Foram revisadas vários critérios para o diagnóstico de esclerose múltipla (EM) e aplicados os de Poser e colaboradores (1983) aos 40 pacientes incluídos neste estudo entre 1982 e 1987. Havia 36 (88%) pacientes do sexo feminino e 5 (12%) do sexo masculino, com EM clinicamente definida (85%) e provável (10%) de acordo com Poser et al., assim como 2 pacientes com doença crônica progressiva. A idade no momento do estudo era de 39 ± 11 anos e a de início da doença de 32 ± 10 anos; o tempo de história era de 6 ± 7 anos (médias ± desvios padrão). Como modo de apresentação da doença encontramos distúrbio de marcha em 50%, de visão em 25% e tontura em 10% dos casos. O exame físico no momento do estudo mostrava déficit motor em 92,5%, sensitivo era 67,5%, ocular visual em 65%, bexiga espástica em 35% e distúrbio vestíbulo-cerebelar em 32% dos pacientes. O potencial evocado visual foi anormal em 65% de 31 casos, o auditivo em 23% de 22 casos e o somes-tésico em 80% de 20 casos. Este estudo demonstra que critérios diagnósticos internacionais, especificamente, o de Poser e colaboradores, são aplicáveis no Brasil, contribuindo claramente para o diagnóstico da doença, bem como para estudos epidemiológicos, clínicos e terapêuticos era nosso país.
The frequency of multiple sclerosis in Brasil is assumed to be lower than in some geographically comparable regions, but internationally available objective diagnostic criteria are not generally used. We have reviewed a number of such criteria and applied those of Poser and colleagues to all patients who could be examined specifically for this study; who had been under our care between 1982-87; with clinically satisfactory history, physical exam, ancillary investigations and follow-up; with enough information to warrant immunosuppressive therapy with azathioprine, methyl-prednisolone or cyclophosphamide. There were 35 (88%) females and 5 (12%) males, with clinically definite (85%), probable (10%) disease according to Poser and cols, as well as 2 patients with chronic progressive disease. Age at time of study was 39 ± 11 years, age at onset had been 32 ± 10 years, and length of history was 6 ± 7 years (mean ± sd). Mode of onset was a disturbance of gait in 50%, of vision in 25% and dizziness in 10%. Physical exam at time of study showed motor deficits in 92.5%, sensory in 67.5%, ocular visual in 65%, spastic bladder in 35%, and vestibulocerebellar disturbances in 32%. Visual evoked responses were abnormal in 65% of 31 cases, auditory in 23% of 22 cases, and somatosensory in 80% of 20 cases. This study shows that international diagnostic criteria, specifically those of Poser and colleagues are applicable in Brasil, providing clear guidelines for diagnosis of multiple sclerosis. We suggest objective diagnostic criteria form the backbone of teaching about the disease, at various levels of medical education. Their wide utilization will in due time provide conditions for epidemiological, clinical and therapeutic studies which have not as yet been carried out in this country.
