1
|
Jack AI, Digney HT, Bell CA, Grossman SN, McPherson JI, Saleem GT, Haider MN, Leddy JJ, Willer BS, Balcer LJ, Galetta SL, Busis NA, Torres DM. Testing the Validity and Reliability of a Standardized Virtual Examination for Concussion. Neurol Clin Pract 2024; 14:e200328. [PMID: 38895642 PMCID: PMC11182663 DOI: 10.1212/cpj.0000000000200328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/27/2024] [Indexed: 06/21/2024]
Abstract
Background and Objectives We determined inter-modality (in-person vs telemedicine examination) and inter-rater agreement for telemedicine assessments (2 different examiners) using the Telemedicine Buffalo Concussion Physical Examination (Tele-BCPE), a standardized concussion examination designed for remote use. Methods Patients referred for an initial evaluation for concussion were invited to participate. Participants had a brief initial assessment by the treating neurologist. After a patient granted informed consent to participate in the study, the treating neurologist obtained a concussion-related history before leaving the examination room. Using the Tele-BCPE, 2 virtual examinations in no specific sequence were then performed from nearby rooms by the treating neurologist and another neurologist. After the 2 telemedicine examinations, the treating physician returned to the examination room to perform the in-person examination. Intraclass correlation coefficients (ICC) determined inter-modality validity (in-person vs remote examination by the same examiner) and inter-rater reliability (between remote examinations done by 2 examiners) of overall scores of the Tele-BCPE within the comparison datasets. Cohen's kappa, κ, measured levels of agreement of dichotomous ratings (abnormality present vs absent) on individual components of the Tele-BCPE to determine inter-modality and inter-rater agreement. Results For total scores of the Tele-BCPE, both inter-modality agreement (ICC = 0.95 [95% CI 0.86-0.98, p < 0.001]) and inter-rater agreement (ICC = 0.88 [95% CI 0.71-0.95, p < 0.001]) were reliable (ICC >0.70). There was at least substantial inter-modality agreement (κ ≥ 0.61) for 25 of 29 examination elements. For inter-rater agreement (2 telemedicine examinations), there was at least substantial agreement for 8 of 29 examination elements. Discussion Our study demonstrates that the Tele-BCPE yielded consistent clinical results, whether conducted in-person or virtually by the same examiner, or when performed virtually by 2 different examiners. The Tele-BCPE is a valid indicator of neurologic examination findings as determined by an in-person concussion assessment. The Tele-BCPE may also be performed with excellent levels of reliability by neurologists with different training and backgrounds in the virtual setting. These findings suggest that a combination of in-person and telemedicine modalities, or involvement of 2 telemedicine examiners for the same patient, can provide consistent concussion assessments across the continuum of care.
Collapse
Affiliation(s)
- Alani I Jack
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Helena T Digney
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Carter A Bell
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Scott N Grossman
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Jacob I McPherson
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Ghazala T Saleem
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Mohammad N Haider
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - John J Leddy
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Barry S Willer
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Laura J Balcer
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Steven L Galetta
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Neil A Busis
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| | - Daniel M Torres
- Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY
| |
Collapse
|
2
|
Tuncer SA, Danacı C, Bilek F, Demir CF, Tuncer T. Utilizing Aerobic Capacity Data for EDSS Score Estimation in Multiple Sclerosis: A Machine Learning Approach. Diagnostics (Basel) 2024; 14:1249. [PMID: 38928664 PMCID: PMC11203342 DOI: 10.3390/diagnostics14121249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis (PwMS). One of the main problems with the EDSS method is that different results can be determined by different physicians for the same patient. In this case, it is necessary to produce autonomous solutions that will increase the reliability of the EDSS, which has a decision-making role. This study proposes a machine learning approach to predict EDSS scores using aerobic capacity data from PwMS. The primary goal is to reduce potential complications resulting from incorrect scoring procedures. Cardiovascular and aerobic capacity parameters of individuals, including aerobic capacity, ventilation, respiratory frequency, heart rate, average oxygen density, load, and energy expenditure, were evaluated. These parameters were given as input to CatBoost, gradient boosting (GBM), extreme gradient boosting (XGBoost), and decision tree (DT) machine learning methods. The most significant EDSS results were determined with the XGBoost algorithm. Mean absolute error, root mean square error, mean square error, mean absolute percent error, and R square values were obtained as 0.26, 0.4, 0.26, 16, and 0.68, respectively. The XGBoost based machine learning technique was shown to be effective in predicting EDSS based on aerobic capacity and cardiovascular data in PwMS.
Collapse
Affiliation(s)
- Seda Arslan Tuncer
- Software Engineering, Faculty of Engineering, Firat University, 23119 Elazığ, Turkey; (S.A.T.); (C.D.)
| | - Cagla Danacı
- Software Engineering, Faculty of Engineering, Firat University, 23119 Elazığ, Turkey; (S.A.T.); (C.D.)
- Department of Software Engineering, Faculty of Technology, Sivas Republic University, 58070 Sivas, Turkey
| | - Furkan Bilek
- Department of Gerontology, Fethiye Faculty of Health Sciences, Muğla Sıtkı Koçman University, 48000 Muğla, Turkey;
| | - Caner Feyzi Demir
- Department of Neurology, School of Medicine, Fırat University, 23119 Elazig, Turkey;
| | - Taner Tuncer
- Computer Engineering, Faculty of Engineering, Firat University, 23119 Elazığ, Turkey
| |
Collapse
|
3
|
Schmidt FR, Coutinho ES, Lima MA, Silva MT, Leite AC, Fonseca IO, Araujo AQ. Performance of the National Institute of Infectious Diseases disability scale in HTLV-1-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2023; 29:555-563. [PMID: 37400732 DOI: 10.1007/s13365-023-01154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic disabling disease. However, there is a lack of an adequate and specific health measurement instrument validated and with good performance to assess their degree of physical disability. This led us to carry out this study and to evaluate the performance of Fiocruz's National Institute of Infectious Diseases (IDS) disability scale, a specific instrument for HAM/TSP. Ninety-two HAM/TSP patients participated in the study. One researcher applied the IDS, IPEC scale, Disability Status Scale (DSS), Expanded DSS (EDSS), Osame scale, Beck Depression Inventory, and the WHOQOL-BREF questionnaire. In parallel, blindly, and separately, other researchers applied the IDS. An inter-rater reliability analysis of the IDS, correlation analysis with the other scales, and depression and quality of life questionnaires were performed. The applicability of the IDS was also evaluated. The IDS showed high reliability in all scores. The inter-rater reliability test for the total IDS score was 0.94 (0.82-0.98) on its four dimensions. The scale adequately indicated the different degrees of disability, presenting a distribution similar to normal. There was a high correlation with the other scales (Spearman coefficients > 0.80, p < 0.001). The scale had good acceptance among users and a short application time. IDS for HAM/TSP was reliable, consistent, easy, and fast to use. It can be used for both prospective evaluations and clinical trials. The present study supports the IDS as a valid instrument to measure disability in patients with HAM/TSP compared to previously used scales.
Collapse
Affiliation(s)
- Felipe R Schmidt
- Department of Neurology, Pedro Ernesto University Hospital, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evandro Sf Coutinho
- Department of Epidemiology, Institute of Social Medicine Hésio Cordeiro, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco A Lima
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Marcus Tt Silva
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Ana Ccb Leite
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Igor O Fonseca
- Department of Neurology and Psychiatry, Paulista State University (UNESP), Botucatu, SP, Brazil
| | - Abelardo Qc Araujo
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil.
- Postgraduate Program in Neurology and Neurosciences, Fluminense Federal University (UFF), Niteroi, RJ, Brazil.
| |
Collapse
|
4
|
Bogaardt H, Golan D, Barrera MA, Attrill S, Kaczmarek O, Zarif M, Bumstead B, Buhse M, Wilken J, Doniger GM, Hancock LM, Penner IK, Halper J, Morrow SA, Covey TJ, Gudesblatt M. Cognitive impairment, fatigue and depression in multiple sclerosis: Is there a difference between benign and non-benign MS? Mult Scler Relat Disord 2023; 73:104630. [PMID: 36965219 DOI: 10.1016/j.msard.2023.104630] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). The severity of disability in people with MS (PwMS) is generally measured with the Expanded Disability Status Scale (EDSS). A variant of MS known as 'benign MS' (BMS) has been defined as an EDSS score of 3 or lower, combined with a disease duration of 10 years or longer; however, there is disagreement in the field about whether BMS really exists. Given that the EDSS does not capture cognitive issues, communication dysfunction, fatigue, depression, or anxiety properly, its ability to accurately represent disability in all PwMS, including BMS, remains questionable. METHODS In this study, 141 persons with BMS (PwBMS) were included, consisting of 115 females (82%) and 26 males (18%) with a mean age of 50.8 (±8.68). A computerized test battery (NeuroTrax®) was used to assess cognition, covering seven cognitive domains (memory, executive function, visual-spatial processing, verbal function, attention, information processing, and motor skills). Fatigue was measured using the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was used to assess symptoms of depression. Cognitive impairment was defined for this study as when someone has a score lower than 85 in at least two subdomains of the cognitive test battery. Rates of impairment were compared to 158 persons with non-benign MS (PwNBMS; with a disease duration of 10 years and longer and an EDSS score higher than 3) and 487 PwMS with a disease duration of fewer than 10 years. RESULTS Cognitive impairment was found in 38% of PwBMS and in 66% of PwNBMS (p<0.001). In PwBMS, the lowest rate of impairment was found in the verbal function domain (18%) and the highest rate of impairment in the domain of information processing (32%). Fatigue and depression were found in 78% and 55% of all PwBMS, with no difference in these rates between PwBMS and PwNBMS (p = 0.787 and p = 0.316 resp.) CONCLUSION: Cognitive impairment, fatigue and depression are common among people with an EDSS-based definition of benign MS. These aspects should be incorporated into a new and better definition of truly benign MS.
Collapse
Affiliation(s)
- Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia.
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Marissa A Barrera
- Katz School of Science and Health, Yeshiva University, New York, United States
| | - Stacie Attrill
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | | | - Myassar Zarif
- South Shore Neurologic Associates, New York, United States
| | | | - Marijean Buhse
- South Shore Neurologic Associates, New York, United States; Department of Nursing, State University of Stony Brook, Stony Brook, NY, United States
| | - Jeffrey Wilken
- Georgetown University Dept of Neurology, Washington D.C. United States; Washington Neuropsychology Research Group, LLC., Fairfax, VA, United States
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Laura M Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - June Halper
- Consortium of Multiple Sclerosis Centers, Hackensack, NJ, United States
| | - Sarah A Morrow
- London Health Sciences Centre, University Hospital, University of Western Ontario (Western), Canada
| | - Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Mark Gudesblatt
- Katz School of Science and Health, Yeshiva University, New York, United States
| |
Collapse
|
5
|
Jacot de Alcântara I, Voruz P, Allali G, Fragnoli C, Antoniou MP, Lalive PH, Péron JA. Personality as a Predictor of Disability in Multiple Sclerosis. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2023:7034215. [PMID: 36764662 PMCID: PMC10369360 DOI: 10.1093/arclin/acad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE As personality changes and personality disorders are frequently observed in multiple sclerosis (MS), personality may be a prognostic factor for this disease. The present study investigated the influence of personality on disability, progression, and treatment adherence in MS. METHOD Personality was assessed in 41 patients with Relapsing-Remitting MS (30 females; mean age = 42.63 years) using the NEO Personality Inventory-3rd edition. Disability was measured with the Expanded Disability Status Scale, and treatment adherence information was collected from the Swiss MS Cohort. Correlation, multiple linear and partial least square regressions were performed to examine relations between personality, disability, and treatment adherence in MS. RESULTS After accounting for age and time since disease onset, our analysis revealed that Neuroticism (β = 0.32, p = 0.01) and its Vulnerability facet (β = 0.28, p < 0.05) predicted greater disability, whereas Extraversion (β = -0.25, p = 0.04) and its Activity facet (β = -0.23, p < 0.05) predicted milder disability. Regarding disability progression, correlational analysis revealed that it was negatively correlated with Extraversion (r = -0.44, p = 0.02) and the Feelings facet of Openness (r = -0.41, p = 0.03), but regressions failed to highlight any predictive links. No significant results could be demonstrated for treatment adherence. CONCLUSIONS Overall, our study showed that some personality traits can impact disability in MS, indicating that these should be considered in clinical practice, as they could be used to adapt and improve patients' clinical support.
Collapse
Affiliation(s)
- Isabele Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland.,Neurology Department, Geneva University Hospitals, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Gilles Allali
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chloé Fragnoli
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
| | - Maria Paraskevi Antoniou
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland
| | - Patrice Henri Lalive
- Neurology Department, Geneva University Hospitals, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Julie Anne Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Switzerland.,Neurology Department, Geneva University Hospitals, Switzerland
| |
Collapse
|
6
|
Aguilar-Zafra S, del Corral T, Valera-Calero JA, Martín-Casas P, Plaza-Manzano G, López-de-Uralde-Villanueva I. Development of the Web-Based Spanish Version of the Barthel Index in Patients with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113965. [PMID: 36360845 PMCID: PMC9657693 DOI: 10.3390/ijerph192113965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND The aims of this study were to develop a web-based Spanish form of the Barthel index (BI), to evaluate its psychometric properties and stability over time (test-retest), and to determine minimal detectable change (MDC) in patients with multiple sclerosis (MS). METHODS Participants answered the BI on two forms (web-based and face-to-face interview), 7-10 days apart. The internal consistency was evaluated using Cronbach's alpha, and intraclass correlation (ICC) and kappa (κ) coefficients were used to investigate the agreement between both forms. RESULTS 143 participants were included. The Spanish web-based form of the BI showed excellent agreement between both forms for each item (κ = 0.86 (0.79 to 0.92), and for total score (κ = 0.87 (0.81 to 0.93); ICC = 0.99 (0.98 to 0.99). The internal consistency was good-excellent (Cronbach's alpha = 0.89 (0.86-0.91)). The stability over time was adequate, the agreement of each item was κ = 0.63 (0.52-0.74)), and for total score (ICC = 0.97), determining a MDC95 of 12.09 points. CONCLUSIONS The Spanish web-based form of the BI is a valid and reliable tool to assess functionality and can be applied in both formats in patients with MS. A total score difference of more than 12 points was found to indicate a deterioration or improvement in the patient's functionality.
Collapse
Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Téxum S.L Physiotherapy Center, 28821 Madrid, Spain
| | - Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-15-17
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physical Therapy, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| |
Collapse
|
7
|
Ellenberger D, Parciak T, Brola W, Hillert J, Middleton R, Stahmann A, Thalheim C, Flachenecker P. Comparison of employment among people with Multiple Sclerosis across Europe. Mult Scler J Exp Transl Clin 2022; 8:20552173221090653. [PMID: 35496757 PMCID: PMC9052831 DOI: 10.1177/20552173221090653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background People with Multiple Sclerosis (PwMS) suffer from an increased risk of
unemployment during the course of the disease. In recent years progress has
been made in increasing the time until patients have to leave the workforce
permanently. Such a retirement is often associated with MS but the driving
factors including disability progression, support measures at the workplace,
and societal aspects are not yet fully understood. Methods We consolidated data from four European MS databases from Germany, Poland,
Sweden, and the United Kingdom, which were able to provide data on working
status, disability progression and quality of life in accordance with the
data harmonization framework of the EUReMS (European Registry in Multiple
Sclerosis) project. Results Factors strongly associated with unemployment are disability progression, low
quality of life and being close to the statutory retirement age. Overall,
highest employment rate (77%) and lowest effects of gender and disease
duration were found in Sweden. Conclusions We found remarkable differences between the European registers and the
countries studied, which may indicate inequalities at European level.
Furthermore, our findings suggest that it is feasible and useful to combine
data from different MS registers in Europe, albeit the data structures are
heterogeneous.
Collapse
Affiliation(s)
| | - Tina Parciak
- University Medical Center, Georg-August-Universität Göttingen, Germany
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland Kielce, Poland
| | | | | | - Alexander Stahmann
- German MS Register, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | | | | |
Collapse
|
8
|
Creating a Real-World Data, United States Healthcare Claims-Based Adaptation of Kurtzke Functional Systems Scores for Assessing Multiple Sclerosis Severity and Progression. Adv Ther 2021; 38:4786-4797. [PMID: 34333756 PMCID: PMC8408077 DOI: 10.1007/s12325-021-01858-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Introduction This article describes the development of a unique mapping of the Kurtzke Functional Systems Scores (KFSS) from International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes among multiple sclerosis (MS) patients within a US Integrated Delivery Network (IDN). Valid identification of increasing disability may allow deeper insight into MS progression and possible treatments. Methods This cohort study identified MS patients in the IDN, Intermountain Healthcare. Experienced clinicians and informaticists mapped electronic health record ICD-9-CM codes to KFSS components generating a modified Kurtzke Expanded Disability Status Scale (EDSS). Modified EDSS scores were used to assess disability progression by calculating means, medians, ranges, and changes in KFSS and modified EDSS scores. Results Overall, 608/2960 (20.5%) patients were identified as having MS progression and presented a wide range of scores on the EDSS 10-point scale. The median (range) first and second EDSS scores were 0 (0–6) and 5 (1–8), respectively. The median (range) change from first to second score was 5 (1–7.5). The median first KFSS score for all systems was 0, and the mean differed among components. The highest mean first KFSS score (1.06) was measured for sensory function and lowest (0.12) for cerebellar functions. Of the 544 patients with their first EDSS scores in the ≤ 2.5 group, 75.2% and 15.1% had their second EDSS scores in group 3–5.5 and ≥ 6, respectively. Of the 62 patients with their first EDSS score in the 3–5.5 group, 58.1% had their second EDSS scores in group ≥ 6. Conclusion This innovative mapping technique is a promising method for future comparative effectiveness and safety research of Disease-Modifying Therapy in Real-World Data repositories. Future research to validate and expand on this method in another healthcare database is encouraged. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01858-9.
Collapse
|
9
|
Alonso RN, Eizaguirre MB, Cohen L, Quarracino C, Silva B, Pita MC, Yastremiz C, Vanotti S, Garcea O. Upper Limb Dexterity in Patients with Multiple Sclerosis: An Important and Underrated Morbidity. Int J MS Care 2020; 23:79-84. [PMID: 33880084 DOI: 10.7224/1537-2073.2019-083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Scales to assess disability in multiple sclerosis (MS) rarely provide reliable data on actual global impairment. Upper limb dysfunction is usually overlooked, which has a negative effect on patient well-being. We sought to analyze associations among upper limb dexterity, lower limb speed, and Expanded Disability Status Scale (EDSS) score; the difference in upper limb dexterity between patients with EDSS scores less than 5 and 5 or greater; and the associations that upper limb dexterity, lower limb speed, and EDSS score have with health-related quality of life measurements and depression. Methods A total of 140 adults with MS were evaluated using the Nine-Hole Peg Test, Timed 25-Foot Walk test, EDSS, Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire, and Beck Depression Inventory. Thorough descriptive-analytical research was conducted using the Spearman correlation, multiple linear regression, and structural equation modeling. Results Upper limb dexterity was more closely related to EDSS score than lower limb speed (r = 0.43 vs 0.29, R 2 = 0.38) and was greatest in patients with EDSS scores less than 5 (P < .01). Moreover, upper limb dexterity was negatively associated with EDSS score and the MusiQoL questionnaire (rS = -0.557 to -0.321, P < .05). The correlation that depression has with upper limb dexterity loss was higher than the one it has with lower limb speed (0.098 vs 0.066, t > 1.96). Conclusions Upper limb dexterity is associated with global disability, depression, and health-related quality of life. We advocate for the assessment of upper limb dexterity in patients with MS to adopt a better approach to their functional impairment.
Collapse
|
10
|
Alonso RN, Eizaguirre MB, Silva B, Pita MC, Yastremiz C, Vanotti S, Cáceres F, Garcea O. Brain Function Assessment of Patients with Multiple Sclerosis in the Expanded Disability Status Scale: A Proposal for Modification. Int J MS Care 2020; 22:31-35. [PMID: 32123526 DOI: 10.7224/1537-2073.2018-084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background There is no consensus regarding assessment of the brain function functional system (FS) of the Expanded Disability Status Scale (EDSS) in patients with multiple sclerosis (MS). We sought to describe brain function FS assessment criteria used by Argentinian neurologists and, based on the results, propose redefined brain function FS criteria. Methods A structured survey was conducted of 113 Argentinian neurologists. Considering the survey results, we decided to redefine the brain function FS scoring using the Brief International Cognitive Assessment for MS (BICAMS) battery. For 120 adult patients with MS we calculated the EDSS score without brain function FS (basal EDSS) and compared it with the EDSS score after adding the modified brain function FS (modified EDSS). Results Of the 93 neurologists analyzed, 14% reported that they did not assess brain function FS, 35% reported that they assessed it through a nonstructured interview, and the remainder used other tools. Significant differences were found in EDSS scores before and after the inclusion of BICAMS (P < .001). Redefining the brain function FS, 15% of patients modified their basal EDSS score, as did 20% of those with a score of 4.0 or less. Conclusions The survey results show the importance of unifying the brain function FS scoring criteria in calculating the EDSS score. While allowing more consistent brain function FS scoring, including the modified brain function FS led to a change in EDSS score in many patients, particularly in the lower range of EDSS scores. Considering the relevance of the EDSS for monitoring patients with MS and for decision making, it is imperative to further validate the modified brain function FS scoring.
Collapse
|
11
|
Clinical instrument to retrospectively capture levels of EDSS. Mult Scler Relat Disord 2019; 39:101884. [PMID: 31865272 DOI: 10.1016/j.msard.2019.101884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Expanded Disability Status Scale (EDSS), a common outcome measure in Multiple Sclerosis (MS), is obtained prospectively through a direct standardized evaluation. The objective of this study is to develop and validate an algorithm to derive EDSS scores from previous neurological clinical documentation. METHODS The algorithm utilizes data from the history, review of systems, and physical exam. EDSS scores formally obtained from research patients were compared to captured EDSS (c-EDSS) scores. To test inter-rater reliability, a second investigator captured scores from a subset of patients. Agreement between formal and c-EDSS scores was assessed using a weighted kappa. Clinical concordance was defined as a difference of one-step in EDSS (0.5) and functional system (1.0) scores. RESULTS Clinical documentation from 92 patients (EDSS range 0.0-8.5) was assessed. Substantial agreement between the c-EDSS and formal EDSS (kappa 0.80; 95% CI 0.74-0.86) was observed. The mean difference between scores was 0.16. The clinical concordance was 78%. Near-perfect agreement was found between the two raters (kappa 0.89; 95% CI 0.84-0.95). The mean inter-rater difference in c-EDSS was 0.23. CONCLUSIONS This algorithm reliably captures EDSS scores retrospectively with substantial correlation with formal EDSS and high inter-rater agreement. This algorithm may have practical implications in clinic, MS research and clinical trials.
Collapse
|
12
|
Decavel P, Sagawa Y. Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation. Neurophysiol Clin 2019; 49:165-171. [DOI: 10.1016/j.neucli.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023] Open
|
13
|
Xu L, Zhang C, Jiang N, He D, Bai Y, Xin Y. Rapamycin combined with MCC950 to treat multiple sclerosis in experimental autoimmune encephalomyelitis. J Cell Biochem 2018; 120:5160-5168. [PMID: 30320900 DOI: 10.1002/jcb.27792] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Ling Xu
- Department of Biotechnology Dalian Medical University Dalian China
- Department of Clinical Laboratory Xinhua Hospital Affiliated to Dalian University Dalian China
| | - Cuili Zhang
- Department of Biotechnology Dalian Medical University Dalian China
| | - Nan Jiang
- Department of Pathology The First Affiliated Hospital of Dalian Medical University Dalian China
| | - Dan He
- Department of Cardiology The Second Affiliated Hospital of Dalian Medical University Dalian China
| | - Ying Bai
- Department of Clinical Laboratory Xinhua Hospital Affiliated to Dalian University Dalian China
| | - Yi Xin
- Department of Biotechnology Dalian Medical University Dalian China
| |
Collapse
|
14
|
Do evoked potentials contribute to the functional follow-up and clinical prognosis of multiple sclerosis? Acta Neurol Belg 2017; 117:53-59. [PMID: 27194163 DOI: 10.1007/s13760-016-0650-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
The clinical variability and complexity of multiple sclerosis (MS) challenges the individual clinical course prognostication. This study aimed to find out whether multimodal evoked potentials (EP) correlate with the motor components of multiple sclerosis functional composite (MSFCm) and predict clinically relevant motor functional deterioration. One hundred MS patients were assessed at baseline (T 0) and about 7.5 years later (T 1), with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) and the MSFCm, including the 9 Hole Peg Test and the Timed 25 Foot Walk (T25FW). The Spearman correlation coefficient (r S) was used to evaluate the cross-sectional and longitudinal relationship between EP Z scores and clinical findings. The predictive value of baseline electrophysiological data for clinical worsening (EDSS, 9-HPT, T25FW, MSFCm) during follow-up was assessed by logistic regression analysis. Unlike longitudinal correlations, cross-sectional correlations between EP Z scores and clinical outcomes were all significant and ranged between 0.22 and 0.67 (p < 0.05). The global EP Z score was systematically predictive of EDSS and MSFCm worsening over time (all p < 0.05). EP latency was a better predictor than amplitude, although weaker than latency and amplitude aggregation in the global EP Z score. The study demonstrates that EP numerical scores can be used for motor function monitoring and outcome prediction in patients with MS.
Collapse
|
15
|
Tanigawa M, Stein J, Park J, Kosa P, Cortese I, Bielekova B. Finger and foot tapping as alternative outcomes of upper and lower extremity function in multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 3:2055217316688930. [PMID: 28680701 PMCID: PMC5480634 DOI: 10.1177/2055217316688930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background While magnetic resonance imaging contrast-enhancing lesions represent an excellent screening tool for disease-modifying treatments in relapsing–remitting multiple sclerosis (RRMS), this biomarker is insensitive for testing therapies against compartmentalized inflammation in progressive multiple sclerosis (MS). Therefore, alternative sensitive outcomes are needed. Using machine learning, clinician-acquired disability scales can be combined with timed measures of neurological functions such as walking speed (e.g. 25-foot walk; 25FW) or fine finger movements (e.g. 9-hole peg test; 9HPT) into sensitive composite clinical scales, such as the recently developed combinatorial, weight-adjusted disability scale (CombiWISE). Ideally, these complementary simplified measurements of certain neurological functions could be performed regularly at patients’ homes using smartphones. Objectives We asked whether tests amenable to adaptation to smartphone technology, such as finger and foot tapping have comparable sensitivity and specificity to current non-clinician-acquired disability measures. Results We observed that finger and foot tapping can differentiate RRMS and progressive MS in a cross-sectional study and can also measure yearly and two-year disease progression in the latter, with better power (based on z-scores) in comparison to currently utilized 9HPT and 25FW. Conclusions Replacing the 9HPT and 25FW with simplified tests broadly adaptable to smartphone technology may enhance the power of composite scales for progressive MS.
Collapse
Affiliation(s)
- Makoto Tanigawa
- Neuroimmunological Diseases Unit (NDU), National Institute of Neurological Disorders and Stroke (NINDS), USA
| | - Jason Stein
- Neuroimmunological Diseases Unit (NDU), National Institute of Neurological Disorders and Stroke (NINDS), USA
| | - John Park
- Neuroimmunological Diseases Unit (NDU), National Institute of Neurological Disorders and Stroke (NINDS), USA
| | - Peter Kosa
- Neuroimmunological Diseases Unit (NDU), National Institute of Neurological Disorders and Stroke (NINDS), USA
| | | | - Bibiana Bielekova
- Neuroimmunological Diseases Unit (NDU), National Institute of Neurological Disorders and Stroke (NINDS), USA
| |
Collapse
|
16
|
Herold S, Kumar P, Jung K, Graf I, Menkhoff H, Schulz X, Bähr M, Hein K. CatWalk gait analysis in a rat model of multiple sclerosis. BMC Neurosci 2016; 17:78. [PMID: 27903258 PMCID: PMC5131412 DOI: 10.1186/s12868-016-0317-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background
Myelin oligodendrocyte glycoprotein (MOG)-induced experimental autoimmune encephalomyelitis (EAE) is a widely used animal model for multiple sclerosis. The characteristic feature of the MOG-EAE model in Brown Norway rats is consistent involvement of the spinal cord resulting in limb paresis. The aim of the study was to investigate whether early subclinical gait abnormalities are present in this animal model and can be detected by CatWalk XT, a fully automated gait analysis system. Furthermore, we investigated the usability of CatWalk system for treatment studies. Results Our gait analysis showed no preclinical abnormalities in MOG-EAE animals. Nevertheless, we characterized a combination of gait parameters that display a high predictive capacity in regard to disease onset. Our detailed histopathological analysis of the spinal cord revealed that lesion formation starts in the lumbar region and propagates toward the cervical part of the spinal cord during the disease course. In the treatment study, the stabilization of gait parameters under the treatment with methylprednisolone was detected in CatWalk as well as in traditional EAE-scoring system. Conclusions The results from CatWalk test indicate no benefit of lab-intensive automated gait system in EAE-model with chronic-progressive disease course as well as in therapeutic studies with pronounced effect on the severity of clinical symptoms. However, due to its quantitative and objective nature this system may display a refined test to detect small but functional relevant changes in regeneration-orientated studies.
Collapse
Affiliation(s)
- Sabine Herold
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Prateek Kumar
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Klaus Jung
- Department of Medical Biometry and Statistical Bioinformatics, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany.,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Irina Graf
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Henrike Menkhoff
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Xenia Schulz
- Department of Medical Biometry and Statistical Bioinformatics, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany
| | - Katharina Hein
- Department of Neurology, University Medicine Göttingen, Robert-Koch Straße 40, 37073, Göttingen, Germany. .,Department of Neurology, University Hospital, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| |
Collapse
|
17
|
Novakovic AM, Krekels EHJ, Munafo A, Ueckert S, Karlsson MO. Application of Item Response Theory to Modeling of Expanded Disability Status Scale in Multiple Sclerosis. AAPS JOURNAL 2016; 19:172-179. [PMID: 27634384 DOI: 10.1208/s12248-016-9977-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
In this study, we report the development of the first item response theory (IRT) model within a pharmacometrics framework to characterize the disease progression in multiple sclerosis (MS), as measured by Expanded Disability Status Score (EDSS). Data were collected quarterly from a 96-week phase III clinical study by a blinder rater, involving 104,206 item-level observations from 1319 patients with relapsing-remitting MS (RRMS), treated with placebo or cladribine. Observed scores for each EDSS item were modeled describing the probability of a given score as a function of patients' (unobserved) disability using a logistic model. Longitudinal data from placebo arms were used to describe the disease progression over time, and the model was then extended to cladribine arms to characterize the drug effect. Sensitivity with respect to patient disability was calculated as Fisher information for each EDSS item, which were ranked according to the amount of information they contained. The IRT model was able to describe baseline and longitudinal EDSS data on item and total level. The final model suggested that cladribine treatment significantly slows disease-progression rate, with a 20% decrease in disease-progression rate compared to placebo, irrespective of exposure, and effects an additional exposure-dependent reduction in disability progression. Four out of eight items contained 80% of information for the given range of disabilities. This study has illustrated that IRT modeling is specifically suitable for accurate quantification of disease status and description and prediction of disease progression in phase 3 studies on RRMS, by integrating EDSS item-level data in a meaningful manner.
Collapse
Affiliation(s)
- A M Novakovic
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24, Uppsala, Sweden.
| | - E H J Krekels
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24, Uppsala, Sweden.,Division of Pharmacology, Leiden Academic Centre of Drug Research, Leiden University, Leiden, Netherlands
| | - A Munafo
- Merck Institute for Pharmacometrics, Merck Serono, Lausanne, Switzerland
| | - S Ueckert
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24, Uppsala, Sweden
| | - M O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24, Uppsala, Sweden
| |
Collapse
|
18
|
D'Souza M, Yaldizli Ö, John R, Vogt DR, Papadopoulou A, Lucassen E, Menegola M, Andelova M, Dahlke F, Schnyder F, Kappos L. Neurostatus e-Scoring improves consistency of Expanded Disability Status Scale assessments: A proof of concept study. Mult Scler 2016; 23:597-603. [PMID: 27364325 DOI: 10.1177/1352458516657439] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To improve the consistency of standardized Expanded Disability Status Scale (EDSS) assessments, an electronic data capture tool and analysis tool was developed, Neurostatus e-Scoring (NESC). This tool allows real-time feedback by comparing entries with established scoring rules. OBJECTIVE To test whether using NESC reduces inconsistencies as compared to the paper-and-pencil version of the Expanded Disability Status Scale (pEDSS). METHODS In all, 100 multiple sclerosis (MS) patients were assessed in random order on the same day by pairs of neurologists, one using pEDSS and one NESC. We compared inter-rater reliability and frequency of inconsistencies in Neurostatus subscores, functional system (FS) scores, ambulation and EDSS steps. RESULTS Inconsistencies of any type were more likely to occur when using pEDSS (mean odds ratio (95% confidence interval (CI)) = 2.93 (1.62; 5.29)). This was also the case for FS score inconsistencies (2.54 (1.40; 4.61)) and more likely for patients in the lower EDSS range (⩽3.5 vs >3.5) (5.32 (1.19; 23.77)). Overall, inter-rater agreement for the assessed Neurostatus subscores was high (median and inter-quartile range = 0.84 (0.73, 0.81)). CONCLUSION Our data provide class II evidence that the use of NESC increases consistency of standardized EDSS assessments, and may thus have the potential to decrease noise and increase power of MS clinical trials.
Collapse
Affiliation(s)
- Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | | | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Athina Papadopoulou
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth Lucassen
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Milena Menegola
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Michaela Andelova
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
19
|
Nicholl L, Hobart J, Dunwoody L, Cramp F, Lowe-Strong A. Measuring disability in multiple sclerosis: is the Community Dependency Index an improvement on the Barthel Index? Mult Scler 2016; 10:447-50. [PMID: 15327044 DOI: 10.1191/1352458504ms1056oa] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Community Dependency Index (CDI) was developed due to concerns that the Barthel Index (BI) was limited as a measure of physical function in community settings. However, no studies have compared the two rating scales within multiple sclerosis (MS). The aim of this study was to determine whether, in a community-based sample of people with MS, the CDI is a better measure than the BI. BI and CDI data were collected from 90 people with MS. Four measurement properties were compared: scaling assumptions (item mean scores, corrected item-total correlations), acceptability (score distributions, floor/ceiling effects), reliability (Cronbach’s alpha) and validity (concurrent, discriminant, group differences, relative validity). Both scales satisfied recommended criteria for scaling assumptions (indicating it was legitimate to report a summed score) and internal consistency reliability (alpha-0.85). The scales were highly correlated (r- 0.96), indicating they measured the same construct. Both scales demonstrated good group differences validity, but the BI was marginally superior. Notable ceiling effects (BI-CDI) were demonstrated for both scales, particularly in those less disabled. This study sample had relatively minor levels of disability, with over 70% still being independently mobile. In this sample of people with MS, the measurement properties of the BI and CDI examined were very similar, suggesting the CDI does not appear to have achieved its goal of better measurement.
Collapse
Affiliation(s)
- L Nicholl
- School of Rehabilitation Sciences, University of Ulster at Jordanstown, Newtownabbey BT37 0QB, Northern Ireland, UK
| | | | | | | | | |
Collapse
|
20
|
Giffroy X, Maes N, Albert A, Maquet P, Crielaard JM, Dive D. Multimodal evoked potentials for functional quantification and prognosis in multiple sclerosis. BMC Neurol 2016; 16:83. [PMID: 27245221 PMCID: PMC4888661 DOI: 10.1186/s12883-016-0608-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional biomarkers able to identify multiple sclerosis (MS) patients at high risk of fast disability progression are lacking. The aim of this study was to evaluate the ability of multimodal (upper and lower limbs motor, visual, lower limbs somatosensory) evoked potentials (EP) to monitor disease course and identify patients exposed to unfavourable evolution. METHODS One hundred MS patients were assessed with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) at baseline (T0) and about 6 years later (T1). The Spearman correlation (rS) was used to evaluate the relationship between conventional EP scores and clinical findings. Multiple (logistic) regression analysis estimated the predictive value of baseline electrophysiological data for three clinical outcomes: EDSS, annual EDSS progression, and the risk of EDSS worsening. RESULTS In contrast to longitudinal correlations, cross-sectional correlations between the different EP scores and EDSS were all significant (0.33 ≤ rS < 0.67, p < 0.001). Baseline global EP score and EDSS were highly significant predictors (p < 0.0001) of EDSS progression 6 years later. The baseline global EP score was found to be an independent predictor of the EDSS annual progression rate (p < 0.001), and of the risk of disability progression over time (p < 0.005). Based on a ROC curve determination, we defined a Global EP Score cut off point (17/30) to identify patients at high risk of disability progression illustrated by a positive predictive value of 70%. CONCLUSION This study provides a proof of the concept that electrophysiology could be added to MRI and used as another complementary prognostic tool in MS patients.
Collapse
Affiliation(s)
- Xavier Giffroy
- Department of Neurology, University Hospital of Liege, Rue Grandfosse 31-33, 4130, Esneux, Belgium.
- Department of Physical Medicine and Rehabilitation, University Hospital of Liege, B35, 4000, Liege, Belgium.
| | - Nathalie Maes
- Department of Biostatistics and Medico-Economic Information, University Hospital (CHU, ULg) of Liege, B35, 4000, Liège, Belgium
| | - Adelin Albert
- Department of Biostatistics and Medico-Economic Information, University Hospital (CHU, ULg) of Liege, B35, 4000, Liège, Belgium
| | - Pierre Maquet
- Department of Neurology, University Hospital of Liege, Rue Grandfosse 31-33, 4130, Esneux, Belgium
| | - Jean-Michel Crielaard
- Department of Physical Medicine and Rehabilitation, University Hospital of Liege, B35, 4000, Liege, Belgium
| | - Dominique Dive
- Department of Neurology, University Hospital of Liege, Rue Grandfosse 31-33, 4130, Esneux, Belgium
| |
Collapse
|
21
|
Komori M, Lin YC, Cortese I, Blake A, Ohayon J, Cherup J, Maric D, Kosa P, Wu T, Bielekova B. Insufficient disease inhibition by intrathecal rituximab in progressive multiple sclerosis. Ann Clin Transl Neurol 2016; 3:166-79. [PMID: 27042677 PMCID: PMC4774261 DOI: 10.1002/acn3.293] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/12/2022] Open
Abstract
Objective Inaccessibility of the inflammation compartmentalized to the central nervous system (CNS) may underlie the lack of efficacy of immunomodulatory treatments in progressive multiple sclerosis (MS). The double blind combination of Rituximab by IntraVenous and IntraThecAl injection versus placebo in patients with Low‐Inflammatory SEcondary progressive MS (RIVITALISE; NCT01212094) trial was designed to answer: (1) Whether an induction dose of intravenous and intrathecal rituximab efficiently depletes CNS B cells? and (2) If so, whether this leads to global inhibition of CNS inflammation and slowing of CNS tissue destruction? Methods Patients aged 18–65 years were randomly assigned to rituximab or placebo. Protocol‐stipulated interim analysis quantified the efficacy of B‐cell depletion. Results The efficacy on cerebrospinal fluid (CSF) biomarkers failed to reach criteria for continuation of the trial. B‐cell‐related CSF biomarkers (sCD21 and B‐cell activating factor) changed only in the active‐treatment arm. While CSF B cells were killed robustly (median −79.71%, P = 0.0176), B cells in CNS tissue were depleted inadequately (~−10–20%, P < 0.0001). Consequently, the T‐cell‐specific CSF biomarker sCD27 decreased slightly (−10.97%, P = 0.0005), while axonal damage marker, neurofilament light chain did not change. Insufficient saturation of CD20, lack of lytic complement, and paucity of cytotoxic CD56dimNK cells contribute to decreased efficacy of rituximab in the CNS. Interpretation Biomarker studies reliably quantified complementary pharmacodynamic effects of rituximab in the CNS, exposed causes for poor efficacy and determined that RIVITALISE trial would be underpowered to measure efficacy on clinical outcomes. Identified mechanisms for poor efficacy are applicable to all CNS‐inflammation targeting monoclonal antibodies.
Collapse
Affiliation(s)
- Mika Komori
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland
| | - Yen Chih Lin
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland
| | | | - Andrew Blake
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland
| | - Joan Ohayon
- Neuroimmunology Clinic NINDS Bethesda Maryland
| | - Jamie Cherup
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland
| | - Dragan Maric
- Flow Cytometry Core Facility NINDS Bethesda Maryland
| | - Peter Kosa
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland
| | - Tianxia Wu
- Clinical Neuroscience Program NINDS Bethesda Maryland
| | - Bibiana Bielekova
- Neuroimmunological Diseases Unit National Institute of Neurological Disorders and Stroke (NINDS) Bethesda Maryland; NIH Center for Human Immunology (CHI)the National Institutes of Health (NIH) Bethesda Maryland
| |
Collapse
|
22
|
Effect of neurofeedback training on depression and fatigue in patients with multiple sclerosis. Appl Psychophysiol Biofeedback 2016; 40:1-8. [PMID: 25362584 DOI: 10.1007/s10484-014-9267-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Depression and fatigue are common symptoms of multiple sclerosis (MS) and are the primary determinants of impaired quality of life in this demyelinating neurological disease. Untreated depression is associated with suicidal ideation, impaired cognitive function and poor adherence to immunomodulatory treatment. For these reasons, systematic screening and management of depressive symptoms and fatigue is recommended for all patients with MS. The objective of this study was to evaluate the effectiveness of neurofeedback in treating depression and fatigue in persons with MS. We conducted a randomized trial with 24 MS patients with primary fatigue and depression. Participants were randomized into two groups: neurofeedback training group (16 sessions of NFB) or treatment as usual. Participants were evaluated at 3 time points (baseline, end of the treatment, and 2-month follow-up) using the Fatigue Severity Scale and Depression subscale of the Hospital Anxiety and Depression Scale as outcome measures. A repeated measures analysis of variance was used to examine differences between the groups. NFB significantly reduced symptoms of depression and fatigue in patients with MS patients, compared to treatment as usual (p < .05), and these effects were maintained the 2-month follow-up (p < .05).
Collapse
|
23
|
Xu L, He D, Bai Y. Microglia-Mediated Inflammation and Neurodegenerative Disease. Mol Neurobiol 2015; 53:6709-6715. [PMID: 26659872 DOI: 10.1007/s12035-015-9593-4] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023]
Abstract
Microglia are the main effectors in the inflammatory process of the central nervous system. As the first line of defense, microglia play an important role in the inflammatory reaction. When there is pathogen invasion or cell debris, microglia will be activated rapidly and remove it, while releasing the inflammatory cytokines to mediate inflammatory reaction. Activated microglia were found surrounding lesions of various neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, muscular amyotrophic lateral sclerosis, and multiple sclerosis. Microglia, the effectors of neuronal degeneration and necrosis, are involved in the removal of necrotic neurons. But over activated microglia may accelerate the process of some neurodegenerative diseases. Activated microglia can release cytotoxic factor and cytokines. Some of them may cause further damage to neuron, and some of them can regulate inflammatory cells to gather to the lesion. Microglia-mediated inflammation was considered to be the possible mechanism for the occurrence or deterioration of neurodegenerative diseases. Therefore, inhibiting the activity of microglia appropriately may be an effective way for the treatment of neurodegenerative diseases.
Collapse
Affiliation(s)
- Ling Xu
- The Department of Neurology, Xin Hua Hospital Affiliated Dalian University, Dalian University, Dalian, 116021, China
| | - Dan He
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116022, China
| | - Ying Bai
- The Department of Neurology, Xin Hua Hospital Affiliated Dalian University, Dalian University, Dalian, 116021, China.
| |
Collapse
|
24
|
Cao H, Peyrodie L, Agnani O, Cavillon F, Hautecoeur P, Donzé C. Evaluation of an Expanded Disability Status Scale (EDSS) modeling strategy in multiple sclerosis. Med Biol Eng Comput 2015; 53:1141-51. [PMID: 26345244 DOI: 10.1007/s11517-015-1383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 08/24/2015] [Indexed: 11/27/2022]
Abstract
The Expanded Disability Status Scale (EDSS) is the most widely used scale to evaluate the degree of neurological impairment in multiple sclerosis (MS). In this paper, we report on the evaluation of an EDSS modeling strategy based on recurrence quantification analysis (RQA) of posturographic data (i.e., center of pressure, COP). A total of 133 volunteers with EDSS ranging from 0 to 4.5 participated in this study, with eyes closed. After selection of time delay (τ), embedding dimension (m) as well as threshold (radius, r) to identify recurrent points, several RQA measures were calculated for each COP's position and velocity data in the mono- and multi-dimensional RQAs. Estimation results lead to the selection of the recurrence rate (RR) of the COP's position as the most pertinent RQA measure. The performance of the models versus raw and noisy data was higher in the mono-dimensional analysis than in the multi-dimensional. This study suggests that the posturographic signal's mono-dimensional RQA is a more pertinent method to quantify disability in MS than the multi-dimensional RQA.
Collapse
Affiliation(s)
- Hua Cao
- Department of Energy, Electricity and Automatic, HEI, 13 rue de Toul, 59046, Lille, France. .,Biomedical Signal Processing Unit, Catholic University of Lille, Lille, France.
| | - Laurent Peyrodie
- Department of Energy, Electricity and Automatic, HEI, 13 rue de Toul, 59046, Lille, France.,Biomedical Signal Processing Unit, Catholic University of Lille, Lille, France
| | - Olivier Agnani
- Biomedical Signal Processing Unit, Catholic University of Lille, Lille, France.,Department of Physical Medicine and Rehabilitation, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lille, France
| | - Fabrice Cavillon
- Biomedical Signal Processing Unit, Catholic University of Lille, Lille, France.,Faculté de Médecine et de Maïeutique, Lille, France
| | - Patrick Hautecoeur
- Faculté de Médecine et de Maïeutique, Lille, France.,Department of Neurology, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lille, France
| | - Cécile Donzé
- Department of Physical Medicine and Rehabilitation, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Lille, France
| |
Collapse
|
25
|
Importance of an individual's evaluation of functional status for health-related quality of life in patients with multiple sclerosis. Disabil Health J 2015; 8:372-9. [DOI: 10.1016/j.dhjo.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 01/05/2015] [Accepted: 02/13/2015] [Indexed: 11/23/2022]
|
26
|
|
27
|
Guerra E, di Cagno A, Mancini P, Sperandii F, Quaranta F, Ciminelli E, Fagnani F, Giombini A, Pigozzi F. Physical fitness assessment in multiple sclerosis patients: a controlled study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2527-2533. [PMID: 25000308 DOI: 10.1016/j.ridd.2014.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale(,) test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F1.19=9.420; p<0.01), Berg (F1.19=13.125; p<0.01), handgrip MIVC (F1.19=4.567; p<0.05), lower limbs MIVC (F1.19=7.429; p<0.01), and 6MWT (F1.19=28.061; p<0.01) between groups. EDSS, Berg test and Borg scores explained 80% of 6MWT variation. Mild grade EDSS patients exhibited impaired balance, muscle strength, and low self pace-6MWT scores, whereas RPE response after the exercise was similar to that of sedentary individuals. Both groups showed similar global physiological adjustments to exercise.
Collapse
Affiliation(s)
- E Guerra
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - A di Cagno
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - P Mancini
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - F Sperandii
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - F Quaranta
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - E Ciminelli
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - F Fagnani
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| | - A Giombini
- Department of Medicine and Health Sciences, University of Molise, V. De Sanctis, Campobasso, Italy.
| | - F Pigozzi
- Department of Health, Movement and Human Sciences University of Rome "Foro Italico", Piazza Lauro de Bosis 15, Rome, Italy.
| |
Collapse
|
28
|
Beier M, D'Orio V, Spat J, Shuman M, Foley FW. Alcohol and substance use in multiple sclerosis. J Neurol Sci 2013; 338:122-7. [PMID: 24411661 DOI: 10.1016/j.jns.2013.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have examined the prevalence of alcohol and drug use in individuals with multiple sclerosis (MS). The current study sought to examine the prevalence and associated demographic, disease-related, and psychological correlates of substance use in an East Coast United States outpatient MS sample. METHODS 157 individuals with MS completed questionnaires prior to, during or after their visit with an MS neurologist. These questionnaires included: the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), CAGE, CAGE-Adapted to Include Drugs (CAGE-AID), Patient Health Questionnaire-9 item (PHQ-9), Beck Depression Inventory-Second Edition (BDI-II) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). RESULTS On the AUDIT-C, 40% of individuals with MS met or exceeded the cutoff for excessive alcohol use. They were more highly educated and younger than non-drinkers. Utilizing the CAGE, 6% of the sample met criteria for a lifetime history of excessive alcohol use and men endorsed higher rates of alcohol use than women. Only a small portion of the sample endorsed a history of drug use (CAGE-AID, 4%). Drug use was associated with greater disability and depression symptoms, but lower self-reported anxiety. CONCLUSIONS Current alcohol use was prevalent in this sample, and excessive use was associated with men, younger age, and more education. Reported drug use was minimal and associated with greater disability, more self-reported depression, but fewer anxiety symptoms.
Collapse
Affiliation(s)
- Meghan Beier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 359612, 325 9th Ave., Seattle, WA 98104, United States.
| | - Vanessa D'Orio
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Jessica Spat
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Melissa Shuman
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| |
Collapse
|
29
|
Lange AP, Zhu F, Sayao AL, Sadjadi R, Alkabie S, Traboulsee AL, Costello F, Tremlett H. Retinal nerve fiber layer thickness in benign multiple sclerosis. Mult Scler 2013; 19:1275-81. [DOI: 10.1177/1352458512474706] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/objective:Retinal nerve fiber layer (RNFL) thickness has been linked to brain atrophy in multiple sclerosis (MS). However, little is known about retinal atrophy in ‘benign’ MS. We compared RNFL thickness in benign MS with healthy controls.Methods:Patients with benign MS (Expanded Disability Status Scale (EDSS) ≤ 3; ≥15 years’ disease duration), identified through the British Columbia MS database, along with age-matched healthy controls, were recruited. RNFL thickness was measured using spectral-domain optical coherence tomography. Analysis of variance (ANOVA) was used to compare groups. The association between RNFL thickness and MS patient characteristics was examined via linear mixed-effects models (adjusting for within-patient inter-eye correlations and history of optic neuritis (ON), where appropriate).Results:Overall, 29 benign MS patients and 29 healthy controls were included, totaling 116 eyes. RNFL thickness was lowest for the benign MS eyes, with and then without a history of ON, followed by healthy controls (mean=73.2 µm, SD ± 0.4; 89.9 µm, SD ± 12.5; 96.7 µm, SD ± 10.4; p<0.02). RNFL thickness was associated with a history of ON ( p<0.0001), but not EDSS or disease duration ( p>0.1).Conclusions:RNFL thickness was lower in patients with benign MS than healthy controls, regardless of the previous history of ON. However, no association was found between RNFL values and disability or MS disease duration.
Collapse
Affiliation(s)
- Alex P Lange
- Neuro-Ophthalmology, Department of Ophthalmology, University of British Columbia, Canada
- Vista Klinik, Vista Diagnostics and Laser Vista, Switzerland
| | - Feng Zhu
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| | - Ana-Luiza Sayao
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| | - Reza Sadjadi
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| | - Samir Alkabie
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| | - Anthony L Traboulsee
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery (Ophthalmology), University of Calgary, Canada
| | - Helen Tremlett
- Faculty and Department of Medicine, Division of Neurology, University of British Columbia, Canada
| |
Collapse
|
30
|
Cao H, Peyrodie L, Boudet S, Cavillon F, Agnani O, Hautecoeur P, Donzé C. Expanded Disability Status Scale (EDSS) estimation in multiple sclerosis from posturographic data. Gait Posture 2013; 37:242-5. [PMID: 22885161 DOI: 10.1016/j.gaitpost.2012.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 06/22/2012] [Accepted: 07/14/2012] [Indexed: 02/02/2023]
Abstract
Expanded Disability Status Scale (EDSS) is the most widely used clinical scale to evaluate levels of multiple sclerosis (MS). As MS can lead to disruptions in the regulation of balance and the disability can be evaluated by force platform posturography, we have developed in this study a new strategy to estimate EDSS from posturographic data. 118 volunteers with EDSS ranging from 0 to 4.5 participated in this study, with eyes closed. By using second-order polynomial regression models, EDSS was estimated from two postural sway parameters, respectively, the length and the surface and four recurrence quantification analysis (RQA) parameters: percentage of recurrence (%Rec), Shannon entropy (Ent), mean diagonal line length (LL) and trapping time (TT). In addition, all four RQA parameters were calculated for position, instantaneous velocity and acceleration of the center of pressure. In order to select the most accurate method for estimating EDSS, four statistical indices (percentage of agreement, underestimation and overestimation, as well as Mean error) were calculated comparing clinical and estimated EDSS scores. The results demonstrate that estimations of EDSS from surface, %Rec and LL of position, best agreed with clinical scores. This study emphasizes the possibility of distinguishing EDSS scores using postural sway and RQA parameters.
Collapse
Affiliation(s)
- Hua Cao
- Université Nord de France, F-59000 Lille, France.
| | | | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Senda J, Watanabe H, Tsuboi T, Hara K, Watanabe H, Nakamura R, Ito M, Atsuta N, Tanaka F, Naganawa S, Sobue G. MRI mean diffusivity detects widespread brain degeneration in multiple sclerosis. J Neurol Sci 2012; 319:105-10. [DOI: 10.1016/j.jns.2012.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 04/18/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
|
33
|
Hirst CL, Ingram G, Pickersgill TP, Robertson NP. Temporal evolution of remission following multiple sclerosis relapse and predictors of outcome. Mult Scler 2012; 18:1152-8. [DOI: 10.1177/1352458511433919] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Relapse is a characteristic clinical feature of multiple sclerosis (MS) and is commonly employed as a measure of efficacy following therapeutic intervention. However, less is known about the temporal evolution of subsequent disability or factors predicting recovery. Objectives: The objective of this study was to assess the pattern of recovery following relapse and identify factors which predict recovery and residual disability following relapse. Methods: A total of 226 relapses were studied prospectively in a cohort of 144 patients with standardised clinical assessments of physical disability including Expanded Disability Status Scale (EDSS), 10-m timed walk, 9-hole peg test and Multiple Sclerosis Impact Scale (MSIS-29) at 0, 2, 6 and 12 months. A total of 82 patients completed 12 months of follow up without further relapse. Results: Thirty per cent of relapses were severe (change in EDSS >2.0) of which 11% failed to recover. All measures showed significant improvement at 2 months but additional improvement was also observed in 9-hole peg test and MSIS-29 up to 12 months following initial assessment. Mean time to second relapse was 382 days. The only predictor of relapse severity in the model tested was younger age; however, increasing age and initial relapse severity were also predictors of poor outcome. Conclusions: This study shows that the majority of improvement in physical disability following relapse occurs by 2 months but that more subtle recovery can take place over 12 months in a small sub-group of patients. These data will aid in patient counselling and will also inform the timing of therapeutic intervention and physical support.
Collapse
Affiliation(s)
- Claire L Hirst
- Department of Neurology, Morriston Hospital, Heol Maes Egwyls, Morriston, Swansea, UK
| | - Gillian Ingram
- Helen Durham Neuro-inflammatory Centre, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Trevor P Pickersgill
- Helen Durham Neuro-inflammatory Centre, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Neil P Robertson
- Helen Durham Neuro-inflammatory Centre, Department of Neurology, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
34
|
Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners. Eur J Integr Med 2011. [DOI: 10.1016/j.eujim.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
35
|
Bielekova B, Richert N, Herman ML, Ohayon J, Waldmann TA, McFarland H, Martin R, Blevins G. Intrathecal effects of daclizumab treatment of multiple sclerosis. Neurology 2011; 77:1877-86. [PMID: 22076546 DOI: 10.1212/wnl.0b013e318239f7ef] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We previously reported that daclizumab, a humanized monoclonal antibody against CD25, reduced contrast-enhancing lesions (CEL) in patients with multiple sclerosis (MS) who were suboptimal responders to interferon-β and that this response correlated with expansion of CD56(bright) NK cells. These data have been reproduced in a placebo-controlled multicenter trial (CHOICE study). The current study investigates whether daclizumab monotherapy reduces CEL in untreated patients with relapsing-remitting MS (RRMS) and the effects of daclizumab on the intrathecal immune system. METHODS Sixteen patients with RRMS with high inflammatory activity were enrolled in an open-label, baseline-vs-treatment, phase II trial of daclizumab monotherapy for 54 weeks and followed by serial clinical and MRI examinations and immunologic biomarkers measured in the whole blood and CSF. RESULTS The trial achieved predefined outcomes. There was an 87.7% reduction in brain CEL (primary) and improvements in Multiple Sclerosis Functional Composite (secondary), Scripps Neurologic Rating Scale, and Expanded Disability Status Scale (tertiary) outcomes. There was significant expansion of CD56(bright) NK cells in peripheral blood and CSF, with resultant decrease in T cells/NK cells and B cells/NK cells ratios and IL-12p40 in the CSF. Surprisingly, CD25 Tac epitope was equally blocked on the immune cells in the CSF and in peripheral blood. CONCLUSIONS Daclizumab monotherapy inhibits formation of MS plaques in patients with RRMS and immunoregulatory NK cells may suppress activation of pathogenic immune responses directly in the CNS compartment. CLASSIFICATION OF EVIDENCE The study provides Class III evidence that daclizumab reduces the number of contrast-enhancing lesions in treatment-naive patients with RRMS over a 54-week period.
Collapse
Affiliation(s)
- B Bielekova
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Dunn J, Blight A. Dalfampridine: a brief review of its mechanism of action and efficacy as a treatment to improve walking in patients with multiple sclerosis. Curr Med Res Opin 2011; 27:1415-23. [PMID: 21595605 DOI: 10.1185/03007995.2011.583229] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) can cause progressive walking impairment that contributes to disability, loss of independence, and reduced quality of life. Dalfampridine (4-aminopyridine), a voltage-dependent potassium channel blocker, has been shown to improve walking in patients with MS, as demonstrated by an increase in walking speed. OBJECTIVE To summarize knowledge about the mechanism of action of dalfampridine in the context of clinical evidence of walking improvement in MS patients. METHODS Although this was not a systematic review, which is the primary limitation of this study, searches of PubMed were performed using relevant search terms to identify studies that examined the mechanism of action related to MS and its effects in patients with MS in clinical trials. RESULTS Voltage-gated potassium channels represent a family of related proteins that span cell membranes, open and close in response to changes in the transmembrane potential, and help regulate ionic potassium currents. Action potential conduction deficits in demyelinated axons result in part from the exposure after demyelination of the paranodal and internodal potassium channels that are distributed in the axonal membrane. This exposure leads to abnormal currents across the axonal membrane that can slow action potential conduction, result in conduction failure, or affect the axon's capacity for repetitive discharge. While dalfampridine is a broad-spectrum blocker of voltage-dependent potassium channels at millimolar concentrations, studies have shown improvement in action potential conduction in demyelinated axons at concentrations as low as 1 μM, and therapeutic plasma concentrations (associated with improved walking) are in the range of 0.25 µM. However, no specific potassium channel subtype has yet been characterized with significant sensitivity to dalfampridine in this range, and the effects of the drug at this low concentration appear to be quite selective. Improved conduction translates into clinical benefit as measured by objectively and subjectively assessed walking relative to placebo. Such improvements were observed in approximately one third of patients treated with an extended-release formulation of dalfampridine in clinical trials. These patients who responded to dalfampridine had an average increase in walking speed of approximately 25%, and greater improvements than nonresponders on a self-reported subjective measure of walking. CONCLUSIONS The extended-release formulation of dalfampridine has been shown in clinical trials to improve walking speed in approximately one third of MS patients with ambulatory impairment. The putative mechanism of action of dalfampridine is restoration of action potential conduction via blockade of an as yet uncharacterized subset of potassium channels in demyelinated axons.
Collapse
Affiliation(s)
- Jeffrey Dunn
- Stanford Multiple Sclerosis Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA 94305-5235, USA.
| | | |
Collapse
|
37
|
|
38
|
Bethoux F, Bennett S. Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice? Int J MS Care 2011; 13:4-14. [PMID: 24453700 PMCID: PMC3882949 DOI: 10.7224/1537-2073-13.1.4] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Walking limitations are among the most visible manifestations of multiple sclerosis (MS). Regular walking assessments should be a component of patient management and require instruments that are appropriate from the clinician's and the patient's perspectives. This article reviews frequently used instruments to assess walking in patients with MS, with emphasis on their validity, reliability, and practicality in the clinical setting. Relevant articles were identified based on PubMed searches using the following terms: "multiple sclerosis AND (walking OR gait OR mobility OR physical activity) AND (disability evaluation)"; references of relevant articles were also searched. Although many clinician- and patient-driven instruments are available, not all have been validated in MS, and some are not sensitive enough to detect small but clinically important changes. Choosing among these depends on what needs to be measured, psychometric properties, the clinical relevance of results, and practicality with respect to space, time, and patient burden. Of the instruments available, the clinician-observed Timed 25-Foot Walk and patient self-report 12-Item Multiple Sclerosis Walking Scale have properties that make them suitable for routine evaluation of walking performance. The Dynamic Gait Index and the Timed Up and Go test involve other aspects of mobility, including balance. Tests of endurance, such as the 2- or 6-Minute Walk, may provide information on motor fatigue not captured by other tests. Quantitative measurement of gait kinetics and kinematics, and recordings of mobility in the patient's environment via accelerometry or Global Positioning System odometry, are currently not routinely used in the clinical setting.
Collapse
Affiliation(s)
- Francois Bethoux
- >From the Mellen Center for Multiple Sclerosis Treatment and Research, The Cleveland Clinic Foundation, Cleveland, OH, USA (FB); and Department of Rehabilitation Science, University at Buffalo, State University of New York, Buffalo, NY, USA (SB)
| | - Susan Bennett
- >From the Mellen Center for Multiple Sclerosis Treatment and Research, The Cleveland Clinic Foundation, Cleveland, OH, USA (FB); and Department of Rehabilitation Science, University at Buffalo, State University of New York, Buffalo, NY, USA (SB)
| |
Collapse
|
39
|
van Winsen LML, Kragt JJ, Hoogervorst ELJ, Polman CH, Uitdehaag BMJ. Outcome measurement in multiple sclerosis: detection of clinically relevant improvement. Mult Scler 2010; 16:604-10. [DOI: 10.1177/1352458509359922] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because the development of new treatments in multiple sclerosis as well as the awareness of the importance of patient-oriented measures have become more important in the last two decades, new outcome measures have been developed with the aim of being more responsive to change and more clinically relevant to patients. The ability to detect improvement is sparsely studied. In the present study we evaluate the responsiveness of the Expanded Disability Status Scale and two quantitative tests (the timed 25-foot walk test and the nine-hole peg test) separately and in combination, to detect improvement after intravenous methylprednisolone. The Expanded Disability Status Scale, the timed 25-foot walk test and the nine-hole peg test were assessed in 112 multiple sclerosis patients before and 6 weeks after intravenous methylprednisolone. In addition patients were asked to rate their change as an anchor to evaluate the performance of the tests. Combining the timed 25-foot walk test and the nine-hole peg test turned out to be the optimal combination of measures to predict patient perceived improvement (positive predictive value of 67% and a negative predictive value of 59%, likelihood ratio of positive test 2.31 (95% confidence interval 1.08—4.95)). In the higher Expanded Disability Status Scale range (4.5 and higher), for all measures a significant change was more often perceived as clinically relevant than in the lower disability range. The Expanded Disability Status Scale seems not to be the preferred outcome of choice to detect patient perceived improvement in multiple sclerosis, especially in the lower Expanded Disability Status Scale range. Combining the timed walk test and the nine-hole peg test can improve the sensitivity to detect clinically relevant changes without conceding with respect to specificity.
Collapse
Affiliation(s)
- Lisa ML van Winsen
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands,
| | - Jolijn J Kragt
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Erwin LJ Hoogervorst
- Department of Neurology, St Antonius Ziekenhuis, Paranadreef 2, 3563 AZ Utrecht, The Netherlands
| | - Chris H Polman
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands, Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
40
|
Bielekova B, Richert N, Howard T, Packer AN, Blevins G, Ohayon J, McFarland HF, Stürzebecher CS, Martin R. Treatment with the phosphodiesterase type-4 inhibitor rolipram fails to inhibit blood--brain barrier disruption in multiple sclerosis. Mult Scler 2009; 15:1206-14. [PMID: 19776093 PMCID: PMC3085182 DOI: 10.1177/1352458509345903] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rolipram, a prototypic phosphodiesterase-4 inhibitor, is highly effective in suppressing Th1 autoimmunity in multiple animal models, including experimental autoimmune encephalomyelitis. In addition, rolipram has been extensively studied as a potential neuroprotective agent. Based on its anti-inflammatory activity, we tested the efficacy of rolipram in suppressing inflammatory disease activity in multiple sclerosis in a proof-of-principle phase I/II open-label clinical trial. Enrolled MS patients were evaluated by monthly MRI and clinical examinations during 3 months (four MRIs) of pretreatment baseline and 8 months of rolipram therapy. The primary outcome was a change in contrast-enhanced lesions between baseline and the last 4 months of rolipram therapy. Previously defined biomarkers of rolipram-mediated immunomodulation were evaluated during the study. The trial was stopped prematurely because the drug was poorly tolerated and because of safety concerns: we observed an increase, rather than decrease, in the brain inflammatory activity measured by contrast-enhanced lesions on brain MRI. At the administered doses rolipram was active in vivo as documented by immunological assays. We conclude that the reasons underlying the discrepancy between the therapeutic efficacy of rolipram in experimental autoimmune encephalomyelitis versus multiple sclerosis are at present not clear.
Collapse
Affiliation(s)
- Bibiana Bielekova
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Nancy Richert
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Thomas Howard
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Amy N. Packer
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Gregg Blevins
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
- Division of Neurology, University of Alberta, 9-101 CSB, Edmonton AB, T6G 2G3, Canada
| | - Joan Ohayon
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Henry F. McFarland
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
| | | | - Roland Martin
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
- Institute of Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology Hamburg, University Medical Center Eppendorf, Falkenried 94, 20251 Hamburg, Germany
| |
Collapse
|
41
|
Gaspari M, Saletti D, Scandellari C, Stecchi S. Refining an Automatic EDSS Scoring Expert System for Routine Clinical Use in Multiple Sclerosis. ACTA ACUST UNITED AC 2009; 13:501-11. [DOI: 10.1109/titb.2008.926498] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
42
|
Bielekova B, Howard T, Packer AN, Richert N, Blevins G, Ohayon J, Waldmann TA, McFarland HF, Martin R. Effect of anti-CD25 antibody daclizumab in the inhibition of inflammation and stabilization of disease progression in multiple sclerosis. ACTA ACUST UNITED AC 2009; 66:483-9. [PMID: 19364933 DOI: 10.1001/archneurol.2009.50] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Several questions arise concerning the use of the anti-CD25 antibody daclizumab to treat multiple sclerosis (MS). OBJECTIVES To answer the following 3 questions related to the efficacy of daclizumab therapy in patients with MS: Is the therapeutic effect of daclizumab dependent on combination with interferon beta? Is a higher dosage of daclizumab more efficacious in patients with persistent disease activity? Can biomarkers predict full vs partial therapeutic response to daclizumab? DESIGN An open-label baseline vs treatment phase II clinical trial of daclizumab in patients having MS with inadequate response to interferon beta. Three months of interferon beta treatment at baseline were followed by 5.5 months of interferon beta-daclizumab combination therapy. If patients experienced more than 75% reduction of contrast-enhancing lesions (CELs) on brain magnetic resonance imaging at month 5.5 compared with baseline, daclizumab was continued as monotherapy for 10 months. Otherwise, the dosage of daclizumab was doubled. SETTING Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland. PATIENTS Fifteen patients with MS receiving standard preparations of interferon beta who experienced more than 1 MS exacerbation or whose clinical disability increased in the preceding 12 months and who had at least 2 CELs on baseline brain magnetic resonance images. INTERVENTION Daclizumab (1 mg/kg) as an intravenous infusion every 4 weeks in combination with interferon beta (months 0-5.5) and as monotherapy (months 6.5-15.5). MAIN OUTCOME MEASURES The primary outcome was the reduction of CELs among interferon beta monotherapy, interferon beta-daclizumab combination therapy, and daclizumab monotherapy. The secondary outcomes included immunologic biomarkers and changes in clinical disability. RESULTS Overall, 5 of 15 patients (33%) experienced adverse effects of therapy. Two patients developed systemic adverse effects, and daclizumab therapy was discontinued. Although daclizumab monotherapy was efficacious in 9 of 13 patients with MS, interferon beta-daclizumab combination therapy was necessary to stabilize disease activity in the other 4 patients. Daclizumab therapy led to 72% inhibition of new CELs and significant improvement in clinical disability. Pilot biomarkers (increase in CD56bright natural killer cells and decrease in CD8+ T cells) were identified that can differentiate between full and partial daclizumab responders. CONCLUSIONS Daclizumab monotherapy is effective in most patients who experienced persistent MS disease activity with interferon beta therapy. Interferon beta-daclizumab combination therapy or higher dosages of daclizumab may be necessary to achieve optimal therapeutic response in all patients. Biomarkers may identify patients with suboptimal response to daclizumab monotherapy. Administration among a large patient sample during a longer period is needed to fully define the safety and long-term efficacy of daclizumab as treatment for high-inflammatory MS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00001934.
Collapse
Affiliation(s)
- Bibiana Bielekova
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bldg 10, Room 5C103, 10 Center Dr, MSC 1400, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Tedeschi G, Dinacci D, Comerci M, Lavorgna L, Savettieri G, Quattrone A, Livrea P, Patti F, Brescia Morra V, Servillo G, Orefice G, Paciello M, Prinster A, Coniglio G, Bonavita S, Di Costanzo A, Bellacosa A, Valentino P, Quarantelli M, Brunetti A, Salemi G, D’Amelio M, Simone I, Salvatore M, Bonavita V, Alfano B. Brain atrophy evolution and lesion load accrual in multiple sclerosis: a 2-year follow-up study. Mult Scler 2008; 15:204-11. [DOI: 10.1177/1352458508098270] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background To investigate in a large cohort of patients with multiple sclerosis (MS), lesion load and atrophy evolution, and the relationship between clinical and magnetic resonance imaging (MRI) correlates of disease progression. Methods Two hundred and sixty-seven patients with MS were studied at baseline and two years later using the same MRI protocol. Abnormal white matter fraction, normal appearing white matter fraction, global white matter fraction, gray matter fraction and whole brain fraction, T2-hyperintense, and T1-hypointense lesions were measured at both time points. Results The majority of patients were clinically stable, whereas MRI-derived brain tissue fractions were significantly different after 2 years. The correlation between MRI data at baseline and their variation during the follow-up showed that lower basal gray matter atrophy was significantly related with higher progression of gray matter atrophy during follow-up. The correlation between MRI parameters and disease duration showed that gray matter atrophy rate decreased with increasing disease duration, whereas the rate of white matter atrophy had a constant pattern. Lower basal gray matter atrophy was associated with increased probability of developing gray matter atrophy at follow-up, whereas gray matter atrophy progression over 2 years and new T2 lesion load were risk factors for whole brain atrophy progression. Conclusions In MS, brain atrophy occurs even after a relatively short period of time and in patients with limited progression of disability. Short-term brain atrophy progression rates differ across tissue compartments, as gray matter atrophy results more pronounced than white matter atrophy and appears to be a early phenomenon in the MS-related disease progression.
Collapse
Affiliation(s)
- G Tedeschi
- Department of Neurological Sciences, Second University of Naples, Naples, Italy; Institute Hermitage Capodimonte, Naples, Italy
| | - D Dinacci
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
| | - M Comerci
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - L Lavorgna
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
| | - G Savettieri
- Department of Neurology, University of Palermo, Palermo, Italy
| | - A Quattrone
- Department of Neurology, University of Catanzaro, Catanzaro, Italy
| | - P Livrea
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - F Patti
- Department of Neurology, University of Catania, Catania, Italy
| | - V Brescia Morra
- Department of Neurological Sciences, University of Naples “Federico II,” Naples, Italy
| | - G Servillo
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
| | - G Orefice
- Department of Neurological Sciences, University of Naples “Federico II,” Naples, Italy
| | - M Paciello
- Department of Neurology, San Carlo Hospital, Potenza, Italy
| | - A Prinster
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - G Coniglio
- Department of Neurology, San Carlo Hospital, Potenza, Italy
| | - S Bonavita
- Department of Neurological Sciences, Second University of Naples, Naples, Italy; Institute Hermitage Capodimonte, Naples, Italy
| | - A Di Costanzo
- Department of Neurological Sciences, Second University of Naples, Naples, Italy
| | - A Bellacosa
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - P Valentino
- Department of Neurology, University of Catanzaro, Catanzaro, Italy
| | - M Quarantelli
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - A Brunetti
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy; Department of Diagnostic Imaging, University of Naples “Federico II,” Naples, Italy
| | - G Salemi
- Department of Neurology, University of Palermo, Palermo, Italy
| | - M D’Amelio
- Department of Neurology, University of Palermo, Palermo, Italy
| | - I Simone
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - M Salvatore
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy; Department of Diagnostic Imaging, University of Naples “Federico II,” Naples, Italy
| | - V Bonavita
- Institute Hermitage Capodimonte, Naples, Italy; Department of Neurological Sciences, University of Naples “Federico II,” Naples, Italy
| | - B Alfano
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| |
Collapse
|
44
|
Mitsonis CI, Zervas IM, Mitropoulos PA, Dimopoulos NP, Soldatos CR, Potagas CM, Sfagos CA. The impact of stressful life events on risk of relapse in women with multiple sclerosis: A prospective study. Eur Psychiatry 2008; 23:497-504. [DOI: 10.1016/j.eurpsy.2008.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 05/10/2008] [Accepted: 06/07/2008] [Indexed: 11/29/2022] Open
Abstract
AbstractPurposeThe aims of this study were first, to examine the general relation between stressful life events (SLEs) and clinical relapses in women with multiple sclerosis (MS) and second, to investigate the relations of the specific stressor attributes of duration, type, and severity on MS exacerbations.MethodsTwenty six ambulating women with relapsing-remitting MS were followed-up for a mean of 56.3 weeks. Patients documented SLEs weekly in self report diaries which were then collected at regular pre-scheduled clinic visits every 4 weeks. SLEs were classified as short-term if they had subjectively no lasting effect and long-term if they had a subjectively felt psychological impact that lasted at least 10–14 days after the event. The severity of SLEs was determined using the Recent Life Change Questionnaire.ResultsExperiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7–16.4, p = 0.003). The presence of at least one long-term SLE was associated with three times (95% CI 1.01–9.13, p < 0.05) the rate of MS exacerbation during the following 4 weeks. There was no significant association between the severity (95% CI 0.99–1.01, p > 0.05) or the type (χ2 = 7.29, df = 5, p > 0.05) of stressor and the risk for relapse.ConclusionAmbulatory women with relapsing-remitting MS who experience cumulative SLEs may be at a greater risk for relapse. Duration is the only stress attribute that seems to increase the risk for relapsing in contrast to stress type and stress severity that were not found to interact with MS exacerbation.
Collapse
|
45
|
Croda MG, de Oliveira ACP, Vergara MPP, Bonasser F, Smid J, Duarte AJDS, Casseb J. Corticosteroid therapy in TSP/HAM patients: The results from a 10 years open cohort. J Neurol Sci 2008; 269:133-7. [DOI: 10.1016/j.jns.2008.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 01/06/2008] [Accepted: 01/10/2008] [Indexed: 11/29/2022]
|
46
|
Weise A, Kesselring J, Coenen M, Cieza A. The development of ICF Core Sets for Multiple Sclerosis. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2008. [DOI: 10.1179/otb.2008.57.1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
McMillan L, Moore KA. The development and validation of the impact of multiple sclerosis scale and the symptoms of multiple sclerosis scale. Arch Phys Med Rehabil 2006; 87:832-41. [PMID: 16731220 DOI: 10.1016/j.apmr.2006.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 12/18/2005] [Accepted: 01/11/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate the Impact of Multiple Sclerosis Scale (IMSS) and the Symptoms of Multiple Sclerosis Scale (SMSS) using the Extended Disability Status Scale (EDSS) for construct validity. DESIGN Panel design involving test-retest over 4 months. SETTING A mailed survey. PARTICIPANTS Volunteers with a diagnosis of multiple sclerosis (MS) recruited from an MS support service in Australia: 193 people (mean age, 39y) and 150 people participated at time 1 and time 2, respectively. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Principal components analyses, the Cronbach alpha, and descriptive statistics for the 2 scales; correlations for construct validity with the EDSS and retest; and confirmatory factor analysis to test the stability of IMSS and SMSS components over time. RESULTS The IMSS yielded 5 independent and reliable components; the SMSS yielded 3 components; both component structures were stable over time. These scales showed convergent validity with the EDSS. CONCLUSIONS The IMSS and SMSS are psychometrically sound scales suitable for clinical and research purposes to assess the symptoms and impact of MS.
Collapse
Affiliation(s)
- Lindsay McMillan
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, Australia
| | | |
Collapse
|
48
|
McClurg D, Ashe RG, Marshall K, Lowe-Strong AS. Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: A randomized pilot study. Neurourol Urodyn 2006; 25:337-48. [PMID: 16637070 DOI: 10.1002/nau.20209] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Bladder dysfunction affects up to 90% of the multiple sclerosis (MS) population. Interventions such as Pelvic Floor Training and Advice (PFTA), Electromyography (EMG) Biofeedback, and Neuromuscular Electrical Stimulation (NMES) have received limited research attention within this population. This study aimed to determine the effectiveness of a combined programme of PFTA, EMG Biofeedback, and NMES for bladder dysfunction in MS. METHODS Females (n = 30) who fulfilled strict inclusion/exclusion criteria were recruited. Outcome measures (weeks 0, 9, 16, and 24) included: 3-day Voiding Diary; 24 hr Pad-Test; Uroflowmetry; Pelvic Floor Muscle Assessment; Incontinence Impact Questionnaire (IIQ); Urogenital Distress Inventory (UDI); King's Health Questionnaire (KHQ), and the Multiple Sclerosis Quality of Life-54 Instrument (MSQoL-54). Following baseline (week 0) assessment, participants were randomly allocated, under double blind conditions, to one of the three groups: Group 1 (PFTA); Group 2 (PFTA and EMG Biofeedback); and Group 3 (PFTA, EMG Biofeedback, and NMES). Treatment was for 9 weeks. RESULTS Baseline severity (measured by number of leaks and pad weight) showed some variation between groups, although not statistically significant (P > 0.05); with the caveat that this baseline imbalance makes interpretation difficult, a picture emerges that at week 9, Group 3 demonstrated superior benefit as measured by the number of leaks and pad test than Group 2, with Group 1 showing less improvement when compared to week 0; this was statistically significant between Groups 1 and 3 for number of leaks (P = 0.014) and pad tests (P = 0.001), and Groups 1 and 2 for pad tests (P = 0.001). A similar pattern was evident for all other outcome measures. CONCLUSION Results suggest that these treatments, used in combination, may reduce urinary symptoms in MS. Further research will establish the effectiveness of these interventions.
Collapse
Affiliation(s)
- D McClurg
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland
| | | | | | | |
Collapse
|
49
|
Verheyden G, Nuyens G, Nieuwboer A, Van Asch P, Ketelaer P, De Weerdt W. Reliability and validity of trunk assessment for people with multiple sclerosis. Phys Ther 2006; 86:66-76. [PMID: 16386063 DOI: 10.1093/ptj/86.1.66] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS). SUBJECTS Thirty people with MS participated in the study. METHODS Interrater and test-retest reliability and construct validity were assessed. RESULTS Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established. DISCUSSION AND CONCLUSION The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS.
Collapse
Affiliation(s)
- Geert Verheyden
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
We conducted a review of existing assessment tools that can be useful to physical medicine and rehabilitation professionals involved in the management of patients with multiple sclerosis (MS). Most generic tools traditionally used in neurorehabilitation, such as gait tests, the functional independence measure, or the SF-36, can be applied to MS, but few have been tested on large patient samples. Disease-specific scales often seem more pertinent and sensitive to change, and their qualities and limitations are better known through clinical trials of disease-modifying therapies.
Collapse
Affiliation(s)
- F Béthoux
- The Mellen Center for MS Treatment and Research, the Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, United States.
| |
Collapse
|