Síndrome Radiológica Isolada em Idade Pediátrica: O Modelo Clínico Ideal para o Estudo da Remielinização?
DOI:
https://doi.org/10.46531/sinapse/AR/210032/2022Palavras-chave:
Criança, Esclerose Múltipla, Ressonância MagnéticaResumo
A síndrome radiológica isolada (RIS) corresponde a uma situação clínica em que são identificadas em exames de imagem, nomeadamente de ressonância magnética, lesões de características desmielinizantes consideradas típicas de esclerose múltipla, sem que o indivíduo tenha tido, em algum momento, qualquer manifestação clínica a elas atribuível. Por este motivo, é a RIS habitualmente considerada como uma fase pré-sintomática da esclerose múltipla, o que a torna um alvo de investigação extremamente apetecível, no sentido de se modificar o risco de que se venha a desenvolver essa mesma doença. A RIS pode ser diagnosticada em idade pediátrica, mas são extremamente escassos os dados existentes sobre esta condição, de manifestação tão precoce na vida. Neste trabalho, far-se-á uma revisão narrativa sobre a RIS em idade pediátrica, refletindo-se criticamente sobre o benefício do seu estudo, particularmente para o (eventual) desenvolvimento de estratégias terapêuticas promotoras da remielinização e neuroproteção.Downloads
Referências
Okuda DT, Mowry EM, Behestian A, Waubant E, Baranzini SE, Goodin DS, et al. Incidental mri anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology. 2009;72:800-5. doi: 10.1212/01. wnl.0000335764.14513.1a.
Makhani N, Lebrun C, Siva A, Brassat D, Carra Dallière C, De Seze J, et al. Radiologically isolated syndrome in children: clinical and radiologic outcomes. Neurol Neuroimmunol NeuroInflamm. 2017;4:e395. doi: 10.1212/ NXI.0000000000000395.
Makhani N, Lebrun C, Siva A, Narula S, Wassmer E, Brassat D, et al. Oligoclonal bands increase the specificity of MRI criteria to predict multiple sclerosis in children with radiologically isolated syndrome. Mult Scler J Exp Transl Clin. 2019;5:2055217319836664. doi: 10.1177/2055217319836664.
Neumann B, Segel M, Chalut KJ, Franklin RJM. Remyelination and ageing: reversing the ravages of time. Mult Scler. 2019;25:1835-41. doi: 10.1177/1352458519884006.
Lubetzki C, Zalc B, Williams A, Stadelmann C, Stankoff B. Remyelination in multiple sclerosis: from basic science to clinical translation. Lancet Neurol. 2020;19:678-88. doi: 10.1016/S1474-4422(20)30140-X.
McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121-7. doi: 10.1002/ana.1032.
Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005; 58:840-6. doi: 10.1002/ana.20703.
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69:292-302. doi: 10.1002/ana.22366.
Filippi M, Rocca MA, Ciccarelli O, de Stefano N, Evangelou N, Kappos L, et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol. 2016;15:292-303. doi: 10.1016/S1474-4422(15)00393-2.
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17:162-73. doi: 10.1016/S1474-4422(17)30470-2.
Wilbur C, Yeh EA. Radiologically isolated syndrome in children: Current knowledge and future directions. Mult Scler Relat Disord. 2018;24:79-84. doi: 10.1016/j.msard.2018.06.010.
Dangouloff-Ros V, Roux CJ, Boulouis G, Levy R, Nicolas N, Lozach C, et al. Incidental brain MRI findings in children: A systematic review and meta-analysis. Am J Neuroradiol. 2019;40:1818-23. doi: 10.3174/ajnr.A6281.
Jansen PR, Dremmen M, van den Berg A. Incidental Findings on Brain Imaging in the General Pediatric Population. N Engl J Med. 2017;377:1593-5. doi: 10.1056/NEJMc1710724.
Granberg T, Martola J, Kristoffersen-Wiberg M, Aspelin P, Fredrikson S. Radiologically isolated syndrome - Incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Mult Scler J. 2013;19:271-80. doi: 10.1177/1352458512451943.
Makhani N. The Radiologically Isolated Syndrome: An Opportunity to Prevent Multiple Sclerosis in Children. Pediatr Neurol. 2018;85:13-5. doi: 10.1016/j.pediatrneurol.2018.05.009.
Sellner J, Schirmer L, Hemmer B, Mühlau M. The radiologically isolated syndrome: Take action when the unexpected is uncovered? J Neurol. 2010;257:1602-11. doi: 10.1007/ s00415-010-5601-9.
Makhani N, Tremlett H. The multiple sclerosis prodrome. Nat Rev Neurol. 2021;17:515-21. doi: 10.1038/s41582-021-00519-3.
Tremlett H, Marrie RA. The multiple sclerosis prodrome: Emerging evidence, challenges, and opportunities. Mult Scler. 2021; 27:6-12. doi: 10.1177/1352458520914844.
Yusuf FLA, Ng BC, Wijnands JMA, Kingwell E, Marrie RA, Tremlett H. A systematic review of morbidities suggestive of the multiple sclerosis prodrome. Expert Rev Neurother. 2020; 20:799-819. doi: 10.1080/14737175.2020.1746645.
Makhani N, Lebrun-Frenay C, Siva A, Wassmer E, Narula S, Mar S, et al. Older Age Is Associated with a First Clinical Demyelinating Event in Children with the Radiologically Isolated Syndrome (2671). Neurology. 2020;94:2671.
Carnero-Contentti E, Pettinicchi JP, Caride A, López PA. Decision-making on radiologically isolated syndrome among Argentinean neurologists: A survey based on clinical experience. Mult Scler Relat Disord. 2019;27:61-4. doi: 10.1016/j.msard.2018.09.030.
Isoelectric Focusing of Tears in Children With Radiologically Isolated or Clinically Isolated Syndrome (OBIT). [consultado Maio 2021] Disponível em: https://clinicaltrials.gov/ct2/ show/NCT03979391
Forster M, Graf J, Mares J, Aktas O, Hartung HP, Kremer D. Drug Treatment of Clinically Isolted Syndrome. CNS Drugs. 2019;33:659-76. doi: 10.1007/s40263-019-00647-x.
de Vries RMV, van Pelt ED, Mescheriakova JY, Wong YYM, Ketelslegers IA, Siepman TAM, et al. Disease course after clinically isolated syndrome in children versus adults: a prospective cohort study. Eur J Neurol. 2017;24:315-21. doi: 10.1111/ene.13196.
Assessment of Tecfidera® in Radiologically Isolated Syndrome (RIS) (ARISE). [consultado Maio 2021] Disponível em: https://clinicaltrials.gov/ct2/show/NCT02739542.
Randomized, Double-blinded Study of Treatment: Teriflunomide in Radiologically Isolated Syndrome (TERIS). [consultado Maio 2021] Disponível em: https://clinicaltrials.gov/ ct2/show/NCT03122652.
Brenton JN, Kammeyer R, Gluck L, Schreiner T, Makhani N. Multiple Sclerosis in Children: Current and Emerging Concepts. Semin Neurol. 2020;40:192-200. doi: 10.1055/s-0040-1703000.
Makhani N. Treatment Considerations in the Radiologically Isolated Syndrome. Curr Treat Options Neurol. 2020;22:3. doi: 10.1007/s11940-020-0608-8.
Baaklini CS, Rawji KS, Duncan GJ, Ho MFS, Plemel JR. Central Nervous System Remyelination: Roles of Glia and Innate Immune Cells. Front Mol Neurosci. 2019;12:225. doi: 10.3389/fnmol.2019.00225.
Franklin RJM, Frisén J, Lyons DA. Revisiting remyelination: Towards a consensus on the regeneration of CNS myelin. Semin Cell Dev Biol. 2020;S1084-9521(20)30157-9. doi: 10.1016/j.semcdb.2020.09.009.
Brown RA, Narayanan S, Banwell B, Arnold DL, Canadian Pediatric Demyelinating Disease Network. Magnetization transfer ratio recovery in new lesions decreases during adolescence in pediatric-onset multiple sclerosis patients. Neuroimage Clin. 2014;6:237-42. doi: 10.1016/j. nicl.2014.09.003.
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Direitos de Autor (c) 2024 Joana Silva, Ricardo Faustino, Filipe Palavra
Este trabalho encontra-se publicado com a Creative Commons Atribuição-NãoComercial 4.0.
