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      Caracterización epidemiológica, clínica e imagenológica de pacientes con esclerosis múltiple Translated title: Epidemiological, clinical and imaging characterization of patients with multiple sclerosis

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          Abstract

          RESUMEN Introducción: la esclerosis múltiple es una enfermedad desmielinizante, degenerativa, crónica, autoinmune e inflamatoria, que afecta al sistema nervioso central. Esta afección constituye la primera causa de invalidez neurológica en adultos jóvenes. Objetivo: caracterizar a los pacientes con diagnóstico de esclerosis múltiple ingresados en el servicio de Neurología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro». Métodos: se realizó un estudio descriptivo y transversal con los pacientes con diagnóstico de esclerosis múltiple ingresados en el servicio de Neurología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro», Santa Clara, Villa Clara, durante el período de enero 2018 - diciembre 2019; la población de estudio quedó constituida por 30 pacientes. Resultados: el promedio de edad de debut fue de 38,7 años. La relación entre pacientes con color de piel blanca y no blanca fue 9:1, y la de mujeres y hombres de 14:1. La esclerosis múltiple recidivante-remitente representó el 70 %, y el grado mínimo de discapacidad el 60 %. El 48,27 %, 41,37 % y 37,93 % de los pacientes presentaron lesiones supratentoriales, infratentoriales y en número de dos a cuatro, respectivamente. Conclusiones: predominó el sexo femenino con edad de debut entre los 20 a 29 años. Los síntomas más comunes fueron: las alteraciones motoras, sensitivas y cerebelosas. La forma clínica de presentación predominante fue la esclerosis múltiple recidivante-remitente y el grado de discapacidad mínimo. Las lesiones supratentoriales e infratentoriales y la cantidad de lesiones en número dos a cuatro fueron las más frecuentes; la mayoría de los casos presentó cambio de intensidad del cuerpo calloso.

          Translated abstract

          ABSTRACT Introduction: multiple sclerosis is a demyelinating, degenerative, chronic, autoimmune and inflammatory disease that affects the central nervous system. This condition is the leading cause of neurological disability in young adults. Objective: to characterize patients with a diagnosis of multiple sclerosis admitted to the Neurology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital. Methods: a descriptive and cross-sectional study was carried out in patients with a diagnosis of multiple sclerosis admitted to the Neurology Service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital, Santa Clara, Villa Clara, from January 2018 to December 2019; the study population consisted of 30 patients. Results: the average age at debut was 38.7 years. The ratio between patients with white and non-white skin color was 9: 1, and that of women and men was 14: 1. Relapsing-remitting multiple sclerosis accounted for 70%, and the minimum degree of disability for 60%. The 48.27%, 41.37% and 37.93% of the patients had supratentorial and infratentorial lesions and two to four in number, respectively. Conclusions: female gender predominated with the age at debut between 20 to 29 years. Motor, sensory and cerebellar alterations were the most common symptoms. Relapsing-remitting multiple sclerosis was the predominant clinical presentation and minimal degree of disability. Supratentorial and infratentorial lesions and the number of lesions in number two to four were the most frequent; most of the cases had a change in intensity of the corpus callosum.

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          Evolving concepts in the treatment of relapsing multiple sclerosis

          In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.
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            Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis.

            Multiple sclerosis (MS) is the most common inflammatory disorder of the central nervous system (CNS) in young adults. When MS is not treated, it leads to irreversible and severe disability. The etiology of MS and its pathogenesis are not fully understood. The recent discovery that MS-associated genetic variants code for molecules related to the function of specific immune cell subsets is consistent with the concept of MS as a prototypic, T-cell-mediated autoimmune disease targeting the CNS. While the therapeutic efficacy of the currently available immunomodulatory therapies further strengthen this concept, differences observed in responses to MS treatment as well as additional clinical and imaging observations have also shown that the autoimmune pathogenesis underlying MS is much more complex than previously thought. There is therefore an unmet need for continued detailed phenotypic and functional analysis of disease-relevant adaptive immune cells and tissues directly derived from MS patients to unravel the immune etiology of MS in its entire complexity. In this review, we will discuss the currently available MS treatment options and approved drugs, including how they have contributed to the understanding of the immune pathology of this autoimmune disease.
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              The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

              Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.
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                Author and article information

                Journal
                mdc
                Medicentro Electrónica
                Medicentro Electrónica
                Universidad de Ciencias Médicas de Villa Clara (Santa Clara, , Cuba )
                1029-3043
                September 2021
                : 25
                : 3
                : 423-447
                Affiliations
                [1] orgnameUniversidad de Ciencias Médicas Villa Clara Cuba
                [2] Santa Clara Villa Clara orgnameHospital Universitario Clínico Quirúrgico Cmdte. Manuel Fajardo Rivero Cuba
                [3] Villa Clara orgnameUniversidad Central Marta Abreu de Las Villas orgdiv1Facultad de Psicología Cuba
                Article
                S1029-30432021000300423 S1029-3043(21)02500300423
                ccf68d5d-7795-4f72-aa2d-98dabadd381b

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 24 September 2020
                : 04 January 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 25
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS ORIGINALES

                multiple sclerosis/epidemiology,enfermedades desmielinizantes,esclerosis múltiple/epidemiología,demyelinating diseases

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