Dados do Trabalho

Título

The association of different acute manifestations of MS on quality of life and functional outcome

Resumo

Introduction: Multiple sclerosis (MS) is an inflammatory demyelinating disease that affects about 2.3 million people worldwide, with a direct impact on quality of life, causing an important degree of disability. The first manifestations of the disease can be subdivided into optic neuritis, with visual blurring or blindness; myelitis, with paresis, plegia, hypoesthesia, and sphincter incontinence; trunk syndrome, with ataxia and cranial nerve syndrome; and mixed syndrome, when symptoms from more than one group are present. Objective: The present study aims to analyze the relationship of the first clinical manifestation on the quality of life and functional outcome of MS patients. Methods: Cross-sectional study, conducted with patients diagnosed with MS according to McDonald 2017 criteria and followed in a neuroimmunology referral service in Bahia from July 2021 to May 2022. Quality of life was quantified based on the EQ-5D Quality of Life Questionnaire and functional outcome was rated by the Extended Disability Status Scale (EDSS). Individuals were classified into 4 groups according to the first manifestation of MS: optic neuritis, myelitis, trunk syndrome, and mixed syndrome. Results: 212 patients participated in this study, of which 59(27.8%) were male and 153(72.2%) were female. The mean EDSS was 2.62(±2.4) and the mean EQ-5D 0.6 (±0.24). Regarding the first clinical manifestation, we obtained: nine in optic neuritis (4.2%); thirty in myelitis (14.2%); thirteen in trunk syndrome (6.1%) and one hundred and sixty in mixed syndrome (75.5%). The Kruskal-wallis test showed that there is an effect of the different syndromic manifestations on the EDSS at admission [X²(3) = 12.8; p<0.01] but not on the EQ5D score [X²(3)=7.7; p=0.052]. Pairwise comparison showed differences between the median EDSS scores of the mixed syndrome and trunk syndrome groups [2(IQR 1-4) vs 0(IQR 0-1); p=0.03], but not between the other groups. Conclusion: The different acute MS conditions have similar impact on the quality of life of patients, but interfere differently in the functional capacity of these individuals. This important divergence between the groups with trunk syndrome and mixed syndrome can be interpreted by the fact that the EDSS is a scale that refers to the functional capacity, especially regarding mobility, therefore, the most affected are those with mixed syndrome and the least affected are those with symptoms related to the trunk syndrome.

Palavras Chave

Multiple Sclerosis, neurology, quality of life, disability