Author Of 3 Presentations
P0076 - Evaluation of diagnosis and treatment practices in patients with Multiple Sclerosis by Brazilian neurologists’ experts in demyelinating disorders. (ID 994)
Abstract
Background
Recent changes in Multiple Sclerosis (MS) diagnostic criteria and new medications promoted a major impact on the way specialists manage the disease.
Objectives
This study aimed to give an insight into the factors considered by Brazilian neurologists in the management of MS, and to identify how these factors contribute to diagnosis and treatment.
Methods
Potential participants were selected by a Steering Committee, which was assembled of MS experts from eleven Brazilian states and was responsible to development the Survey. Only MS specialists were included in the study (neurologists who have completed a neuroimmunology fellowship or who treat more than 30 patients with MS). Links to the online survey were distributed between March 2019 and January 2020. The questionnaire was composed of 11 question sections with hypothetical scenarios, as radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS).
Results
Neurologists from 13 Brazilian states responded to Survey (n=94). In CIS scenario, respondents agreed to treat patients with high risk of MS diagnosis, results that was not founded in RIS case, which half of the respondents opted to not treat, even in high risk patients. In RRMS and high-risk CIS, choice of treatment was distributed among interferon beta, glatiramer acetate and teriflunomide, which were changed to dimethyl fumarate and fingolimod as RRMS severity increased. In PPMS case, almost all respondents agreed to start treatment with ocrelizumab or rituximab. In contrast, the majority of respondents opted to treat SPMS only if there is evidence of disease activity. Reasons for switching medication, in a 12-month period, were appearance of one new or enlarging brain T2 lesion; one gadolinium-enhancing lesion in brain imaging; and one clinical relapse. Almost all specialists perform lumbar puncture for diagnoses, and monitor disease through a 12-months interval neuroimaging. Furthermore, almost all specialists check levels of vitamin D and prescribe supplements for low levels.
Conclusions
This study allowed the identification of areas of agreement among Brazilian neurologists on different scenarios related to patients with MS. These results can be used to promote debate among Brazilian experts, with the goal of helping update future protocols and improve patient management.
P1018 - Differences in perceptions of neurologists and patients about the challenges and outcomes in Multiple Sclerosis. (ID 992)
Abstract
Background
Patients perception about Multiple Sclerosis (MS) is a complex multifactor process, which involves physical, social and cognitive aspects. A good relationship between neurologists and patients is essential to their knowledge and interest about the disease.
Objectives
The aim of this study is to promote greater awareness of the differences in perception between patients with MS and neurologists. We perform a cross-sectional study to evaluate neurologist’s and patient’s opinions about challenges, disabling symptoms and quality of life during MS diagnosis and treatment.
Methods
Participants were divided into two groups: one compound of Brazilian neurologists (selected by a Steering Committee, which was composed of MS specialists) and other compound of Brazilian MS patients (selected by a non-governmental patient support organization, called AME - Amigos Múltiplos da Esclerose). Data were collected through online questionnaires, made by the Steering Committee, in a 1-year period. The survey was composed of topics of quality of life, challenges, disabling symptoms and orientations about the disease, and was proposed for both groups.
Results
A total of 330 patients and 182 neurologists answered the questionnaires. In the analysis of symptoms related by patients, the most voted were fatigue, ambulation issues, imbalance, falls and cognitive/memory problems, which were not related to patient’s age or disease duration. However, patients with primarily progressive MS (PPMS) complained more about ambulation issues, imbalance and falls (p < 0.001), when compared to other presentations of the disease. In analysis comparing neurologist’s and patient’s answers, divergent results were found. While almost 90% of the neurologists reported that they include the patient’s opinion in treatment choice, less than 30% of patients revealed to participate in these process (p < 0.001). More than 85% of neurologists reported guiding their patients about future plans, while less than 25% of patients described having been instructed on this (p < 0.001). While more than 90% of neurologists reported to guide their patients to smoking cessation, only almost 25% of the previously smoking patients revealed to be advised to stop the habit (p < 0.001).
Conclusions
This study revealed the need for neurologists to re-evaluate conduct and make them more frequent, with the intention of understanding patient’s priorities and increasing their interest in the disease.