A importância da implantação de um protocolo assistencial para o tratamento agudo da neurite óptica no Hospital de Base do Distrito Federal: relato de caso
DOI:
https://doi.org/10.34119/bjhrv9n1-077Keywords:
neurite óptica, protocolo assistencial, EM, MOGAD, NMOSDAbstract
Considerando que as doenças desmielinizantes, como a esclerose múltipla (EM), a síndrome do espectro da neuromielite óptica (NMOSD) e a doença associada ao anticorpo MOG (MOGAD), são condições crônicas e incapacitantes, e que o diagnóstico e o tratamento tardios resultam em grave deterioração funcional, o problema deste estudo reside na falta de padronização do manejo dos pacientes admitidos com neurite óptica no Hospital de Base do Distrito Federal. Objetiva-se nesta pesquisa demonstrar a importância de implantar um protocolo assistencial padronizado para o tratamento agudo da neurite óptica, aplicando o princípio de que "o tempo é tecido" para evitar danos cumulativos. Para tanto, procedeu-se à realização de um estudo de três relatos de casos, com coleta de dados clínicos e revisão de literatura, buscando-se artigos nas plataformas Scielo, Lilacs, Clinicalkey e Pubmed. Desse modo, observa-se que o Caso 3 (EM) apresentou uma resposta dramática à pulsoterapia. O Caso 1 (MOGAD) iniciou a pulsoterapia dentro da janela ideal de 4 dias, alcançando a melhora completa da visão. Contudo, o Caso 2 (NMOSD) sofreu um atraso de 26 dias no início da pulsoterapia, resultando em uma resposta insuficiente e baixa acuidade visual mantida, mesmo após a plasmaférese, destacando as consequências do atraso em doenças mediadas por anticorpos. Portanto, conclui-se que a implementação de um protocolo institucional é crucial para garantir o acesso rápido a terapias eficazes e evitar resultados visuais insatisfatórios, essenciais para reduzir o impacto individual e coletivo dessas condições.
References
ABBOUD, H. et al. Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. Multiple Sclerosis Journal, v. 22, n. 2, p. 185–192, 2016. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25921047/.
ANDERSEN, J.; BRILOT, F. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): Insights into pathogenesis and biomarkers of prognosis. Seminars in Immunology, v. 78, p. 101944, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40088708/.
BANWELL, B. et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. The Lancet Neurology, v. 22, n. 3, p. 268–282, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36706773/.
BERGERON, E.; BOUFFARD, M. A. Evidence-based management of optic neuritis. Current Opinion in Ophthalmology, v. 35, n. 1, p. 73–82, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37846574/.
BERKOVICH, R. Treatment of acute relapses in multiple sclerosis. In: LALIVE, P. H.; VALLI, M. (org.). Translational Neuroimmunology in Multiple Sclerosis. San Diego: Elsevier, 2016. p. 307–328. Disponível em: https://pubmed.ncbi.nlm.nih.gov/23229226/.
BRENTON, J. N. Pediatric acquired demyelinating disorders. Continuum (Minneapolis, Minn.), v. 28, n. 4, p. 1104–1130, 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35938659/.
BUTZKUEVEN, H. et al. Brain health–time matters: multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and related conditions: 2024 report. Multiple Sclerosis and Related Disorders, v. 101, p. 106456, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40578068/.
CACCIAGUERRA, L.; FLANAGAN, E. P. Updates in NMOSD and MOGAD diagnosis and treatment: a tale of two central nervous system autoimmune inflammatory disorders. Neurologic Clinics, v. 42, n. 1, p. 77–114, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37980124/.
COSTELLO, F. Neuromyelitis optica spectrum disorders. Continuum (Minneapolis, Minn.), v. 28, n. 4, p. 1131–1170, 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35938660/.
CROSS, A.; RILEY, C. Treatment of multiple sclerosis. Continuum (Minneapolis, Minn.), v. 28, n. 4, p. 1025–1051, 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35938656/.
DOBSON, R.; GIOVANNONI, G. Multiple sclerosis: a review. European Journal of Neurology, v. 26, n. 1, p. 27–40, 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30300457/.
ERNSTSSON, O. et al. Cost of illness of multiple sclerosis: a systematic review. PLoS ONE, v. 11, n. 7, p. e0159129, 2016. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27411042/.
FABIAN, M. T.; KRIEGER, S. C.; LUBLIN, F. D. Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In: DAROFF, R. B. et al. (org.). Bradley’s Neurology in Clinical Practice. 8. ed. Philadelphia: Elsevier, 2021. p. 1227–1253. Disponível em: https://www.clinicalkey.com/.
FILIPPI, M. et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. The Lancet Neurology, v. 15, n. 3, p. 292–303, 2016. Disponível em: https://www.thelancet.com/.
GEORGE, M.; GANTIOQUE, R. Neuromyelitis optica spectrum disorder: an early diagnosis to prevent blindness and paraplegia. The Journal for Nurse Practitioners, v. 19, p. 104654, 2023. Disponível em: https://www.sciencedirect.com/.
GEORGIEVA, D. et al. Cost avoidance from health system specialty pharmacist interventions in patients with multiple sclerosis. Journal of Managed Care & Specialty Pharmacy, v. 30, n. 4, p. 336–344, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38555624/.
GIOVANNONI, G. et al. “No evident disease activity”: the use of combined assessments in the management of patients with multiple sclerosis. Multiple Sclerosis Journal, v. 23, n. 8, p. 1077–1085, 2017. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28381105/.
GOMEZ HJERTENA, I. et al. Underemployment, work hour reduction, and income loss: a global, multi-centered cohort study of neuromyelitis optica. Journal of the Neurological Sciences, v. 455, p. 121066, 2023. Disponível em: https://www.sciencedirect.com/.
HOSHINA, Y. et al. Prolonged corticosteroid therapy and steroid-sparing maintenance immunotherapy lower relapse risk in pediatric and adult MOGAD. Journal of Neuroimmunology, v. 407, p. 578709, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40763382/.
IANCU, R. et al. Visual function improvement after plasma exchange therapy for acute optic neuritis in neuromyelitis optica spectrum disorders: case series and review. Diagnostics, v. 14, n. 9, p. 863, 2024. Disponível em: https://www.mdpi.com/.
LEVY, M.; FUJIHARA, K.; PALACE, J. New therapies for neuromyelitis optica spectrum disorder. The Lancet Neurology, v. 20, n. 1, p. 60–67, 2021. Disponível em: https://www.sciencedirect.com/.
MOLAZADEH, N. et al. Predictors of relapsing disease course following index event in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Journal of the Neurological Sciences, v. 458, p. 122909, 2024. Disponível em: https://www.clinicalkey.com/.
MS INTERNATIONAL FEDERATION. Atlas of MS: Mapping multiple sclerosis around the world. 3. ed. London: MSIF, 2020. Disponível em: https://www.msif.org/.
PANDIT, L. et al. Demographic and clinical features of neuromyelitis optica: a review. Multiple Sclerosis Journal, v. 21, n. 8, p. 993–1001, 2015. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25921037/.
PONZIO, M. et al. The economic impact of comorbidity in multiple sclerosis. Neurological Sciences, v. 44, n. 3, p. 999–1008, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36441342/.
PULA, J. H.; MACDONALD, C. J. Current options for the treatment of optic neuritis. Clinical Ophthalmology, v. 6, p. 1211–1223, 2012. Disponível em: https://pubmed.ncbi.nlm.nih.gov/22927730/.
QIN, C. et al. Predictive factors of resistance to high-dose steroids therapy in acute attacks of neuromyelitis optica spectrum disorder. Frontiers in Neurology, v. 11, p. 585471, 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33281722/.
RACSA, P. et al. A comparison of clinical, utilization, and cost outcomes between oral treatments for multiple sclerosis. Journal of Managed Care & Specialty Pharmacy, v. 30, n. 2, p. 129–140, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38308623/.
RAMIREZ, D. A. et al. Central American and Caribbean consensus for the treatment of MS, NMOSD, and MOGAD. Multiple Sclerosis and Related Disorders, v. 95, p. 106334, 2025. Disponível em: https://www.sciencedirect.com/.
REINDL, M.; WATERS, P. Myelin oligodendrocyte glycoprotein antibodies in neurological disease. Nature Reviews Neurology, v. 14, n. 2, p. 89–102, 2018. Disponível em: https://www.nature.com/.
REMPE, T. et al. Frequency, characteristics, predictors and treatment of relapsing myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Multiple Sclerosis and Related Disorders, v. 87, p. 105672, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38749350/.
RICE, D. R. et al. Quantifying the economic burden to patients of relapse events from neuromyelitis optica spectrum disorders. Multiple Sclerosis and Related Disorders, v. 71, p. 104580, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36805175/.
SANTORO, J. D. et al. The impact of neuroimmunologic disease and developing nervous system. Pediatric Neurology, v. 148, p. 189–197, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37442652/.
SATISH, S. et al. Multiple sclerosis in the emergency department: a retrospective case-control study in a large US center. Neurology: Neuroimmunology & Neuroinflammation, v. 12, n. 4, p. e200445, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40674662/.
SIRIRATNAM, P. et al. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmunity Reviews, v. 22, p. 103465, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37852514/.
SMETS, I. et al. Corticosteroids in the management of acute multiple sclerosis exacerbations. Acta Neurologica Belgica, v. 117, n. 2, p. 623–632, 2017. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28391390/.
SPAIN, R. Approach to symptom management in multiple sclerosis with a focus on wellness. Continuum (Minneapolis, Minn.), v. 28, n. 4, p. 1052–1082, 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35938657/.
STIEBEL-KALISH, H. et al. Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis? Neurology: Neuroimmunology & Neuroinflammation, v. 6, n. 4, p. e572, 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31355308/.
TIAN, Y. et al. Radiomics analysis of DTI data to assess vision outcome after intravenous methylprednisolone therapy in neuromyelitis optica optic neuritis. Journal of Magnetic Resonance Imaging, v. 48, n. 2, p. 482–491, 2018. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30252996/.
TREWIN, B. P. et al. MOGAD: a comprehensive review of clinicoradiological features, therapy and outcomes in 4699 patients globally. Autoimmunity Reviews, v. 24, p. 103693, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39577549/.
UAWITHYA, E. et al. Real-world data and patient perspectives on the impact of multiple sclerosis, neuromyelitis optica spectrum disorder, and related disorders on employment. Multiple Sclerosis and Related Disorders, v. 101, p. 106580, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40517520/.
VERGANI, V. E. et al. The impact of multiple sclerosis on wellbeing, productivity, and societal relations. Arquivos de Neuro-Psiquiatria, v. 83, n. 5, p. e00451809400, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40541243/.
WALTON, C. et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Multiple Sclerosis Journal, v. 26, n. 14, p. 1816–1821, 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33174475/
