1
|
Selmaj K, Cree BAC, Barnett M, Thompson A, Hartung HP. Multiple sclerosis: time for early treatment with high-efficacy drugs. J Neurol 2024; 271:105-115. [PMID: 37851189 PMCID: PMC10769939 DOI: 10.1007/s00415-023-11969-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023]
Abstract
This review addresses current changes in the approach to treating patients with multiple sclerosis (MS). The widely practiced approach of utilizing agents with lower treatment efficacy (LETA) at onset with subsequent escalation has been challenged by new data suggesting that MS patients derive greater benefit when therapy is initiated with high-efficacy treatment agents (HETA). Several recent studies compared treatment efficacy and safety of early administration of HETA versus LETA. The results of randomized, double blind, phase III studies with LETA as a control arm and population-based larger and longer studies using propensity scoring, marginal structural modeling and weighted cumulative exposure analysis support the benefit of early treatment with HETA. Patients initiating their treatment with HETA, regardless of prognostic factors and MRI burden at baseline, showed significantly lower annualized relapse rate (ARR) and reduced disability progression in follow-up periods of up to 10-15 years. Moreover, the safety profile of recently approved HETA ameliorates concerns about off-target effects associated with a number of earlier high-efficacy drugs. Patient perception has also changed with an increasing preference for medication profiles that both improve symptoms and prevent disease progression. Accumulating data from randomized studies and the results of large population-based studies demonstrating short-term and longer-term patient benefits support the view that HETA should be more widely used. The adoption of early treatment with HETA capitalizes on a window of opportunity for anti-inflammatory drugs to maximally impact disease pathology and heralds a sea change in clinical practice toward pro-active management and away from a philosophy routed in generating clinical benefit as a consequence of treatment failure.
Collapse
Affiliation(s)
- Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, 30 Warszawska Ave, 10-082, Olsztyn, Poland.
- Center of Neurology, Lodz, Poland.
| | - Bruce A C Cree
- Department of Neurology, Weill Neurosciences Institute, UCSF, San Francisco, USA
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Alan Thompson
- Faculty of Brain Sciences, University College, London, London, UK
| | - Hans-Peter Hartung
- Brain and Mind Centre, University of Sydney, Sydney, Australia
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic
| |
Collapse
|
2
|
Kondo A, Ikeguchi R, Kitagawa K, Shimizu Y. Disease Activity and Progression of Disability in Multiple Sclerosis Patients Aged Over 50 With or Without Disease-Modifying Drug Treatment: A Retrospective Cohort Study. Cureus 2023; 15:e49927. [PMID: 38058522 PMCID: PMC10697689 DOI: 10.7759/cureus.49927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
Background This study aimed to clarify the need for disease-modifying drug (DMD) treatment in elderly patients with multiple sclerosis (MS) aged 50 years or older. MS is an autoimmune, demyelinating disease of the central nervous system that predominantly affects young women. Various DMDs are effective in preventing relapses and slowing the progression of disability in patients with MS. Although disease activity in MS is believed to decrease with aging, a consensus on the appropriate DMD treatment for elderly patients with MS is lacking. Methodology This study included elderly patients with MS (>50 years old). We compared the occurrence of relapses, worsening of disability, and conversion to secondary progressive MS (SPMS) between patients with DMD treatment and those without. Logistic regression analysis was performed to determine the predictors of these outcomes. Confounding factors were adjusted using propensity scores. Results From January 1991 to October 2022, 76 elderly patients with MS were included. The mean age at the last visit was 57.4 ± 6.3 years, with 51 patients being female. The mean age of onset of MS was 37.1 ± 10.1 years. Fifty-four patients were included in the DMD treatment group. The overall relapse rate was 38% (33% and 48% in the DMD treatment and untreated groups, respectively). No significant differences in relapse rates (p = 0.72) or in the Expanded Disability Status Scale (EDSS) scores were identified between the two groups. Kaplan-Meier curves showed no differences in the time to first relapse within five years between the two groups. Additionally, no significant predictors of relapse were identified. Among 61 patients with relapsing-remitting MS, 25% converted to SPMS during the observation period. Logistic regression analysis showed that older age at the final visit and the presence of brainstem lesions at the age of 50 years were associated with a higher rate of transition to SPMS. Conclusions In the present study, no significant difference was found in the rate of relapse, disability progression, and conversion to SPMS between the DMD treatment and untreated groups in elderly patients with MS. Therefore, in patients without long-term relapse, no poor prognostic functional factors or predictors of conversion to SPMS, discontinuation of DMDs may be considered. In addition, the presence of brainstem lesions at 50 years of age may predict the conversion to SPMS. Thus, the continuation of DMD or conversion to an appropriate DMD should be considered in patients with brainstem lesions at 50 years of age.
Collapse
Affiliation(s)
- Akihiro Kondo
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ryotaro Ikeguchi
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Yuko Shimizu
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| |
Collapse
|
3
|
Nakahara J. [History and prospects of multiple sclerosis treatment]. Rinsho Shinkeigaku 2022; 62:517-523. [PMID: 35753791 DOI: 10.5692/clinicalneurol.cn-001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system of unknown etiology. Based on a hypothesis that MS is caused by certain viral infections, the efficacy of interferon β was examined in patients and it became the first disease-modifying drug (DMD) approximately 30 years ago. Through the series of research utilizing experimental autoimmune encephalomyelitis, many other DMDs were later developed. With emerging insights on limitation of the animal model, newer treatment strategies are being developed based on pathological findings from MS patients. In the current article, the history of MS treatment and its future prospects will be reviewed and discussed.
Collapse
Affiliation(s)
- Jin Nakahara
- Department of Neurology, Keio University School of Medicine
| |
Collapse
|
4
|
Hamdy E, Talaat F, Said SM, Ramadan I, Marouf H, Hamdy MM, Sadallah H, Ashmawi GAH, Elsalamawy D. Diagnosing ‘transition’ to secondary progressive multiple sclerosis (SPMS): A step-by-step approach for clinicians. Mult Scler Relat Disord 2022; 60:103718. [DOI: 10.1016/j.msard.2022.103718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
|
5
|
Koch-Henriksen N, Magyari M. Apparent changes in the epidemiology and severity of multiple sclerosis. Nat Rev Neurol 2021; 17:676-688. [PMID: 34584250 DOI: 10.1038/s41582-021-00556-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
Collapse
Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
6
|
Cortese R, Battaglini M, Parodi F, Stromillo ML, Portaccio E, Razzolini L, Giorgio A, Sormani MP, Amato MP, De Stefano N. Mild gray matter atrophy in patients with long-standing multiple sclerosis and favorable clinical course. Mult Scler 2021; 28:154-159. [PMID: 34100326 DOI: 10.1177/13524585211019650] [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: 11/16/2022]
Abstract
The mechanisms responsible for the favorable clinical course in multiple sclerosis (MS) remain unclear. In this longitudinal study, we assessed whether magnetic resonance imaging (MRI)-based changes in focal and diffuse brain damage are associated with a long-term favorable MS diseases course. We found that global brain and gray matter (GM) atrophy changes were milder in MS patients with long-standing disease (⩾30 years from onset) and favorable (no/minimal disability) clinical course than in sex-age-matched disable MS patients, independently of lesions accumulation. Data showed that different trajectories of volume changes, as reflected by mild GM atrophy, may characterize patients with long-term favorable evolution.
Collapse
Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesca Parodi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emilio Portaccio
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy/Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Lorenzo Razzolini
- Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Maria Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy/Department of Neurological and Psychiatric sciences (NEUROFARBA), University of Florence, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| |
Collapse
|
7
|
Mathey G, Pisché G, Soudant M, Pittion-Vouyovitch S, Guillemin F, Debouverie M, Epstein J. Long-term analysis of patients with benign multiple sclerosis: new insights about the disability course. J Neurol 2021; 268:3817-3825. [PMID: 33791847 DOI: 10.1007/s00415-021-10501-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the course of disability in patients with benign multiple sclerosis-i.e., with an expanded disability status scale score < 3 10 years after disease onset-for up to 30 years after disease onset. We evaluated the proportion of patients remaining in the benign state on the long term and the factor associated with this favorable outcome and determined the pattern of disability course after the loss of the benign status. METHODS Patients were selected from the ReLSEP, a French population-based registry. We studied the probability (Kaplan-Meier method) and predictors (multivariate Cox model) of remaining < 3 after year 10, and the course of disability after score 3 according to the duration of the benign phase in patients with ≥ 30 years of follow-up (graphs of the course of the mean expanded disability status scale scores in subgroups of patients). RESULTS 2295/3440 patients had benign multiple sclerosis (66.7%). The probability of remaining benign at year 30 was 0.26 (95% CI 0.26-0.32). A young age at disease onset and a good recovery after the first relapse were associated with remaining benign. Graphs illustrate that those who lost their benign status between years 10 and 30 follow a two-stage course. Beyond score 3, disability accumulation is similar in all but lower disability scores at advanced age are associated with longer benign periods. CONCLUSION The longer a patient remains in the benign state, the lower the final EDSS at advanced age.
Collapse
Affiliation(s)
- Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. .,Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.
| | - Guillaume Pisché
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.,Department of Neurology, Haguenau Hospital, 67504, Haguenau, France
| | - Marc Soudant
- CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
| | - Sophie Pittion-Vouyovitch
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Francis Guillemin
- Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Hôpital Central, service de neurologie, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France
| | - Jonathan Epstein
- Université de Lorraine, EA 4360 APEMAC, 54500, Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, 54500, Nancy, France
| |
Collapse
|
8
|
Kleiter I, Ayzenberg I, Havla J, Lukas C, Penner IK, Stadelmann C, Linker RA. The transitional phase of multiple sclerosis: Characterization and conceptual framework. Mult Scler Relat Disord 2020; 44:102242. [DOI: 10.1016/j.msard.2020.102242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
|
9
|
Ziemssen T, Tolley C, Bennett B, Kilgariff S, Jones E, Pike J, Tomic D, Piani-Meier D, Lahoz R. A mixed methods approach towards understanding key disease characteristics associated with the progression from RRMS to SPMS: Physicians' and patients' views. Mult Scler Relat Disord 2019; 38:101861. [PMID: 31865132 DOI: 10.1016/j.msard.2019.101861] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/16/2019] [Accepted: 11/16/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) evolves over time and it can be challenging for physicians to identify progression early. Typically, SPMS is diagnosed retrospectively with a significant delay, based on a history of gradual worsening, independent of relapses, following an initial relapsing-remitting disease course. As such, SPMS is often associated with a considerable period of diagnostic uncertainty. This study aimed to explore and characterize key symptoms and impacts associated with transitioning from RRMS to SPMS and inform the content for a tool to support evaluation of early subtle signs suggestive of progressive disease. METHODS The qualitative study involved 60-min, face-to-face, concept elicitation (CE) interviews with 32 patients with MS (US = 16 and Germany = 16); and 30-min, telephone, CE interviews with 16 neurologists (US = 8 and Germany = 8). Multivariate analysis on data from a real-world observational study of 3294 MS patients assessed the differences between early-RRMS and early-SPMS, and identified factors that were significant drivers of this difference. These studies informed selection of the key variables to be included in a pilot tool. Sixteen physicians used the pilot tool, presented as a paper questionnaire, with a sample of patients whom they suspected were progressing to SPMS (n ≥ 5). Following this, the physicians participated in a 30-min cognitive debriefing (CD) interview to evaluate the relevance and usefulness of the tool. Qualitative analysis of all anonymized, verbatim transcripts was performed using thematic analysis. RESULTS Patients and physicians reported signs that indicated progression to SPMS including gradual worsening of symptoms, lack of clear recovery, increased severity and presence of new symptoms. No specific symptoms definitively indicated progression to SPMS, however a number of potential symptoms associated with progression were identified by SPMS patients and physicians, including worsening ambulation, cognition, balance, muscle weakness, visual symptoms, bladder symptoms and fatigue. Quality of life domains reported to be more severely impacted in SPMS than MS in general included: physical activity, work, daily activities, emotional and social functioning. Multivariate analysis of the observational study data identified several variables strongly associated with progression to SPMS including, requirement of assistance in daily living, presence of motor symptoms, presence of ataxia/coordination symptoms, and unemployment. Physicians reported that items included in the tool were easy to understand and relevant. Physicians also reported that there is an unmet need for a tool to help identify signs of SPMS progression and so the tool would be useful in clinical practice. CONCLUSIONS This was the first stage of development of a novel, validated, physician-completed tool to support physician-patient interactions in evaluating signs indicative of disease progression to SPMS. Qualitative and quantitative methods (involving physician and patients) were used to determine tool content. The usefulness and unmet need for such a tool in clinical practice was confirmed via CD interviews with physicians. Further work is now warranted to develop a scoring algorithm and validate the tool so that it can be reliably implemented in clinical practice.
Collapse
Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, MS Center, University Clinic Carl Gustav Carus, TU Dresden, Germany.
| | - Chloe Tolley
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | - Bryan Bennett
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | | | - Eddie Jones
- Adelphi Real World, Bollington, Cheshire, United Kingdom
| | - James Pike
- Adelphi Real World, Bollington, Cheshire, United Kingdom
| | | | | | | |
Collapse
|
10
|
Skoog B, Hedman B. Intrathecal Baclofen Dosage for Long-Term Treatment of Patients With Spasticity Due to Traumatic Spinal Cord Injuries or Multiple Sclerosis. Ann Rehabil Med 2019; 43:555-561. [PMID: 31693845 PMCID: PMC6835137 DOI: 10.5535/arm.2019.43.5.555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate dosage changes in intrathecal baclofen during long-term treatment of patients with severe leg spasticity. METHODS We performed a retrospective chart review of 49 patients treated with an intrathecal baclofen pump (ITB) because of severe leg spasticity, for a minimum of 7 years. Eight patients were excluded due to catheter/pump failure or factors aggravating spasticity. Of the remaining 41 patients, 19 had spinal cord injury (SCI) and 22 were diagnosed with multiple sclerosis (MS). Among the SCI patients, 15 had cervical and 4 thoracic SCI, with 7 patients showing the American Spinal Injury Association impairment scale (AIS) A and 12 patients with AIS B-D. The dose was regulated by discussion among the patients and their physicians, usually 4-10 times annually, to reduce leg spasticity and also avoid leg/trunk weakness. RESULTS After 1 year patients on ITB needed a median dose of 168 mg/24 hr (range, 30-725 mg) for an optimal effect. After 7 to 10 years the dosage needed to reduce leg spasticity in the MS patients was significantly increased compared with the initial dose (mean 157%, n=22 and mean 194%, n=18). In contrast, the SCI patients needed only a modest increase (mean 113% and 121%). The difference between MS and SCI patients was significant (t-test p=0.006 and p=0.004). CONCLUSION The increased dosage in MS patients compared with patients diagnosed with SCI probably reflects the progressive disease course. The need for a large dosage increase in patients with SCI suggests possible pump failure, triggering factors for spasticity or progressive spinal disease.
Collapse
Affiliation(s)
- Bengt Skoog
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Hedman
- Department of Neurology, Karolinska Hospital, Stockholm, Sweden
| |
Collapse
|
11
|
Skoog B, Link J, Tedeholm H, Longfils M, Nerman O, Fagius J, Andersen O. Short-term prediction of secondary progression in a sliding window: A test of a predicting algorithm in a validation cohort. Mult Scler J Exp Transl Clin 2019; 5:2055217319875466. [PMID: 35145727 PMCID: PMC8822449 DOI: 10.1177/2055217319875466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction The Multiple Sclerosis Prediction Score (MSPS, www.msprediction.com) estimates, for any month during the course of relapsing–remitting multiple sclerosis (MS), the individual risk of transition to secondary progression (SP) during the following year. Objective Internal verification of the MSPS algorithm in a derivation cohort, the Gothenburg Incidence Cohort (GIC, n = 144) and external verification in the Uppsala MS cohort (UMS, n = 145). Methods Starting from their second relapse, patients were included and followed for 25 years. A matrix of MSPS values was created. From this matrix, a goodness-of-fit test and suitable diagnostic plots were derived to compare MSPS-calculated and observed outcomes (i.e. transition to SP). Results The median time to SP was slightly longer in the UMS than in the GIC, 15 vs. 11.5 years (p = 0.19). The MSPS was calibrated with multiplicative factors: 0.599 for the UMS and 0.829 for the GIC; the calibrated MSPS provided a good fit between expected and observed outcomes (chi-square p = 0.61 for the UMS), which indicated the model was not rejected. Conclusion The results suggest that the MSPS has clinically relevant generalizability in new cohorts, provided that the MSPS was calibrated to the actual overall SP incidence in the cohort.
Collapse
Affiliation(s)
- B Skoog
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
| | - J Link
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - H Tedeholm
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
| | - M Longfils
- Department of Mathematical Sciences, Chalmers University of Technology, Sweden
| | - O Nerman
- Department of Mathematical Sciences, Chalmers University of Technology, Sweden
| | - J Fagius
- Neurology, Department of Neuroscience, Uppsala University, Sweden
| | - O Andersen
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Sweden
| |
Collapse
|
12
|
Crielaard L, Kavaliunas A, Ramanujam R, Olsson T, Hillert J, Stridh P, Kockum I, Manouchehrinia A. Factors associated with and long-term outcome of benign multiple sclerosis: a nationwide cohort study. J Neurol Neurosurg Psychiatry 2019; 90:761-767. [PMID: 30824631 DOI: 10.1136/jnnp-2018-319913] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Benign multiple sclerosis (BMS) is often defined by the Expanded Disability Status Scale (EDSS) score of ≤3.0 after ≥15 years of disease duration. This classification's clinical relevance remains unclear as benign patients may suffer other impairments and advance towards a progressive course, prompting our objective to holistically investigate factors associated with BMS and its long-term prognosis. METHODS Benign cases were identified in the Swedish Multiple Sclerosis registry. Baseline clinical data, demographic features and influence of multiple sclerosis (MS) major risk alleles on likelihood of benign course were investigated. Physical disability (EDSS), cognitive function (Symbol Digit Modalities Test; SDMT) and self-reported and socioeconomic differences between benign and non-benign patients were evaluated using generalised estimation equations models. RESULTS 11222 patients (2420 benign/8802 non-benign) were included. Benign patients were more likely to be female and younger at MS onset, have fewer relapses within the first two and 5 years from onset and fully recover from the first relapse (p<0.001). No association between human leucocyte antigen (HLA) DRB1*15:01 carriership (OR: 0.97, 95% CI: 0.86 to 1.09) or HLA-A*02:01 lacking (OR: 0.99, 95% CI: 0.87 to 1.11) and benign/non-benign was found. Non-benign patients accumulated an extra 0.04 (95% CI 0.03 to 0.04, p<0.001) EDSS score/year, lost an extra 0.3 (95% CI - 0.39 to - 0.18, p<0.001) SDMT score/year and deteriorated faster in self-reported impact and socioeconomic measures (p<0.001). CONCLUSION Patients with BMS have a better disease course as they progress more slowly at the group level in all respects. Lack of an association with major genetic risk factors indicates that MS course is most likely influenced by either environmental factor(s) or genetic factors outside the HLA region.
Collapse
Affiliation(s)
- Loes Crielaard
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Tomas Olsson
- The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Pernilla Stridh
- The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- The Karolinska Neuroimmunology & Multiple Sclerosis Centre, Centre for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Ahrweiller K, Rousseau C, Le Page E, Bajeux E, Leray E, Michel L, Edan G, Kerbrat A. Decreasing impact of late relapses on disability worsening in secondary progressive multiple sclerosis. Mult Scler 2019; 26:924-935. [PMID: 31094285 DOI: 10.1177/1352458519848090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Changes in relapse activity during secondary progressive multiple sclerosis (SPMS) need to be accurately characterized in order to identify patients who might benefit from continuing disease-modifying therapies. Objective: To describe relapse occurrence in patients with SPMS during long-term follow-up and assess its impact on disability worsening. Methods: This retrospective cohort study included 506 patients. We assessed the influence of relapses on time from SPMS onset to an Expanded Disability Status Scale score of 6 (EDSS 6), and on irreversible worsening of EDSS scores across different periods. Results: The annualized relapse rate (ARR) decreased with patient’s age (mean reduction of 43% per decade) and SPMS duration (mean reduction of 46% every 5 years). Post-progression relapses were associated with shorter time from secondary progressive (SP) phase onset to EDSS 6 (hazard ratio (HR) = 1.29, 95% confidence interval (CI) = (1.01, 1.64)). Relapse occurrence during the first 3 years and 3–5 years after SP onset was associated with an increased risk of irreversible EDSS worsening (OR = 3.12 (1.54, 6.31) and 2.04 (1.16, 3.58)). This association was no longer significant after 5 years. Conclusion: The occurrence of relapses was a marker of short-term disability progression during early SPMS, but did not have decisive impact in later SPMS.
Collapse
Affiliation(s)
- Kevin Ahrweiller
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Chloé Rousseau
- Clinical Investigation Center (CIC-P) INSERM 1414, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | - Emmanuelle Le Page
- Department of Neurology, Rennes University Hospital, Rennes, France/Clinical Investigation Center (CIC-P) INSERM 1414, Rennes University Hospital, Rennes, France/West Neuroscience Network of Excellence (WENNE), Rennes, France
| | - Emma Bajeux
- Department of Epidemiology and Public Health, Rennes University Hospital, Rennes, France
| | - Emmanuelle Leray
- Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France
| | - Laure Michel
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Gilles Edan
- Department of Neurology, Rennes University Hospital, Rennes, France/Clinical Investigation Center (CIC-P) INSERM 1414, Rennes University Hospital, Rennes, France/West Neuroscience Network of Excellence (WENNE), Rennes, France
| | - Anne Kerbrat
- Department of Neurology, Rennes University Hospital, Rennes, France/West Neuroscience Network of Excellence (WENNE), France
| |
Collapse
|
14
|
Tallantyre EC, Major PC, Atherton MJ, Davies WA, Joseph F, Tomassini V, Pickersgill TP, Harding KE, Willis MD, Winter M, Robertson NP. How common is truly benign MS in a UK population? J Neurol Neurosurg Psychiatry 2019; 90:522-528. [PMID: 30177509 PMCID: PMC6581074 DOI: 10.1136/jnnp-2018-318802] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/05/2018] [Accepted: 07/22/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The prevalence and definition of benign multiple sclerosis (BMS) remain controversial. Most definitions are based on the Expanded Disability Status Scale (EDSS), not encompassing the wider impact of disease. The explanation for favourable outcomes remains unclear. We aim to provide a detailed characterisation of patients with low EDSS scores at long disease durations. METHODS We screened a population-based registry containing 3062 people with MS to identify individuals with unlimited walking ability at disease durations >15 years. A representative cohort underwent detailed clinical assessment and classified as having BMS according to EDSS score <3, no significant fatigue, mood disturbance, cognitive impairment or disrupted employment, and had not received a disease-modifying therapy. We determined patient-reported perceptions of MS status and made comparisons with EDSS-based definitions. RESULTS Of 1049 patients with disease duration of >15 years, 200 (19.1%) had most recent EDSS score <4.0. Detailed contemporary clinical assessment of a representative sample of 60 of these patients revealed 48 (80%) had an EDSS score of <4.0, 35 (58%) <3.0 and 16 (27%) <2.0. Only nine (15%) fulfilled our criteria for BMS; impaired cognition (57%) and effects on employment (52%) the most common causes for exclusion. Meanwhile, 33/60 (69%) patients considered their disease benign. Population frequency for BMS was estimated at 2.9% (95% CI 2.0 to 4.1). CONCLUSIONS Comprehensive assessment reveals a small minority of people with MS who appear genuinely benign after 15 years. Study of such individuals may uncover insights about disease pathogenesis. However, discrepancy between patient perception and clinician perception of BMS undermines use of the term 'benign' in clinical settings.
Collapse
Affiliation(s)
- Emma Clare Tallantyre
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Paula C Major
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Michael J Atherton
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - W Adam Davies
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Fady Joseph
- Department of Neurology, Royal Gwent Hospital, Newport, UK
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Trevor P Pickersgill
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Katharine Elizabeth Harding
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Mark Douglas Willis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Mia Winter
- Department of Clinical Neuropsychology, University Hospital of Wales, Cardiff, UK
| | - Neil P Robertson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
15
|
Schaefer LM, Poettgen J, Fischer A, Gold S, Stellmann JP, Heesen C. Impairment and restrictions in possibly benign multiple sclerosis. Brain Behav 2019; 9:e01259. [PMID: 30884218 PMCID: PMC6456783 DOI: 10.1002/brb3.1259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/08/2018] [Accepted: 02/10/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim was to describe a broad range of health dimensions in possibly benign multiple sclerosis (MS) hypothesizing that despite some limitations there is a high adaptation to the disease. METHODS All patients from an outpatient university clinic data registry with an Expanded Disability Status Scale (EDSS) ≤3.5 and disease duration ≥15 years were addressed in a cross-sectional study. Physical impairment, neuropsychological functioning but also influence on activities and patient reported outcome measures including coping were studied. RESULTS One hundred and twenty-five patients could be included (mean EDSS: 2.8; mean disease duration: 24 years). Cognitive impairment was minor (8%) but fatigue (73%) and depression (46%) were prevalent. Nevertheless, QOL and daily activities seemed to be less affected. Patients showed high social support, coping abilities, and sense of coherence, which was predictive for their perceived benignity of the disease. Based on the EDSS alone, we estimated the rate of benign MS after 15 years of MS as high as 23% decreasing to 16% if cognition was included in the definition. However, cognitive performance was not relevantly associated with other outcomes. CONCLUSION Common benign MS definitions seem to simplify a complex disease picture where different impairments and personal resources lead to more or less impact on people's lives.
Collapse
Affiliation(s)
- Laura Melanie Schaefer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Poettgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Fischer
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,University of Central Lancashire, Preston, UK
| | - Stefan Gold
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
16
|
Vohl K, Duscha A, Gisevius B, Kaisler J, Gold R, Haghikia A. Predictors for Therapy Response to Intrathecal Corticosteroid Therapy in Multiple Sclerosis. Front Neurol 2019; 10:132. [PMID: 30853935 PMCID: PMC6395388 DOI: 10.3389/fneur.2019.00132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: The autoimmune disease Multiple Sclerosis (MS) represents a heterogeneous disease pattern with an individual course that may lead to permanent disability. In addition to immuno-modulating therapies patients benefit from symptomatic approaches like intrathecal corticosteroid therapy (ICT), which is frequently applied in a growing number of centers in Germany. ICT reduces spasticity, which elongates patient's walking distance and speed, thus improves quality of life. Methods: In our study we set out to investigate cerebrospinal fluid (CSF) parameters and clinical predictors for response to ICT. Therefore, we analyzed 811 CSF samples collected from 354 patients over a time period of 12 years. Patients who received ICT were divided in two groups (improving or active group) depending on their EDSS-progress. As control groups we analyzed data of ICT naïve patients, who were divided in the two groups as well. Additionally we observed the clinical progress after receiving ICT by comparison of patients in both groups. Results: The results showed clinical data had a significant influence on the probability to benefit from ICT. The probability (shown by Odds Ratio of 1.77–2.43) to belong to the improving group in contrast to the active group is significantly (p < 0.0001) higher at later stages of disease with early disease onset (< 35 years, OR = 2.43) and higher EDSS at timepoint of ICT-initiation (EDSS > 6, OR = 2.06). Additionally, we observed lower CSF cell counts (6.68 ± 1.37 μl) and lower total CSF protein (412 ± 18.25 mg/l) of patients who responded to ICT compared to patients who did not (p < 0.05). In the control group no significant differences were revealed. Furthermore analyses of our data revealed patients belonging to the improving group reach an EDSS of 6 after ICT-initiation less often than patients of the active group (after 13 years 39.8% in the improving group, 67.8% in the active group). Conclusion: Our study implies two relevant messages: (i) although the study was not designed to prospectively assess clinical data, in this cohort no severe side effects were observed under ICT; (ii) disease onset, EDSS, CSF cell count, and total protein may serve as predictive markers for therapy response.
Collapse
Affiliation(s)
- Katja Vohl
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Alexander Duscha
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Barbara Gisevius
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Johannes Kaisler
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Aiden Haghikia
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| |
Collapse
|
17
|
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disorder. Although all MS patients initially show a relapsing-remitting course, 20-50% subsequently enter a chronic progressive course at 10-20 years after onset that greatly influences their activities of daily living. There are 2.5 million MS patients worldwide with large regional and racial differences. In particular, there are many MS patients among Caucasians living in Europe, while the disease is relatively rare in Asians and Africans.Although MS is regarded as an autoimmune disease, many factors such as genetic background, environmental factors, and sex are involved in its pathogenesis. While the immunological mechanisms remain to be fully elucidated, invasion of autoreactive T cells into the central nervous system (CNS) tissue is considered the first step of the disease. These T cells react with myelin antigens and initiate demyelination of the CNS by activating cytotoxic T cells, macrophages, and B cells through the release of inflammatory cytokines. As a treatment option, disease-modifying therapies have recently been developed to prevent the recurrence of MS in addition to conventional treatment with corticosteroids for acute relapse. However, there are still few effective treatments for the chronic progressive phase, and it is thus imperative to decipher the mechanism for chronic progression.
Collapse
|
18
|
Fabis-Pedrini MJ, James I, Seewann A, Yau WY, van de Bovenkamp AA, Sanders FRK, Qiu W, Burton J, Mastaglia FL, Carroll WM, Kermode AG. Natural history of benign multiple sclerosis: Clinical and HLA correlates in a Western Australian cohort. J Neurol Sci 2018; 388:12-18. [PMID: 29627005 DOI: 10.1016/j.jns.2018.02.036] [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: 08/14/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Benign multiple sclerosis (BMS) is a controversial term that has been used for MS patients with minimal disability decades after disease onset. Herein, we evaluated disease status after 20 years in a Western Australian cohort defined as BMS based on an Expanded Disability Status Scale (EDSS) score ≤ 3.0 at 10 years from onset. METHODS MS patients with an EDSS score ≤ 3.0 at 10 years from onset and minimum of 20 years follow up were included in the study. The 20-year EDSS score was considered the primary outcome. Associations with demographic and clinical characteristics and HLA-DRB1 genotype were investigated. RESULTS Among 120 patients with a benign course at 10 years, 78 (65%) remained benign at the 20-year follow up, but patients with an EDSS ≥ 2.5 were more likely to go on to develop more severe disability in the next decade. When considering factors associated with an increase in EDSS score ≤ 1 from 10 to 20 years, indicating limited progression, apart from the EDSS score at 10 years, poly-symptomatic presentation (p = 0.004) and cerebellar/brainstem mono-symptomatic presentation (p = 0.016) were independently associated with more rapid progression compared with other mono-symptomatic presentations. Carriage of the high risk HLA-DRB1*1501 allele was marginally associated with slower progression. CONCLUSIONS In this geographically isolated MS cohort of predominantly Anglo-Celtic origin clinical progression in the benign MS group was similar to that in other published series from Western countries. These results are in keeping with the view that patients labeled as benign MS are part of a heterogeneous continuum of disease progression and do not possess unique clinical characteristics. Possible genetic determinants of a benign course warrant further investigation.
Collapse
Affiliation(s)
- Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Ian James
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| | - Alexandra Seewann
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Wai Y Yau
- Sir Charles Gairdner Hospital, Neurology Department, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Arnold A van de Bovenkamp
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Fay R K Sanders
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Wei Qiu
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Jason Burton
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Sir Charles Gairdner Hospital, Neurology Department, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Frank L Mastaglia
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Sir Charles Gairdner Hospital, Neurology Department, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, UWA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; Sir Charles Gairdner Hospital, Neurology Department, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia.
| |
Collapse
|
19
|
Andersen O, Hildeman A, Longfils M, Tedeholm H, Skoog B, Tian W, Zhong J, Ekholm S, Novakova L, Runmarker B, Nerman O, Maier SE. Diffusion tensor imaging in multiple sclerosis at different final outcomes. Acta Neurol Scand 2018; 137:165-173. [PMID: 28741711 DOI: 10.1111/ane.12797] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Methods to evaluate the relative contributions of demyelination vs axonal degeneration over the long-term course of MS are urgently needed. We used magnetic resonance diffusion tensor imaging (DTI) to estimate degrees of demyelination and axonal degeneration in the corpus callosum (CC) in cases of MS with different final outcomes. MATERIALS AND METHODS We determined DTI measures mean diffusivity (MD), fractional anisotropy (FA), and axial (AD) and radial (RD) diffusivities in the CC of 31 MS patients, of whom 13 presented a secondary progressive course, 11 a non-progressive course, and seven a monophasic course. The study participants were survivors from an incidence cohort of 254 attack-onset MS patients with 50 years of longitudinal follow-up. As reference, we included five healthy individuals without significant morbidity. RESULTS In patients with secondary progression, compared to all other groups, the corpus callosum showed increased RD and reduced FA, but no change in AD. None of the parameters exhibited differences among non-progressive and monophasic course groups and controls. CONCLUSION Increased RD was observed in secondary progressive MS, indicating significant myelin loss. Normal RD values observed in the clinically isolated syndrome and non-progressive groups confirm their benign nature. AD was not a characterizing parameter for long-term outcome. Demyelination revealed by increased RD is a distinguishing trait for secondary progression.
Collapse
Affiliation(s)
- O. Andersen
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - A. Hildeman
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - M. Longfils
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - H. Tedeholm
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - B. Skoog
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - W. Tian
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
| | - J. Zhong
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
| | - S. Ekholm
- Department of Imaging Sciences Medical Center University of Rochester Rochester NY USA
- Department of Radiology Sahlgrenska University Hospital Gothenburg Sweden
| | - L. Novakova
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - B. Runmarker
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - O. Nerman
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
| | - S. E. Maier
- Department of Radiology Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
20
|
Farshidfar Z, Faeghi F, Haghighatkhah H, Abdolmohammadi J. The Optimization of Magnetic Resonance Imaging Pulse Sequences in Order to Better Detection of Multiple Sclerosis Plaques. J Biomed Phys Eng 2017; 7:265-270. [PMID: 29082217 PMCID: PMC5654132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) is the most sensitive technique to detect multiple sclerosis (MS) plaques in central nervous system. In some cases, the patients who were suspected to MS, Whereas MRI images are normal, but whether patients don't have MS plaques or MRI images are not enough optimized enough in order to show MS plaques? The aim of the current study is evaluating the efficiency of different MRI sequences in order to better detection of MS plaques. MATERIALS AND METHODS In this cross-sectional study which was performed at Shohada-E Tajrish in Tehran - Iran hospital between October, 2011 to April, 2012, included 20 patients who suspected to MS disease were selected by the method of random sampling and underwent routine brain Pulse sequences (Axial T2w, Axial T1w, Coronal T2w, Sagittal T1w, Axial FLAIR) by Siemens, Avanto, 1.5 Tesla system. If any lesion which is suspected to the MS disease was observed, additional sequences such as: Sagittal FLAIR Fat Sat, Sagittal PDw-fat Sat, Sagittal PDw-water sat was also performed. RESULTS This study was performed in about 52 lesions and the results in more than 19 lesions showed that, for the Subcortical and Infratentorial areas, PDWw sequence with fat suppression is the best choice, And in nearly 33 plaques located in Periventricular area, FLAIR Fat Sat was the most effective sequence than both PDw fat and water suppression pulse sequences. CONCLUSION Although large plaques may visible in all images, but important problem in patients with suspected MS is screening the tiny MS plaques. This study showed that for revealing the MS plaques located in the Subcortical and Infratentorial areas, PDw-fat sat is the most effective sequence, and for MS plaques in the periventricular area, FLAIR fat Sat is the best choice.
Collapse
Affiliation(s)
- Z. Farshidfar
- MSc of Medical Imaging Technology (MRI), Radiology Department of Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - F. Faeghi
- Ph.D. in Medical Physics, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H.R. Haghighatkhah
- MD, Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - J. Abdolmohammadi
- MSc. of Medical Imaging Technology (MRI), Department of Radiology, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
21
|
Definition, prevalence and predictive factors of benign multiple sclerosis. eNeurologicalSci 2017; 7:37-43. [PMID: 29260023 PMCID: PMC5721547 DOI: 10.1016/j.ensci.2017.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022] Open
Abstract
Background Multiple sclerosis (MS) is characterized by a great inter-individual variability in disease course and severity. Some patients experience a rather mild course, controversially called 'benign MS' (BMS). The usefulness of this entity in clinical practice remains unclear. Methods We performed a literature search in PubMed, Web of Science and Cochrane Library databases from November 1980 to December 2015, using the following key words: benign multiple sclerosis, diagnosis, imaging, prognosis, predictive, natural history and predefined inclusion criteria. Results Our search yielded 26 publications. Most definitions were based on the Expanded Disease Status Scale (EDSS), which is heavily weighted towards physical disability. Between 30 and 80% of relapsing-remitting MS patients have EDSS < 3 or 4 at 10 years after onset. Having only one relapse in the first 5 years and EDSS ≤ 2 at 5 years or EDSS ≤ 3 at 10 years appears to be predictive for a prolonged benign disease course, without protecting against disease progression at a later stage. Evidence on the predictive value of MRI parameters remains limited. Conclusions Current BMS definitions have some predictive value for future physical disability, but do not take into account the age at EDSS and the potentially disrupting effects of non-EDSS symptoms and cognitive impairment. It appears to correspond to mild RRMS in the first decades and its prevalence varies. Since early and accurate prediction of BMS is not yet possible, the clinical relevance is limited. Research approaches are suggested.
Collapse
|
22
|
Meca-Lallana V, Arroyo-González R, Meca-Lallana J, Martín-Hernández J, Sánchez-de la Rosa R. A consensus initiative for the assessment of patients newly diagnosed with multiple sclerosis in Spain: the eXamina Project. Neurodegener Dis Manag 2016; 6:363-74. [DOI: 10.2217/nmt-2016-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To create a national consensus checklist to assess newly diagnosed multiple sclerosis patients when considering treatment initiation in Spain. Materials & methods: The Delphi consensus method was used. A scientific committee drafted items/domains, 52 experts evaluated their inclusion in the project checklist and 47 experts assessed checklist use in clinical practice. Results: Forty-eight items from seven dimensions were selected: sociodemographics, n = 3; medical history, n = 10; multiple sclerosis clinical factors, n = 14; laboratory/MRI, n = 8; multiple sclerosis signs affecting treatment, n = 4; multiple sclerosis signs affecting management, n = 1; treatment-related features, n = 8. Understanding, acceptance, ease of use, effectiveness and suitability of checklist use were favorably rated by ≥75.5% of experts. Conclusion: This project provides a consensus checklist gathering necessary information when considering multiple sclerosis treatment in newly diagnosed patients.
Collapse
Affiliation(s)
- Virginia Meca-Lallana
- Neurology Department, Demyelinating Disease Unit, Hospital Universitario La Princesa, Diego de León, 62, 28006 Madrid, Spain
| | - Rafael Arroyo-González
- Neurology Department, Hospital Universitario Quirón Madrid, Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Spain
| | - José Meca-Lallana
- Neurology Department, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Carretera Madrid-Cartagena, S/N, 30120 Murcia, Spain
- Department of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, Avenida Jerónimos, 135, 30107 Guadalupe, Spain
| | | | | |
Collapse
|
23
|
Hutchinson M. A useful annual review of cognition in relapsing MS is beyond most neurologists - Commentary. Mult Scler 2016; 22:730-2. [PMID: 27048309 DOI: 10.1177/1352458516642624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Hutchinson
- School of Medicine and Medical Sciences, University College Dublin and St Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
24
|
Negreiros AALVD, Sousa-Munõz RLD, Oliveira BESD, Nóbrega PVD, Monteiro LLD. Clinical and epidemiological profile of patients diagnosed with multiple sclerosis in João Pessoa, Paraíba, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:741-5. [PMID: 26352490 DOI: 10.1590/0004-282x20150111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prevalence rates of multiple sclerosis (MS) suggest an interrelationship between genetic and environmental factors, ranging worldwide.Objectives Clinical and epidemiological characterization of MS patients in João Pessoa, Paraíba city.Methods Study involving patients treated in five services in the city.Results It included 87 patients with MS, representing a prevalence of 12.0 cases/100,000 population, mainly women (77%) and white people (66.7%) with mean age of 43 years and average age of the first outbreak of 32.2 years. Motor symptoms (65.5%) and relapsing-remitting clinical form (78.2%) predominated; the average of the Expanded Disability Status Scale (EDSS) scores was 3.5 and 72% used a type of immunomodulatory drug. There was a positive correlation between the number of outbreaks and the duration of the disease with EDSS scores.Conclusions The prevalence of the disease is considered average. The clinical and epidemiological characteristics are in line with most similar Brazilian studies.
Collapse
|
25
|
Tedeholm H, Skoog B, Lisovskaja V, Runmarker B, Nerman O, Andersen O. The outcome spectrum of multiple sclerosis: disability, mortality, and a cluster of predictors from onset. J Neurol 2015; 262:1148-63. [PMID: 25712541 DOI: 10.1007/s00415-015-7674-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
Interest in the long-term natural history of multiple sclerosis (MS) is being revived, as disability endpoints become increasingly important with the advent of highly efficacious long range but potentially harmful drugs. MS had an increasingly benign course, probably due to better assessment and changing diagnostic criteria. Incidence cohorts reduce inclusion bias, capturing both extreme benign and severe cases. We conducted a 50-year follow-up of an incidence cohort of Gothenburg residents with MS onset in 1950-1964 (n = 254; 212 with an initial relapsing-remitting course and 42 with a monophasic course, diagnostic criteria according to Poser). Patients were followed longitudinally until censoring, death, or study termination in 2012 and evaluated using Kaplan-Meier estimates and Cox regression analysis. Median time to secondary progression was 15 years. Median time to EDSS6 and EDSS7 was 26 and 48 years (n = 254), respectively. The cumulative risk of reaching EDSS6 was 50% at 55 years of age and 80% at 80 years of age (n = 212). A score based on a cluster of clinical features at onset predicted secondary progression, EDSS6, EDSS7, and EDSS10 (hazard ratio 1.6-2.3 per score unit for women, 0.99-1.49 for men). This score predicted the disease course during five decades indirectly, by predicting time to secondary progression. Age at onset predicted the course in men, with 3-6% yearly increase in the risk of reaching disability milestones. The present incidence cohort provided hard outcome data in untreated patients over several decades.
Collapse
Affiliation(s)
- Helen Tedeholm
- Section of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 11, 3tr, Sahlgrenska Universitetssjukhuset, 413 45, Gothenburg, Sweden
| | | | | | | | | | | |
Collapse
|
26
|
Sundal C, Baker M, Karrenbauer V, Gustavsen M, Bedri S, Glaser A, Myhr KM, Haugarvoll K, Zetterberg H, Harbo H, Kockum I, Hillert J, Wszolek Z, Rademakers R, Andersen O. Hereditary diffuse leukoencephalopathy with spheroids with phenotype of primary progressive multiple sclerosis. Eur J Neurol 2014; 22:328-333. [PMID: 25311247 DOI: 10.1111/ene.12572] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/25/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Hereditary diffuse leukoencephalopathy with spheroids (HDLS) is a devastating, hereditary white matter (WM) disorder with heterogeneous neuropsychiatric features. Colony stimulating factor 1 receptor (CSF1R) mutations were looked for in primary progressive multiple sclerosis (PPMS) patients and the clinical features of a family with a novel CSF1R mutation are reported. METHODS CSF1R exons 12-22 in a cohort of 220 PPMS patients from the Swedish and Norwegian national multiple sclerosis registries were sequenced. RESULTS One patient had a novel mutation, c.2562T>A; p.Asn854Lys, in the CSF1R gene. Her symptoms started at the age of 29 years with insidious onset of pyramidal weakness in the left leg. The cerebrospinal fluid examination showed four intrathecal immunoglobulin G bands. A magnetic resonance imaging scan performed 4 years after symptom onset demonstrated patchy deep WM lesions. She was diagnosed as having PPMS and treated with intramuscular interferon beta 1a. Due to slow disease progression, the development of memory decline and cerebellar signs, she was given subcutaneous interferon beta 1a without any benefit. The updated pedigree indicated that five siblings also had the CSF1R gene mutation; one was diagnosed with PPMS. Six more distant relatives also had a neurological disorder; four were clinically diagnosed with PPMS. CONCLUSIONS Our study indicates that a chronic course of HDLS may mimic PPMS. Genetic testing for CSF1R gene mutations in PPMS cases with a positive family history of neurological disorders may establish the diagnosis of HDLS.
Collapse
Affiliation(s)
- Christina Sundal
- Department of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Matt Baker
- Department of Neurosciences and Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Virginija Karrenbauer
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marte Gustavsen
- Department of Neurology, Oslo University Hospital, Ullevål and University of Oslo, Norway
| | - Sahl Bedri
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjell-Morten Myhr
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Norway.,Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Hanne Harbo
- Department of Neurology, Oslo University Hospital, Ullevål and University of Oslo, Norway
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Zbigniew Wszolek
- Department of Neurosciences and Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Rosa Rademakers
- Department of Neurosciences and Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Oluf Andersen
- Department of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
27
|
Skoog B, Tedeholm H, Runmarker B, Odén A, Andersen O. Continuous prediction of secondary progression in the individual course of multiple sclerosis. Mult Scler Relat Disord 2014; 3:584-92. [PMID: 26265270 DOI: 10.1016/j.msard.2014.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/23/2014] [Accepted: 04/12/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prediction of the course of multiple sclerosis (MS) was traditionally based on features close to onset. OBJECTIVE To evaluate predictors of the individual risk of secondary progression (SP) identified at any time during relapsing-remitting MS. METHODS We analysed a database comprising an untreated MS incidence cohort (n=306) with five decades of follow-up. Data regarding predictors of all attacks (n=749) and demographics from patients (n=157) with at least one distinct second attack were included as covariates in a Poisson regression analysis with SP as outcome. RESULTS The average hazard function of transition to SPMS was 0.046 events per patient year, showing a maximum at age 33. Three covariates were significant predictors: age, a descriptor of the most recent relapse, and the interaction between the descriptor and time since the relapse. A hazard function termed "prediction score" estimated the risk of SP as number of transition events per patient year (range <0.01 to >0.15). CONCLUSIONS The insights gained from this study are that the risk of transition to SP varies over time in individual patients, that the risk of SP is linked to previous relapses, that predictors in the later stages of the course are more effective than the traditional onset predictors, and that the number of potential predictors can be reduced to a few (three in this study) essential items. This advanced simplification facilitates adaption of the "prediction score" to other (more recent, benign or treated) materials, and allows for compact web-based applications (http://msprediction.com).
Collapse
Affiliation(s)
- Bengt Skoog
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Gothenburg, Sweden.
| | - Helen Tedeholm
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Gothenburg, Sweden
| | - Björn Runmarker
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Gothenburg, Sweden
| | - Anders Odén
- Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Oluf Andersen
- University of Gothenburg, the Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Gothenburg, Sweden
| |
Collapse
|
28
|
Alexoudi A, Zachaki S, Stavropoulou C, Chatzi I, Koumbi D, Stavropoulou K, Kollia P, Karageorgiou CE, Sambani C. CombinedGSTP1andNQO1germline polymorphisms in the susceptibility to Multiple Sclerosis. Int J Neurosci 2014; 125:32-7. [DOI: 10.3109/00207454.2014.899597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
29
|
Köpke S, Kern S, Ziemssen T, Berghoff M, Kleiter I, Marziniak M, Paul F, Vettorazzi E, Pöttgen J, Fischer K, Kasper J, Heesen C. Evidence-based patient information programme in early multiple sclerosis: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2014; 85:411-8. [PMID: 24104856 DOI: 10.1136/jnnp-2013-306441] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an evidence-based patient information programme aiming to increase informed choice in patients with early multiple sclerosis (MS). BACKGROUND Patients with early MS face a number of uncertainties concerning diagnosis, prognosis and effectiveness of immunotherapy. Prior studies suggest that evidence-based patient information combined with group education can promote informed choice in MS patients. METHODS A 12-month, six-centre, double-blind randomised controlled clinical trial with 192 patients with a diagnosis of confirmed relapsing-remitting MS or clinical isolated syndrome in Germany. A 4-h interactive evidence-based educational programme was compared with a 4-h MS-specific stress management programme. The primary endpoint was informed choice after 6 months comprising risk knowledge and congruency between attitude towards immunotherapy and actual immunotherapy uptake. Secondary endpoints included autonomy preference, decision autonomy, decisional conflict and satisfaction, anxiety and depression, and number of immunotherapies. RESULTS For the primary endpoint, a significant difference was shown with 50 of 85 (59%) participants in the intervention group achieving informed choice after 6 months compared with 18 of 89 (20%) in the control group (OR 0.2 (95% CI 0.1 to 0.4), p<0.001). Four weeks after the intervention, more participants in the intervention group showed good risk knowledge (difference between groups 39% (95% CI 26% to 53%), p<0.001). There were no significant differences between groups for attitude towards immunotherapy and for immunotherapy uptake. There were trends towards increased autonomy preference after the intervention and increased adherence to immunotherapies in the intervention group. CONCLUSIONS The intervention significantly increased informed choice and relevant risk knowledge without negative side effects.
Collapse
Affiliation(s)
- Sascha Köpke
- Institute of Social Medicine, University of Lübeck, , Lübeck, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, Herbert J. Natural history of multiple sclerosis symptoms. Int J MS Care 2014; 15:146-58. [PMID: 24453777 DOI: 10.7224/1537-2073.2012-053] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry is a database that contains information from over 35,000 patient volunteers on symptom severity in 11 domains commonly affected in multiple sclerosis (MS): mobility, hand function, vision, fatigue, cognition, bowel/bladder function, sensory, spasticity, pain, depression, and tremor/coordination. The Registry affords a unique opportunity to study the frequency and severity of domain-specific impairment in a contemporary, mostly treated MS cohort over the course of the disease. The objective of this work was to calculate symptom prevalence in each of the 11 domains for years 0 to 30 from symptom onset. The resulting "symptom prevalence tables" demonstrate that a majority of participants perceive at least some degree of impairment in most domains as early as the first year of disease. The severity of impairment increases with disease duration across all domains, but the patterns of disability accumulation differ. The symptom prevalence tables illustrate the magnitude of perceived impact of the disease and highlight the extent of unmet need in symptomatic management. The tables are easy to use and allow MS patients and their clinicians to compare an individual's own impairment in any of the 11 domains to that of NARCOMS participants with the same disease duration.
Collapse
Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Tamar E Bacon
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Eric Chamot
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Amber R Salter
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Gary R Cutter
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Jennifer T Kalina
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Joseph Herbert
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| |
Collapse
|
31
|
Scalfari A, Neuhaus A, Daumer M, Muraro PA, Ebers GC. Onset of secondary progressive phase and long-term evolution of multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:67-75. [PMID: 23486991 DOI: 10.1136/jnnp-2012-304333] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess factors affecting the rate of conversion to secondary progressive (SP) multiple sclerosis (MS) and its subsequent evolution. METHODS Among 806 patients with relapsing remitting (RR) onset MS from the London Ontario database, we used Kaplan-Meier, Cox regression and multiple logistic regression analyses to investigate the effect of baseline clinical and demographic features on (1) the probability of, and the time to, SP disease, (2) the time to bedbound status (Disability Status Scale (DSS 8)) from onset of progression. RESULTS The risk of entering the SP phase increased proportionally with disease duration (OR=1.07 for each additional year; p<0.001). Shorter latency to SP was associated with shorter times to severe disability. The same association was found even when patients were grouped by number of total relapses before progression. However, the evolution of the SP phase was not influenced by the duration of the RR phase. Male sex (HR=1.41; p<0.001), older age at onset (age ≤20 and 21-30 vs >30 HR=0.52 (p<0.001), 0.65 (p<0.001), respectively) and high early relapse frequency (1-2 attacks vs ≥3 HR=0.63 (p<0.001), 0.75 (p=0.04), respectively) predicted significantly higher risk of SP MS and shorter latency to progression. Times to DSS 8 from onset of progression were significantly shorter among those with high early relapse frequency (≥3 attacks), and among those presenting with cerebellar and brainstem symptoms. CONCLUSIONS The onset of SP MS is the dominant determinant of long-term prognosis, and its prevention is the most important target measure for treatment. Baseline clinical features of early relapse frequency and age at onset can be used to select groups at higher risk of developing severe disability based on the probability of their disease becoming progressive within a defined time period.
Collapse
Affiliation(s)
- Antonio Scalfari
- Division of Experimental Medicine, Centre for Neuroscience, Imperial College London, , London, UK
| | | | | | | | | |
Collapse
|
32
|
Novakova L, Skoog B, Runmarker B, Ekholm S, Winblad S, Lisovskaja V, Andersen O. Clinically isolated syndromes with no further disease activity suggestive of multiple sclerosis at the age of population life expectancy. Mult Scler 2013; 20:496-500. [PMID: 23868138 DOI: 10.1177/1352458513496345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The proportion of patients with clinically isolated syndrome (CIS) reported to convert to clinically definite multiple sclerosis varied between 30 and 75%. We studied the lifetime probability of remaining in the "CIS only" condition. The study was based on the longitudinally followed Gothenburg 1950-1964 incidence cohort (n = 306). Survival analysis revealed that 17.8% of 236 attack onset patients remained "CIS only". Patients with afferent (optic and sensory) symptoms had a better prognosis with approximately 30% of these patients remaining "CIS only". Patients who had experienced no relapse during the first 25 years remained "CIS only" for the subsequent 25 years of follow-up.
Collapse
Affiliation(s)
- L Novakova
- Section of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden
| | | | | | | | | | | | | |
Collapse
|
33
|
Kister I, Chamot E, Salter AR, Cutter GR, Bacon TE, Herbert J. Disability in multiple sclerosis: a reference for patients and clinicians. Neurology 2013; 80:1018-24. [PMID: 23427319 DOI: 10.1212/wnl.0b013e3182872855] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To create a reference table of disability outcomes in multiple sclerosis (MS) that would enable patients to rank their disability relative to others' with similar disease duration and to develop a cost-effective research tool for comparing MS severity across patient populations and time periods. METHODS The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry collects disability data from patients with MS on a validated, 9-point Patient-Determined Disease Steps (PDDS) scale. We compiled the Disability Expectancy Table, which displays cumulative frequencies of PDDS scores for each year of disease duration, from 0 to 45 years. We also tabulated disease duration-adjusted mean ranks of PDDS scores, referred to as Patient-derived MS Severity Scores (P-MSSS). RESULTS The cohort consisted of 27,918 NARCOMS enrollees, 72.7% of whom were female and 90.1% of whom were white. Mean age at symptom onset was 30.1 ± 10.1 years, and age at enrollment was 47.1 ± 11.0 years. The Disability Expectancy Table and P-MSSS afford a detailed overview of disability outcomes in a large MS cohort over a 45-year period. In the first year of disease, 15% of patients reported need of ambulatory aid, and 4% needed bilateral assistance or worse; after 45 years of disease, 76% of patients required ambulatory aid, and 52% bilateral assistance or worse. Proportion of patients who reported minimal or no interference in daily activities (PDDS ≤ 1) declined from 63% in the first year to 8% after 45 years of disease. CONCLUSION The Disability Expectancy Table allows individual patients to determine how their disability ranks relative to NARCOMS enrollees with the same disease duration. P-MSSS may be used to compare disability across patient populations and to track disease progression in patient cohorts. P-MSSS does not require a formal neurologic examination and may therefore find wide applicability as a practical and cost-effective outcome measure in epidemiologic studies.
Collapse
Affiliation(s)
- Ilya Kister
- Department of Neurology, NYU-Multiple Sclerosis Care Center, NYU School of Medicine, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Andersen O. From the Gothenburg cohort to the Swedish multiple sclerosis registry. Acta Neurol Scand 2012:13-9. [PMID: 23278651 DOI: 10.1111/ane.12023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
An overview of prevalence and incidence studies performed in Swedish centres is provided, showing improving coverage and methodology, notably the development in Gothenburg of the representative incidence cohort design. A common database for major Swedish centres was established in 1995, implementing the terminology of predictors from the Gothenburg cohort. By 2001, these databases were merged into the web-based national multiple sclerosis (MS) registry, which has had an ever-increasing coverage, although with still moderate data density. The registry now contains records on 13,000 Swedish patients with MS. It has the status of a national quality registry and exerts nation-wide pharmacological surveillance. In addition, it has been, and is being, used in nearly 100 scientific studies, including large epidemiological and genetic projects.
Collapse
Affiliation(s)
- O. Andersen
- Institution of Neuroscience and Physiology; University of Gothenburg; Gothenburg; Sweden
| |
Collapse
|
35
|
Abstract
Personalized treatment is highly desirable in multiple sclerosis because it is an immensely heterogeneous disease. This heterogeneity is seen in both the disease course and the treatment responses. Currently, a combination of clinical features and imaging parameters in magnetic resonance imaging is used to classify active and non-active patients and treatment responders and non-responders. Although this classification works on a group level, individual patients often behave differently from the group. Therefore additional biomarkers are needed to provide better indicators for prognosis and treatment response. Basic and clinical research have discovered different promising targets. It is now essential to verify the utility and accuracy of these markers in large, prospectively sampled patient cohorts.
Collapse
Affiliation(s)
- Tobias Derfuss
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| |
Collapse
|
36
|
Leray E, Coustans M, Le Page E, Yaouanq J, Oger J, Edan G. 'Clinically definite benign multiple sclerosis', an unwarranted conceptual hodgepodge: evidence from a 30-year observational study. Mult Scler 2012; 19:458-65. [PMID: 22859724 DOI: 10.1177/1352458512456613] [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 Benign multiple sclerosis (BMS) is a controversial concept which is still debated. However identification of this kind of patients is crucial to prevent them from unnecessary exposure to aggressive and/or long term medical treatments. OBJECTIVES To assess two definitions of 'clinically definite benign multiple sclerosis' (CDBMS) using long-term follow-up data, and to look for prognostic factors of CDBMS. METHODS In 874 patients with definite relapsing-remitting MS, followed up for at least 10 years, disability was assessed using the Disability Status Scale (DSS). CDBMS was defined by either DSS score≤2 (CDBMS1 group) or DSS score≤ 3 (CDBMS2 group) at 10 years. We estimated the proportion of patients who were still benign at 20 and 30 years after clinical onset. RESULTS CDBMS frequency estimates were 57.7% and 73.9% when using CDBMS1 and CDBMS2 definitions, respectively. In the CDBMS1 group, only 41.7% (105/252) of cases were still benign 10 years later, and 41.1% (23/56) after an additional decade, while there were 53.8% (162/301) and 59.5% (44/74) respectively in the CDBMS2 group. CONCLUSIONS This 30-year observational study, which is one of the largest published series, indicates that favourable 10-year disability scores of DSS 2 or 3 fail to ensure a long-term benign course of multiple sclerosis. After every decade almost half of the CDBMS were no longer benign. CDBMS, as currently defined, is an unwarranted conceptual hodgepodge. Other criteria using new biomarkers (genetic, biologic or MRI) should be found to detect benign cases of MS.
Collapse
Affiliation(s)
- E Leray
- Epidemiology Department, EHESP School of Public Health, Rennes, France
| | | | | | | | | | | |
Collapse
|
37
|
Hutchinson M. There is no such thing as a mild MS relapse. The mild relapse is an Anglo-Saxon delusion - Commentary. Mult Scler 2012; 18:930-1. [DOI: 10.1177/1352458512450091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Hutchinson
- Consultant Neurologist, St Vincent’s University Hospital and Newman Clinical Research Professor, University College Dublin, Ireland
| |
Collapse
|
38
|
|