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Objective. The aim of this study was to determine the long term clinical course and prognosis of subclinical (‘silent’) neurological involvement in Behçet’s disease (BD).

Methods. We included patients with BD who did not have any neurological complaints other than headache, diziness or other non-specific complaints, that showed abnormal neurological findings (Silent Group). We compared these patients with the patients with overt parenchymal neuro-Behçet’s disease (Overt Group). Cases with at least 8 years of follow-up were included. Results. There were 22 patients in the Silent Group (15M, 7F), with a mean follow-up of 12.8±4 years. Magnetic resonance imaging was abnormal in 8 of 21 patients, while neuropsychological testing revealed mild abnormalities in 15 of 20 patients. During the follow up period, 3 patients of the Silent Group had 4 overt neurological attacks. In the last visit, 21 patients were independent, while one that had previously developed overt neurological attack was deceased. The Overt Group consisted of 51 patients (45M, 6F). In the Overt Group the ratio of males was higher, nearing a marginal significance (p= 0.051); whereas age at onset of BD, and frequency of other organ manifestations of BD were not different. In the Overt Group at the final visit, 19 patients were independent (37%), while the remaining were either dependent to others, or deceased, which was significantly higher when compared to the Silent Group (p= 0.005). Conclusion. Silent neurological involvement in BD seems to represent a milder form of the disease, since the mortality and disability rate in this group is significantly low.