Estudo da evolução dos agravos neurológicos em uma coorte brasileira de pacientes com doença inflamatória intestinal

Abstract

Patients with inflammatory bowel disease (IBD) may suffer from numerous forms of extra- intestinal manifestations. Among them, several neurological disorders were observed, have

imprecise prevalence, are partly unknown or unrecognized, which makes them the object of increasing attention in clinical trials and in the literature. In this research, we studied the onset and evolution of neurological disorders over 10 years in a cohort of patients with IBD conducted at the Hospital Universitário Walter Cantídio. We evaluated 248 patients with IBD, 114 with Crohn's disease (CD) and 134 with ulcerative colitis (UC). Significant differences (p<0.001) between the beginning and end of the cohort were found in the following conditions: any neurological impairment, any neurological impairment without headache, any neurological impairment without headache/syncope/hypoacusis, peripheral neuropathy (PN), small fiber neuropathy (SFN), large fiber neuropathy (LFN), polyneuropathy and mononeuropathy. Differences were also observed in restless legs syndrome (RLS) (p=0.001), myeloneuropathy (p=0.003) and radiculopathy (p=0.032). Earlier, no patient was diagnosed with any type of PN, trigeminal neuralgia, RLS, myeloneuropathy, myelopathy, myopathy, myasthenia gravis, chorea, Alzheimer's, radiculopathy and central venous thrombosis, all discovered during the cohort. Most frequently identified neurological disorders were tension headache, migraine, NP, SFN, LFN, polyneuropathy and mononeuropathy. Univariate analysis of these conditions identified their risk factors and was followed by multivariate regression. The neurological disorders that showed association with the IBD group compared with the control were epilepsy (p=0.049), LFN (p=0.0009), SFN (p=0.004) and any neuromuscular disorder (p<0.0001). Similar associations were seen with the DC group. In univariate and multivariate logistic regression analysis to verify the probability of the IBD, CD and UC groups concomitantly manifesting some type of PN with some type of headache, 25 of the 27 analysis did not show a statistically significant association and two showed that, respectively, in the IBD group, PN is a protective factor for headache (adjusted OR=0.59; 95%CI 0.35-0.98; p=0.012) and in the CD group, PN is a protective factor for migraine (adjusted OR=0.36; CI95% 0.12-0.94; P=0.045). The following studies were produced that addressed specific neurological entities: secondary hypokalemic periodic paralysis, myasthenia gravis and Parkinson's disease. We also carried out an investigative survey to assess the patient's level of awareness about the neurological disorders that affect him. In summary, patients with IBD manifest a wide variety of neurological disorders, sometimes undersized, which suggest the need for close interaction between specialists. Headache and PN affect different groups of patients with IBD.