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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789352
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Epidemiological study on multiple sclerosis in Brazil: demographic and clinical characteristics according to geographic distribution – a BRANDO study

Alfredo Damasceno
1   Universidade Estadual de Campinas, Campinas SP, Brazil.
,
Carlos Bernardo Tauil
2   Universidade de Brasília, Brasília DF, Brazil.
,
Henry Koiti Sato
3   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Dagoberto Callegaro
3   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Maria Fernanda Mendes
4   Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo SP, Brazil.
,
José Artur Costa D’Almeida
5   Hospital Geral de Fortaleza, Departamento de Neuroimunologia, Fortaleza CE, Brazil.
,
Denise Sisterolli Diniz
6   Universidade Federal de Goiás, Goiânia GO, Brazil.
,
Osvaldo J. M. Nascimento
3   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Laura Fiuza Parolin
7   Neurovie, Departamento de Neurologia, Joinville SC, Brazil.
,
Thiago Goncalves Fukuda
3   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Paulo Diniz da Gama
8   Pontifícia Universidade Católica de São Paulo, Sorocaba SP, Brazil.
,
Herval Neto
3   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Marco Lana-Peixoto
9   Universidade Federal de Minas Gerais, Faculdade de Medicina, Centro de Investigação de Esclerose Múltipla, Belo Horizonte MG, Brazil.
,
Giordani Rodrigues dos Passos
10   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.
,
Rayllene da Silva Caetano
10   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.
,
Kleber Cavalcante dos Santos
11   Secretaria de Saúde do Distrito Federal, Brasília DF, Brazil.
,
Caio César Diniz Disserol
12   Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brazil.
,
Gabriel Vieira
1   Universidade Estadual de Campinas, Campinas SP, Brazil.
,
Eliana Tomomi Shimabukuro da Cunha
13   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Guilherme Diogo Silva
13   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Natália Cirino Talim
9   Universidade Federal de Minas Gerais, Faculdade de Medicina, Centro de Investigação de Esclerose Múltipla, Belo Horizonte MG, Brazil.
,
Cintia Ramari
14   University of Hasselt, Brazilian Committee for Treatment and Research in Multiple Sclerosis, Hasselt, Belgium.
,
Jefferson Becker
10   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Porto Alegre RS, Brazil.
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    Address for correspondence: Cintia Ramari (email: cintiaramarif@gmail.com).

    Abstract

    Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disorder whose prevalence varies across Brazil (15 to 18 per 100 thousand people on average; Southern region: 27 per 100 thousand people), and the absence of an extensive national study limits the epidemiological understanding of MS in a nation as diverse as Brazil.

    Objective: To describe the epidemiological differences among people with MS across four Brazilian regions.

    Methods: Data from 2,974 MS patients in the Collaborative Latin American Database for Multiple Sclerosis (BRANDO) were analyzed. We assessed demographics (sex, ethnicity) and clinical outcomes (age at onset, disability status, relapse frequency and topography, MS phenotype, and initial treatment) to elucidate regional differences.

    Results: The cohort was predominantly female (72.5%) with age at MS onset of 30.6 years. Ethnicity: Caucasian (75.8%), Mixed – Brown/Mulato (18.5%), African descent (5.3%), and Asian (0.4%). Relapse topography involved the optic nerve (48.8%), brain (51.4%), posterior fossa (37.6%), and spinal cord (53.6%). Relapsing-remitting (RR) was the most common phenotype (81.0%). Natalizumab (18%) and beta-interferon 1A (10.4%) were the most prevalent initial treatments. Regional differences: lower predominance of female patients (68.7%; p = 0.003) in the Southeastern region; higher mixed ethnicity (p = 0.000), of 40.3% and 63.7%, in the Midwestern and Northeastern regions respectively; Differences (p = 0.000) in the number of relapses (Southeast [1.6] = Northeast [1.5] > South [0.98] > Midwest [0.51]); higher EDSS score in the Northeast (4.0; p = 0.000) compared with all other regions (mean range: 2.6–3.2); Higher prevalence of RR in the Southeast and Midwest (87%; p < 0.001), while the Northeast presented (p < 0.001) the highest rates of primary progressive (15.8%) and secondary progressive MS (18%). Glatiramer acetate (19.7%) was the prevalent initial treatment in the Northeast, compared with natalizumab (15%–21%) in the other regions.

    Conclusion: Marking Brazil’s first extensive MS cohort study, our findings underscore regional epidemiological variations, and we advocate for tailored approaches in MS management and research.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    02 October 2024

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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