Padronização da Multiple Sclerosis Functional Composite Measure (MSFC) na população brasileira

Innate immune cells and myelin profile in multiple sclerosis: a multi-tracer PET/MR study

PURPOSE

Neuropathological studies have demonstrated distinct profiles of microglia activation and myelin injury among different multiple sclerosis (MS) phenotypes and disability stages. PET imaging using specific tracers may uncover the in vivo molecular pathology and broaden the understanding of the disease heterogeneity.

METHODS

We used the 18-kDa translocator protein (TSPO) tracer (R)-[¹¹C]PK11195 and [¹¹C]PIB PET images acquired in a hybrid PET/MR 3 T system to characterize, respectively, the profile of innate immune cells and myelin content in 47 patients with MS compared to 18 healthy controls (HC). For the volume of interest (VOI)-based analysis of the dynamic data, (R)-[¹¹C]PK11195 distribution volume (V_T) was determined for each subject using a metabolite-corrected arterial plasma input function while [¹¹C]PIB distribution volume ratio (DVR) was estimated using a reference region extracted by a supervised clustering algorithm. A voxel-based analysis was also performed using Statistical Parametric Mapping. Functional disability was evaluated by the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and Symbol Digit Modality Test (SDMT).

RESULTS

In the VOI-based analysis, [¹¹C]PIB DVR differed between patients and HC in the corpus callosum (P = 0.019) while no differences in (R)-[¹¹C]PK11195 V_T were observed in patients relative to HC. Furthermore, no correlations or associations were observed between both tracers within the VOI analyzed. In the voxel-based analysis, high (R)-[¹¹C]PK11195 uptake was observed diffusively in the white matter (WM) when comparing the progressive phenotype and HC, and lower [¹¹C]PIB uptake was observed in certain WM regions when comparing the relapsing-remitting phenotype and HC. None of the tracers were able to differentiate phenotypes at voxel or VOI level in our cohort. Linear regression models adjusted for age, sex, and phenotype demonstrated that higher EDSS was associated with an increased (R)-[¹¹C]PK11195 V_T and lower [¹¹C]PIB DVR in corpus callosum (P = 0.001; P = 0.023), caudate (P = 0.015; P = 0.008), and total T₂ lesion (P = 0.007; P = 0.012), while better cognitive scores in SDMT were associated with higher [¹¹C]PIB DVR in the corpus callosum (P = 0.001), and lower (R)-[¹¹C]PK11195 V_T (P = 0.013).

CONCLUSIONS

Widespread innate immune cells profile and marked loss of myelin in T₂ lesions and regions close to the ventricles may occur independently and are associated with disability, in both WM and GM structures.

Cognitive assessment of Brazilian patients with multiple sclerosis: weighing the impact of disability and depressive symptoms

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognition is not routinely assessed in patients with MS though they frequently have cognitive complaints or dysfunction.

Objective

The aim of this study was to compare the cognitive status of patients with MS with age, sex, and schooling matched controls and to evaluate the potential influence of clinical parameters on cognition.

Methods

A total of 35 patients with MS (mean±SD age 37.9 years±11.44, M/F: 12/23) and 33 healthy controls (mean±SD age 38.8 years±12.6, M/F: 12/21) were enrolled in this study. All subjects underwent a structured clinical assessment and the cognitive tools are as follows: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, and Verbal Fluency Tests (letters F, A, and S and animal category). Psychopathology was assessed with the Mini International Neuropsychiatric Interview and the Beck Depression Inventory (BDI). The Expanded Disability Status Scale (EDSS) was used for patients.

Results

Patients performed worse than controls in almost all tests, with approximately 70% of patients presenting cognitive impairment. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed (22.8%). SDMT was inversely correlated with disease severity, as assessed by the EDSS. Depression did not influence cognitive performance in this cohort.

Conclusions

Cognitive dysfunction is common among patients with MS. While motor impairment was associated with information processing speed, depression did not influence cognitive performance.

Assessment of patients with multiple sclerosis according to tests of the Multiple Sclerosis Functional Composite

Abstract Introduction: The Multiple Sclerosis Functional Composite (MSFC) is a scale that evaluates the functional and cognitive aspects of patients with multiple sclerosis (MS). Objective: To compare the performance of individuals with the relapsing-remitting form of MS (RRMS) with a group of healthy subjects using the MSFC. Methods: Twenty subjects were investigated in this study, consisting of 10 patients with clinical diagnosis of RRMS and 10 controls with similar gender and age to the group with the disease. The three tests that comprise the MSFC were used for the evaluation of gait, upper limb motor function and cognition (memory and processing speed). Student's t-test was used to assess data with normal distribution and data with skewed distribution were evaluated using the Mann-Whitney test. Results: The results showed that the patients with RRMS took longer to perform the locomotion test (6.91 ± 2.35) compared to the control group (5.16 ± 1.28). The MS group (22.06 ± 5.44) also showed greater difficulty in performing a task with the dominant upper limb compared to the healthy subjects (17.79 ± 2.96). No statistically significant difference was found between the groups in the performance of cognitive tasks (p = .65). Conclusion: The use of the MSFC tests proved valuable for measuring possible motor and cognitive impairments in patients with RRMS. Thus, it is suggested that this scale is adopted in clinical practice, improving therapies for the treatment of MS patients and thereby providing them a better quality of life.

Relato de Experiência em Acompanhamento Cognitivo com um Paciente com Esclerose Múltipla

A Esclerose Múltipla (EM) é uma doença crônica e autoimune, caracterizada por desmielinização, inflamação e neurodegeneração do Sistema Nervoso Central. Entre 30 e 50% dos indivíduos com EM apresentam comprometimento cognitivo. O processo de reabilitação cognitiva visa capacitar o paciente a conviver, reduzir e/ou superar os déficits cognitivos decorrentes da doença. Este trabalho relata a experiência de uma estagiária de Psicologia ao participar de um projeto de extensão universitária de acompanhamento cognitivo a um paciente com EM. Inicialmente o paciente foi submetido à avaliação neuropsicológica, identificando funções cognitivas preservadas e déficits. Foram observados déficits na recordação tardia, compreensão léxica, compreensão aritmética e aprendizagem numérica. Posteriormente, o paciente recebeu acompanhamento cognitivo semanal pelo período de seis meses. Após o período do acompanhamento, foi feita a reavaliação neuropsicológica. Observou-se melhora significativa na capacidade de recordação tardia e na aprendizagem aritmética, que deixaram de consistir em déficits. Além disso, houve abrandamento do déficit na compreensão aritmética. Os demais resultados permaneceram sem alterações. O trabalho mostra o impacto positivo que o acompanhamento cognitivo pode trazer ao paciente com EM e como a experiência de extensão pode auxiliar na formação dos estudantes de Psicologia.

Does fatigue occur in MS patients without disability?

BACKGROUND

Motor dysfunction and fatigue are the most common impairments that are associated with multiple sclerosis (MS). Walk tests and scales demonstrate the presence of fatigue in patients with MS with different levels of disability.

OBJECTIVE

To evaluate objective and subjective fatigue in MS patients without disability.

METHODS

Were selected MS patients with relapsing remitting clinical course, from 18 to 55 years old and EDSS 0 to 1.5; controls were paired for age, gender, body mass index, and physical activity level. Fatigue caused by pulmonary diseases, anemia, diabetes, thyroid disease, psychiatry diseases (except depression), and orthopedic and rheumatologic diseases are excluded. All participants performed the 6-minute walk test (6MWT), the MS Functional Composite (MSFC), and completed the Modified Fatigue Impact Scale (MFIS) and the Beck Depression Inventory. A multivariate model was applied to identify the variables associated with fatigue.

RESULTS

54 individuals were selected (31 patients; 23 controls). In the MSFC and 6MWT, no significant difference was observed between the groups. A MFIS total score indicated fatigue in 35% of the patients, 42% in the physical domain, 25.8% in the cognitive domain, and 29% in the psychosocial domain, which differed from the controls in all comparisons. Fatigue was associated with MS, low-physical activity, and mood disorders.

CONCLUSIONS

Fatigue occurs in patients with MS in the absence of motor dysfunction and is associated with the disease itself, the sedentary lifestyle, and mood disorders. The 6MWT is not useful to demonstrate motor fatigue in subjects without neurological disability.

Cross-cultural adaptation and validation of the 12-item Multiple Sclerosis Walking Scale (MSWS-12) for the Brazilian population

Gait impairment is reported by 85% of patients with multiple sclerosis (MS) as main complaint. In 2003, Hobart et al. developed a scale for walking known as The 12-item Multiple Sclerosis Walking Scale (MSWS-12), which combines the perspectives of patients with psychometric methods.

OBJECTIVE

This study aimed to cross-culturally adapt and validate the MSWS-12 for the Brazilian population with MS.

METHODS

This study included 116 individuals diagnosed with MS, in accordance with McDonald's criteria. The steps of the adaptation process included translation, back-translation, review by an expert committee and pretesting. A test and retest of MSWS-12/BR was made for validation, with comparison with another scale (MSIS-29/BR) and another test (T25FW).

RESULTS

The Brazilian version of MSWS-12/BR was shown to be similar to the original. The results indicate that MSWS-12/BR is a reliable and reproducible scale.

CONCLUSIONS

MSWS-12/BR has been adapted and validated, and it is a reliable tool for the Brazilian population.

Paced auditory serial addition test (PASAT): a very difficult test even for individuals with high intellectual capability

OBJECTIVE: To assess the difficulty of paced auditory serial addition test (PASAT) in a population of high intellectual level, under ideal cognitive testing circumstances. METHOD: One hundred medical students underwent PASAT testing. They had slept well the night before, they had eaten before the assessment, they were not using any drugs that could affect the central nervous system and they did not have depression, anxiety or any chronic disease. RESULTS: The average result from the three-second version of PASAT was 57.5% and, from the two-second version, it was 44.3%. CONCLUSION: Even under ideal circumstances, PASAT is a very difficult test for the general population. It may not be ideal for neurologists to screen, assess and follow up patients with cognitive function in multiple sclerosis.

Validation of the "Six Step Spot Test" for gait among patients with multiple sclerosis in Brazil

The clinical manifestations of multiple sclerosis (MS) are variable among patients, and the course of disease is not linear. Different symptoms are presented, with gradual accumulation of disability. These variations are difficult to quantify in clinical practice, and several studies have attempted to create instruments capable of measuring these disabilities. The Six Step Spot Test (SSST) was developed for quantitative evaluation of the lower limbs (LL) over time. Performance in this test reflects the complexity of sensory-motor function, including LL strength, spasticity, coordination and balance, going beyond vision and cognition. The aim of the present study was to validate the SSST in a population of MS patients in Brazil. This prospective study included 75 patients with MS, with EDSS 0 to 6.5 in the study group. Ninety-one healthy subjects were randomly selected for the control group. The results showed that the groups were similar, and that the SSST is a reliable and reproducible test. According to the statistical analysis on the data in this study, the SSST is a valid, reliable and reproducible tool for use in the Brazilian MS patient population.

Validation of the brazilian version of Guy's neurological disability scale

The Guy's neurological disability scale (GNDS) has recently been introduced as a new measure of disability in multiple sclerosis. It is patient-oriented, multidimensional, and not biased towards any particular disability. The purpose of the present study was to validate the Brazilian version of the GNDS. The adaptation of the scale was based on the translation/back-translation methodology. Sixty-two patients with clinically definite multiple sclerosis (CDMS) according to Poser's criteria were recruited for this study. GNDS was administered individually to each subject. The EDSS and the ambulation index (AI) scores were assigned by a neurologist. The intraclass correlation coefficient and the Cronbach's alpha values of the Brazilian version of GNDS (0.94 and 0.83, respectively) were comparable to the original one (0.98 and 0.79, respectively). Furthermore, the factor analysis of the Brazilian version of GNDS suggested, as the original article, a four-factor solution which accounted for 68.8% of the total variance. The Brazilian version of GNDS was found to be clinically relevant as it correlated significantly with the EDSS and AI. In conclusion, the Brazilian version of GNDS can be considered an important tool to evaluate the disability in MS patients, with clinical usefulness and psychometrics soundness.