severe form (p=0.01). The mortality rate was 2.12 percent (4 patients died). This study was similar to other Brazilian series with regard to sex and age, and lack of correlation between EDSS and number of relapses; it confirmed south-southeast African-descendants gradient distribution and association between first mono-symptomatic relapses and Caucasian; we found lower frequency of benign forms.

Estudamos as características clínico-evolutivas de pacientes com esclerose múltipla (EM) acompanhados no HUCFF-UFRJ desde 1978. Foram usados critérios de Poser et al. e MC Donald et al. para o diagnóstico de EM. De 188, 122 foram incluídos. Oitenta e cinco eram mulheres. A média de idade de início foi 32,2 anos (6,0-61,0±10,3), predominando caucasianos (n=82/67 por cento). A forma recorrente-remitente (EMRR) foi mais freqüente (n=106/86,8 por cento). Formas mono-sintomáticas no primeiro surto foram significativamente mais freqüentes em caucasianos do que em afro-brasileiros (p<0,05). Dezessete pacientes apresentavam a forma benigna (13,9 por cento) e 43 a grave (35,2 por cento). A forma benigna foi associada com a EMRR (p=0,01). A taxa de letalidade 2,12 por cento (4 óbitos). Nossos resultados são semelhantes aos de outras séries brasileiras no que se refere ao sexo e idade, e falta de correlação entre EDSS e número de surtos; confirmamos gradiente sul-sudeste de distribuição afro-descendente, associação significativa entre primeiro surto mono-sintomático e caucasianos e menor freqüência de formas benignas.

Differential patterns of memory performance in relapsing, remitting and secondary progressive multiple sclerosis.

BACKGROUND: Memory dysfunction is common in multiple sclerosis (MS). A retrieval failure has been reported as the primary cause for the memory deficits, although some studies also described a faulty acquisition. AIMS: The aim of the study was to examine memory function in relapsing remitting (RR) and secondary progressive (SP) MS patients, analyze the patterns of performance and to investigate whether disease course influences this performance. DESIGN AND SETTINGS: Case-control prospective study conducted in a clinical setting. MATERIALS AND METHODS: Fifty-five RR, 23 SP MS patients and 80 normal subjects were evaluated with a comprehensive neuropsychological battery. Memory was assessed with tasks from the Signoret memory battery. Attention and executive function were also assessed. STATISTICAL ANALYSIS: Univariate analysis of variance, Mann-Whitney U-test, multivariate logistic regression and Chi-square test were used as appropriate. RESULTS: MS patients performed significantly worse than controls on almost all measures of memory (P < 0,001). MS subgroups differed in tasks of delayed recall (logical memory- P =0,019; wordlist delayed recall, P < 0,001), semantic cued recall (P < 0,001), recognition trials (P =0,006) rate of forgetting (P < 0,001) and confabulation and intrusion errors (P =0,004). CONCLUSIONS: Memory is consistently impaired in MS patients and disease course differentially affects the pattern of performance. SP patients show greater difficulties and a more pervasive pattern of dysfunction than RR patients. Delayed recall was the most affected memory measure and performance on this task discriminates between RR and SP MS patients. Relapsing remitting patients performed within the mildly impaired range while SP patients showed a moderate to severe impairment.

Successful treatment of intrathecal morphine overdose.

A 47-year-old woman was diagnosed with secondary progressive multiple sclerosis, and was treated with intrathecal morphine for chronic pain via a slow-release subcutaneous pump. She accidentally received a 35-ml (510 mg) bolus injection of morphine by this route, which led to status epilepticus. She was treated with continuous intravenous naloxone infusion, and with medication to control hypertension and stop the seizure activity. The outcome was excellent, and the patient returned to her neurological baseline. This report describes the complications and the successful treatment of intrathecal morphine overdose. In order to prevent these serious errors, it is vital that only care providers who are proficient with these devices perform the refilling procedure.