Resumen
Definition
History and exam
Key diagnostic factors
- distúrbio visual em um olho
- fenômenos sensitivos peculiares
Other diagnostic factors
- sexo feminino
- idade de 20-40 anos
- marcha escarvante ou talonante
- cãibras nas pernas
- fadiga
- polaciúria
- disfunção intestinal
- espasticidade/aumento do tônus muscular
- aumento dos reflexos tendinosos profundos
- falta de equilíbrio/coordenação
- disco óptico pálido ou perda da visão incorrigível
- respostas incorretas aos cartões do teste de cores de Ishihara
- movimentos oculares anormais
Risk factors
- sexo feminino
- história familiar de EM
- latitude norte
- fatores genéticos
- tabagismo
- deficiência de vitamina D
- doença autoimune
- Vírus Epstein-Barr
- sobrepeso/obesidade em crianças e adolescentes
Diagnostic investigations
1st investigations to order
- ressonância nuclear magnética (RNM) - cranioencefálica
- RNM - medula espinhal
- Hemograma completo
- perfil metabólico completo
- hormônio estimulante da tireoide
- cianocobalamina (vitamina B12)
Investigations to consider
- teste de anticorpos para distúrbios do espectro da neuromielite óptica
- avaliação do líquido cefalorraquidiano
- potenciais evocados
Treatment algorithm
recidiva aguda que afeta a função
esclerose múltipla (EM) remitente recidivante
esclerose múltipla (EM) progressiva secundária
esclerose múltipla (EM) progressiva primária
Contributors
Authors
Mary Alissa Willis, MD
Associate Professor and Chair
Department of Neurology
University of Mississippi Medical Center
Jackson
MS
Disclosures
MAW has been compensated for Speakers' Bureau participation with Alexion, Biogen, Bristol-Myers Squibb, Genzyme, and Genentech, and advisory board participation with Alexion, Biogen, Greenwich Biosciences, Genentech, and Horizon.
Acknowledgements
Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. We have since been made aware that Dr Stone is deceased.
Peer reviewers
Alex Rae-Grant, MD
Project Leader for Neurology
Neurological Institute
Cleveland Clinic
Cleveland
OH
Disclosures
ARG declares that he has no competing interests.
Sarah A. Morrow, MD, FRCPC, MS
Associate Professor of Neurology
Department of Clinical Neurological Sciences
London Health Sciences Centre
University Hospital
Ontario
Canada
Disclosures
SAM declares that she has no competing interests.
Marcelo Kremenchutzky, MD
Director
The London Multiple Sclerosis Clinic
Associate Professor
Schulich School of Medicine
University of Western Ontario
Neurologist
Clinical Neurological Sciences Department
University Hospital
London Health Sciences Centre
Ontario
Canada
Disclosures
MK declares that he has no competing interests.
Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCPGlasg, FRCPLond
Consultant Neurologist
Department of Neurology
Queen’s Hospital
Romford
UK
Disclosures
AC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014 Jul 15;83(3):278-86.Full text Abstract
Wattjes MP, Ciccarelli O, Reich DS, et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. 2021 Aug;20(8):653-670.Full text Abstract
Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-73. Abstract
Kantarci O, Wingerchuk D. Epidemiology and natural history of multiple sclerosis: new insights. Curr Opin Neurol. 2006 Jun;19(3):248-54. Abstract
Tramacere I, Del Giovane C, Salanti G, et al. Immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis: a network meta-analysis. Cochrane Database Syst Rev. 2015 Sep 18;(9):CD011381.Full text Abstract
Scolding N, Barnes D, Cader S, et al. Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis. Pract Neurol. 2015 Aug;15(4):273-9.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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