Predictive value of evoked potentials on the long-term outcome of multiple sclerosis

[S. R. Lazarević]

68 листова

Uvod: Cilj je bio da ispitamo prediktivnu vrednost evociranih potencijala (EP) na dostizanje povoljnog ishoda dugogodišnjeg lečenja imunomodulatornom terapijom obolelih od relapsno-remitentne multiple skleroze (RRMS), da procenimo značaj EP kao pokazatelja kognitivnog oštećenja, i uticaj depresije i zamora na EP i ishod lečenja. Metodologija: U retro- i prospektivnom istraživanju oboleli su praćeni tokom 2, 5 ili 10 godina. Na početku praćenja su rađeni vizuelni evocirani potencijali (VEP) i kognitivni EP (ERP), takođe i nakon dugogodišnjeg praćenja. Dobijeni su podaci o optičkom neuritisu (ON), procenjeni stepen onesposobljenosti, kognitivne funkcije, stepen depresivnosti i zamora, rađena magnetna rezonanca (MR) endokranijuma. Povoljan ishod lečenja predstavlja dostizanje NEDA-3 (No Evidence of Disease Activity). Rezultati: Učestvovalo je 112 sobolelih od RRMS i 32 zdrave kontrole. NEDA-3 je dostiglo 19 (22,9%), a nije dostiglo 64 (77,1%) lečenih od RRMS. Nalaz EP skora (r=0,008, OR=0,344 (0,156–0,757)) i latence (r=0,042, OR=0,966 (0,934–0,999)) na početku bolesti su prediktivni faktori na dostizanje NEDA-3. Depresija utiče na kognitivno oštećenje (r=0,047, OR=1,077 (1,001–1,159)) i povećanje onesposobljenosti (r=0,002, OR=1,143 (1,051–1,243)). Depresija i zamor negativno utiču na kognitivne funkcije, a ne utiču na amplitude i latence ERP. Reakciono vreme pozitivno korelira sa depresijom (r=0,246, p=0,01) i zamorom (r=0,281, p=0,01). Zaključak: Uredan VEP na početku bolesti uvećava šansu za dostizanje NEDA-3 oko 6 puta. Depresija utiče na povećanje onesposobljenosti i kognitivno oštećenje. Depresija i zamor negativno utiču na kognitivne funkcije, a ne utiču na amplitudu i latencu ERP. ERP ne mogu učestvovati u proceni kognitivnog oštećenja obolelih od RRMS.

Objective: The study examined predictive value of evoked potentials (EP) to achieve a outcome of long-term treatment of patients with relapsing-remitting multiple sclerosis (RRMS) with first-line immunomodulatory therapy, to assess EP as an indicator of cognitive impairment, and impact of depression and fatigue on EP and the outcome of treatment. Method: In retrospective and prospective study patients were followed for 2, 5 or 10years. At the diagnosis visual evoked potentials (VEP) and event-related potentials (ERP) were done, also after follow-up period. Each patient was assigned a degree of disability – EDSS (Expanded Disability Status Scale), cognitive functions, degree of depression and fatigue, MRI of the endocranium. Favourable outcome is achieving NEDA-3 (No Evidence of Disease Activity). Results: A total of 112 patients with RRMS and 32 healthy controls participated. NEDA-3 reached 19 (22,9%) and did not 64 (77,1%) treated patients. We found that the VEP score (р=0,008, OR=0,344 (0,156–0,757)) and latency (r=0,042, OR=0,966 (0,934–0,999)) at diagnosis were predictive factors to achieve NEDA-3. Depression affects cognitive impairment (r=0,047, OR=1,077 (1,001-1,159)) and increases future disability (r=0,002, OR=1,143 (1,051-1,243)). Depression and fatigue negatively affected cognitive functions, and did not affect the ERP. Reaction time (RT) positively correlated with depression (r=0,246, p=0,01) and fatigue (r =0,281, p=0,01). Conclusions: Normal EP findings at diagnosis are 6 times more likely to achieve NEDA. Depression affects disability and cognitive impairment. Depression and fatigue have a negative impact on cognitive functions, and have no effect on ERP. Amplitude and latency cannot participate in risk assessment for the cognitive impairment in patients with RRMS.

multipla skleroza, evocirani potencijali, depresija, zamor, kognitivno oštećenje, optički neuritis, NEDA.

multiple sclerosis, evoked potentials, depression, fatigue, cognitive impairment, optic neuritis, NEDA.

616.832-004(043.3)

Multipla skleroza - Imunomodulatori - Lečenje

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