Avaliação neuro-morfométrica do encéfalo em pacientes com esclerose múltipla
Data
2023-05-11
Autores
Sino, Raíssa Mazzer 
Orientadores
Céspedes, Isabel Cristina
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A esclerose múltipla (EM) é uma das doenças inflamatórias mais comuns do sistema nervoso central. Atualmente, mais de 2,8 milhões de pessoas em todo o mundo vivem com EM. É uma doença crônica desmielinizante, que afeta a transmissão de impulsos nervosos, e desencadeia os diversos sintomas da doença. Considerada uma doença multifatorial, apresenta como fatores predisponentes características genéticas, infecção viral, inflamação autoimune e fatores ambientais. O diagnóstico precoce realizado por
avaliação clínica, exame laboratorial do líquido cefalorraquidiano e de imagem por ressonância magnética (RM) facilita o tratamento precoce evitando o aumento das lesões em substância branca, atrofia da substância cinzenta e agravamento dos sintomas. No entanto, ainda é necessário o desenvolvimento de métodos preditores do curso da doença, para o seu melhor manejo. Assim, o objetivo deste projeto foi avaliar alterações morfométricas em substância branca e cinzenta do encéfalo de pacientes com diagnóstico de Esclerose Múltipla, além do número e tamanho das lesões encefálicas, buscando correlacioná-las às características clínicas pelo desempenho na Escala Expandida do Estado de Incapacidade (Expanded Disability Status Scale – EDSS). Foram selecionados 65 indivíduos do Ambulatório de Neurologia Clínica, Setor de Doenças Desmielinizantes, do Hospital São Paulo da Escola Paulista de Medicina da UNIFESP que possuíam exame de ressonância magnética nas sequências 3D T1, FLAIR e gradiente-eco. Dados sociodemográficos e clínicos (escala EDSS) foram obtidos para a análise de correlação com os dados volumétricos obtidos pelas imagens de ressonância magnética. As imagens foram analisadas pelas técnicas de morfologia baseada em voxel (VBM) e algoritmo de crescimento da lesão (LGA). Com base em nossos achados nós pudemos concluir que apesar da maior prevalência de indivíduos diagnosticados para EM do tipo recorrente-remitente (EMRR), aqueles com o tipo Secundária Progressiva (EMSP) apresentaram maior pontuação na EDSS. Com base em nossos achados nós podemos concluir que quanto maior a extensão das lesões de substância branca no cérebro, maior a pontuação total do grau de incapacidade analisado pela EDSS, mas o número de lesões não exerceu influência sobre esta análise clínica. Com relação ao volume de regiões cerebrais, quanto maior a pontuação na EDSS, maior perda de volume em diversas regiões associadas às capacidades cognitivas, sensoriais e espaciais. Nestes pacientes, a idade potencializou a perda volumétrica em diversas áreas, sendo que o sexo não exerceu influência. A extensão das lesões foi associada a aumento volumétrico em diversas áreas, provavelmente associada ao edema cerebral provocado pela presença das lesões ativas. O número de lesões não exerceu influência volumétrica.
Multiple sclerosis (MS) is one of the most common inflammatory diseases of the central nervous system. Currently, more than 2.8 million people in the world are living with MS. It is a chronic demyelinating disease that affects the transmission of nerve impulses, and triggers the various symptoms of the disease. Considered a multifactorial disease, it presents as predisposing factors genetic characteristics, viral infection, autoimmune inflammation, and environmental factors. Early diagnosis by clinical evaluation, laboratory examination of the cerebrospinal fluid, and magnetic resonance imaging (MRI) facilitates early treatment by avoiding the increase of lesions in the white matter, atrophy of the gray matter, and worsening of symptoms. However, the development of methods to predict the course of the disease is still needed for its better management. Nevertheless, our objective were to evaluate morphometric alterations in the white and gray matter of the brain of patients diagnosed with Multiple Sclerosis, as well as the number and size of brain lesions, trying to correlate them to clinical characteristics by performance in the Expanded Disability Status Scale (EDSS). We selected 65 individuals from the Ambulatório de Neurologia Clínica, Setor de Doenças Desmielinizantes, Hospital São Paulo, Escola Paulista de Medicina - UNIFESP who had 3D T1, FLAIR and gradient-echo MRI scans. Sociodemographic and clinical data (EDSS scale) were obtained for correlation analysis with volumetric data obtained by MRI images. Images were analyzed by voxel-based morphology (VBM) and lesion growth algorithm (LGA) techniques. Based on our findings we conclude that despite the higher prevalence of individuals diagnosed for relapsing-remitting type MS (relapsing-remitting MS), those with the Secondary Progressive type (SPMS) had higher EDSS scores. Based on our findings we can conclude that the greater the extent of white matter lesions in the brain, the greater the total disability grade score analyzed by the EDSS, but the number of lesions had no influence on this clinical analysis. Regarding the volume of brain regions, the higher the EDSS score, the greater the loss of volume in several regions associated with cognitive, sensory and spatial abilities. In these patients, age potentiated the volume loss in several areas, and gender had no influence. The extension of the lesions was associated with volumetric increase in several areas, probably associated with brain edema caused by the presence of active lesions. The number of lesions had no volumetric influence.
Multiple sclerosis (MS) is one of the most common inflammatory diseases of the central nervous system. Currently, more than 2.8 million people in the world are living with MS. It is a chronic demyelinating disease that affects the transmission of nerve impulses, and triggers the various symptoms of the disease. Considered a multifactorial disease, it presents as predisposing factors genetic characteristics, viral infection, autoimmune inflammation, and environmental factors. Early diagnosis by clinical evaluation, laboratory examination of the cerebrospinal fluid, and magnetic resonance imaging (MRI) facilitates early treatment by avoiding the increase of lesions in the white matter, atrophy of the gray matter, and worsening of symptoms. However, the development of methods to predict the course of the disease is still needed for its better management. Nevertheless, our objective were to evaluate morphometric alterations in the white and gray matter of the brain of patients diagnosed with Multiple Sclerosis, as well as the number and size of brain lesions, trying to correlate them to clinical characteristics by performance in the Expanded Disability Status Scale (EDSS). We selected 65 individuals from the Ambulatório de Neurologia Clínica, Setor de Doenças Desmielinizantes, Hospital São Paulo, Escola Paulista de Medicina - UNIFESP who had 3D T1, FLAIR and gradient-echo MRI scans. Sociodemographic and clinical data (EDSS scale) were obtained for correlation analysis with volumetric data obtained by MRI images. Images were analyzed by voxel-based morphology (VBM) and lesion growth algorithm (LGA) techniques. Based on our findings we conclude that despite the higher prevalence of individuals diagnosed for relapsing-remitting type MS (relapsing-remitting MS), those with the Secondary Progressive type (SPMS) had higher EDSS scores. Based on our findings we can conclude that the greater the extent of white matter lesions in the brain, the greater the total disability grade score analyzed by the EDSS, but the number of lesions had no influence on this clinical analysis. Regarding the volume of brain regions, the higher the EDSS score, the greater the loss of volume in several regions associated with cognitive, sensory and spatial abilities. In these patients, age potentiated the volume loss in several areas, and gender had no influence. The extension of the lesions was associated with volumetric increase in several areas, probably associated with brain edema caused by the presence of active lesions. The number of lesions had no volumetric influence.