Estudo epidemiológico de pacientes com esclerose lateral amiotrófica em um hospital de referência de reabilitação no centro oeste brasileiro
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2019-05-14
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Universidade Federal de Goiás
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INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS), Charcot's disease, is a
neurodegenerative progressive disease characterized by a selective loss of motoneurons in the
spinal cord, brain stem and motor cortex and leads patient to death in 2 to 5 years. Epidemiological
studies have been developed with the objective of studying the survival and the clinical and
demographic characteristics of this disease. OBJECTIVE: To describe and to analyze the clinical-
epidemiological profile of ALS in Goias, through the analyzed sample, stratifying them by sex,
age, type of sclerosis presentation and county of origin; to evaluate the existing constraints using
the International Classification of Functionality, Disability and Health, known as ICF.
METHODOLOGY: This is an observational study, retrospective of the descriptive type of ALS
cases treated at the Centro Estadual de Reabilitação e Readaptação Dr. Henrique Santillo, from
January 1st 2016 to January 1st 2018. The statistical analysis was made using the SPSS program,
version 15.0 and the data were summarized in averages, medians and proportions. RESULTS: 135
patients with ALS according to El Escorial criteria were studied, being 7 patients with familial 128
with Sporadic ALS. The analyzed sample consisted of 73 (54.1%) patients from the male sex and
62 (45.9%) female, being the sex ratio (M: F), 1.18: 1. They were grouped into two with 34 (25.2%)
patients classified as Bulbars and 101 (74.8%) grouped as non-Bulbars. The average age was 59
years. The average time from first symptoms to the first evaluation in the institution was 4.64 years.
In the Bulbars the highest prevalence was of the female population (p 0.034). There was not a
statistically significant difference in mortality between the two groups, during the two-year follow-
up. The Bulbar patients have already arrived at the institution to rehabilitation with severe
dysphagia (p 0.007) and gastrostomy (p 0.007) and in its large majority, with complete inability to
communicate verbally (d3300: 4 with p 0.007). The Kolmogorov-Smirnov adhesion test was
performed to evaluate if the distance of each county and age contributed to the abandonment of
follow-up and the loss of CRER follow-up, there was no statistical difference between the two
groups. The distribution of the predominant non-Bulbar and Bulbar clinical forms, presents itself
similar to those reported in the literature with an average of 59 years, with a variation between 22
and 87 years old, in which the elderly population accounted for more than 53%, in the male sex
(1,18: 1). The bulbar form was more frequent in females in relation to the classical form. It was
observed that patients arrived at the institution with great incapacity to perform the Instrumental
Activities of Daily Living (IADL), as well as with a significant percentage of disability for Daily
Life Activities (ADL). Analyzing the initial function losses with the clinical classification in the
studied groups, we observed the highest prevalence of aphasia (p 0.007, OR 3.22), severe dysphagia
(p 0.007, OR 1.44) and consequently gastrostomized patients in the evaluation of the group whose
patients were classified as Bulbars, a fact that corroborates the clinic of the referred subgroup. The
survival study demonstrates variation when we analyze non-Bulbar forms and Bulbar.
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BRAGA, Cristhiano Augusto de Oliveira Holanda. Estudo epidemiológico de pacientes com esclerose lateral amiotrófica em um hospital de referência de reabilitação no centro oeste brasileiro. 2019. 95 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2019.