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Abstract(s)
A esclerose múltipla é uma doença inflamatória, desmielinizante e crónica, que afeta o
sistema nervoso central, e está entre as causas mais frequentes de incapacidade neurológica não
traumática em adultos jovens. Apesar de se suspeitar de uma etiologia autoimune, os mecanismos
causadores desta patologia permanecem desconhecidos.
Uma das peculiaridades mais curiosas da esclerose múltipla é a enorme variabilidade nos
desfechos clínicos dos diferentes pacientes, levando a que o espetro da doença oscile entre os casos
benignos, e até assintomáticos, aos mais malignos e agressivos. Esta estranha característica
origina um dos maiores desafios do cuidado destes pacientes: É ainda impossível conseguir
identificar quais os doentes que terão um bom ou mau prognóstico, com base no seu perfil
demográfico e clínico, ou através de achado de exames complementares. Consequentemente, esta
patologia é de difícil gestão para todos os envolvidos: Para o clínico, pois este não sabe em que
doentes apostar com terapias mais eficientes, mas também mais agressivas, nem sabe responder
às questões que lhe são colocadas; E é de extrema dificuldade para o paciente, uma vez que terá
de aprender a lidar com a incerteza do que o futuro lhe reserva, fonte de ansiedade e stress
psicológico.
Dado o debilitante impacto desta situação e a pertinência da continuação da investigação
nesta área, a presente dissertação constitui uma revisão alargada da literatura relativa aos fatores
prognósticos da esclerose múltipla universalmente aceites nos dias que correm.
Multiple sclerosis is a chronic, demyelinating and inflammatory disease that affects the central nervous system, and is one of the main causes of non-traumatic neurological disability in young adults. Despite the suspicion that its etiology is autoimmunity, the causing mechanisms of this pathology remain unknown. One of the most curious peculiarities of multiple sclerosis is the enormous clinical variability seen in the outcomes of different patients, making the spectrum of disease fluctuate between benign, and even asymptomatic cases, to the most malignant and aggressive ones. This odd characteristic brings us one of the biggest challenges in the care of these patients: It is still impossible to identify which patients will have a good or bad prognosis, on the basis of their demographic and clinical profile, or through findings on complementary diagnostic tests. As a consequence, this pathology is incredibly hard to manage to every party involved in it: It is difficult to the clinician, because he can’t know in which patients he should try the most efficient therapies, but also the highly aggressive ones, nor does he know how to answer the questions addressed to him; And it is extremely hard to the patient, for he will have to learn how to deal with the uncertainty of what the future withholds, which becomes a cause of anxiety and psychologic distress. Given the debilitating impact of this situation and the pertinence of continuing research in this area, the present dissertation constitutes a large literature review related to the prognostic factors of multiple sclerosis universally accepted as of these days.
Multiple sclerosis is a chronic, demyelinating and inflammatory disease that affects the central nervous system, and is one of the main causes of non-traumatic neurological disability in young adults. Despite the suspicion that its etiology is autoimmunity, the causing mechanisms of this pathology remain unknown. One of the most curious peculiarities of multiple sclerosis is the enormous clinical variability seen in the outcomes of different patients, making the spectrum of disease fluctuate between benign, and even asymptomatic cases, to the most malignant and aggressive ones. This odd characteristic brings us one of the biggest challenges in the care of these patients: It is still impossible to identify which patients will have a good or bad prognosis, on the basis of their demographic and clinical profile, or through findings on complementary diagnostic tests. As a consequence, this pathology is incredibly hard to manage to every party involved in it: It is difficult to the clinician, because he can’t know in which patients he should try the most efficient therapies, but also the highly aggressive ones, nor does he know how to answer the questions addressed to him; And it is extremely hard to the patient, for he will have to learn how to deal with the uncertainty of what the future withholds, which becomes a cause of anxiety and psychologic distress. Given the debilitating impact of this situation and the pertinence of continuing research in this area, the present dissertation constitutes a large literature review related to the prognostic factors of multiple sclerosis universally accepted as of these days.
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Keywords
Curso Clínico Esclerose Múltipla Incerteza Previsão Prognóstico