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Yıl:2019; Cilt: 56; Sayı: 4>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2019;56(4):269-272
Genel Nörologlar ve Multipl Skleroz Konusunda Deneyimli UzmanlarınMultipl Sklerozlu Hastalara Yaklaşım Farklılıkları:Bir Ulusal Anket Çalışması
M Kürtüncü , A Tuncer , U Uygunoğlu , Z Çalışkan , AK Paksoy , H Efendi , A S Kocaman , C Özcan , M Terzi , Ö F Turan , S Saip , R Karabudak , A Siva
İstanbul Üniversitesi, İstanbul
Amaç: Multipl sklerozun (MS) tanı ve tedavisinde yeni laboratuvar yöntemlerinin ve tedavilerin ortaya çıkması ile hastaların takip ve tedavi süreçleri karmaşıklaşmıştır. Klinisyenlerin MS hakkındaki deneyimleri bu süreçlerde seçilen yolun belirlenmesinde önemli bir rol oynamaktadır. Bu çalışma tecrübenin etkisini belirlemek amacıyla, genel nörologlar (GN) ile MS konusunda deneyimli nörologların (MSDN) hastalara yaklaşım farklılıklarını ortaya koymak için planlanmıştır. Yöntem: Çalışmamızda 36 sorudan oluşan bir anket 33’ü MS konusunda deneyimli olan toplam 318 nöroloji uzmanına uygulanmıştır. Çalışma sonunda tüm nörologların MS’de ortaya çıkan özel durumlara yaklaşımları araştırılmış ve uzmanlar ile genel nörologlar arasındaki farklılıklar ortaya konmaya çalışılmıştır. Bulgular: Çalışmamızda GN’ler ve MSDN’ler arasında hastalığın yönetimi ve tedavisi açısından belirgin farklılıklar olduğu gözlendi. Bunların başında tedavi başlanması ve değiştirilmesi konusunun geldiği izlendi. GN’lerin MSDN’lere göre hastalık modifiye edici tedavileri (HMT) daha geç başlamalarına karşın, daha kolay değiştirdikleri saptandı. GN’lerin %27,2’sinin McDonald kriterlerine göre tanı koysalar bile hastalık modifiye edici tedavi (HMT) başlamadığı ve tedavi için ikinci atağı beklediği gözlendi. Ayrıca, GN’lerin daha sık olarak manyetik rezonans görüntüleme (MRG) istemelerine karşın beyin atrofisine MSDN’ler kadar önem vermedikleri de saptandı. İlginç şekilde, GN’lerin D vitamin düzeyi düşük hastalarda bile replasman tedavisi yapmadıkları saptandı (%27,0’a karşın %6,0; p<0,01). Sonuç: Çalışmamız MSDN’ler ile GN’ler arasında MS hastalarına yaklaşım açısından önemli farklılıkların olduğunu ortaya koymaktadır. Bu durum, ülkemizde GN’lerin MS hakkında bilgilendirilmesi konusunda halen eksikliklerin olduğunu düşündürmektedir
Differences Between General Neurologists and Multiple Sclerosis Specialists in theManagement of Multiple Sclerosis Patients: A National Survey
Introduction: The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs). Methods: We conducted a survey of 36 questions to 318 neurologists, including 33 MSSs. The survey covered topics including laboratory investigations, pregnancy, and treatment. Results: Our study found many differences between GNs and MSSs in terms of management, the most important being treatment initiation and switching. GNs had a tendency to initiate treatment later than MSSs however, they tended to switch treatment faster. Our study also showed that GNs ordered magnetic resonance imaging (MRI) more frequently than MSSs, even if patients were clinically stable. Moreover, although GNs more frequently relied on MRI, they did not consider brain atrophy as an important measure in the follow-up of their patients. Furthermore, GNs considered replacement therapy less often than MSSs, even in patients with vitamin D deficiency. Discussion: Our study revealed important discrepancies between the management patterns of GNs and MSSs in MS patients. These findings suggest the need for a national education program for GNs on MSSs.

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