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Arroyo Pereiro P, Muñoz-Vendrell A, León Moreno I, Bau L, Matas E, Romero-Pinel L, Martínez Yélamos A, Martínez Yélamos S, Andrés-Benito P. Baseline serum neurofilament light chain levels differentiate aggressive from benign forms of relapsing-remitting multiple sclerosis: a 20-year follow-up cohort. J Neurol 2024; 271:1599-1609. [PMID: 38085343 PMCID: PMC10973070 DOI: 10.1007/s00415-023-12135-w] [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] [Received: 10/08/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Serum biomarkers are emerging as useful prognostic tools for multiple sclerosis (MS); however, long-term studies are lacking. We aimed to evaluate the long-term prognostic value of the serum levels of neurofilament light chain (NfL), total tau, glial fibrillary acidic protein (GFAP), and chitinase 3-like-1 (CHI3L1) measured close to the time of MS onset. METHODS In this retrospective, exploratory, observational, case and controls study, patients with relapsing-remitting MS (RRMS) with available baseline serum samples and prospectively follow-up in our MS unit for a long time were selected based on their clinical evolution to form two groups: (1) a benign RRMS (bRRMS) group, defined as patients with an Expanded Disability Status Scale (EDSS) score of ≤ 3 at ≥ 10 years of follow-up; (2) an aggressive RRMS (aRRMS) group, defined as patients with an EDSS score of ≥ 6 at ≤ 15 years of follow-up. An age-matched healthy control (HC) group was selected. NfL, total tau, and GFAP serum levels were quantified using a single-molecule array (SIMOA), and CHI3L1 was quantified using ELISA. RESULTS Thirty-one patients with bRRMS, 19 with aRRMS, and 10 HC were included. The median follow-up time from sample collection was 17.74 years (interquartile range, 14.60-20.37). Bivariate and multivariate analyses revealed significantly higher NfL and GFAP levels in the aRRMS group than in the bRRMS group. A receiver operating characteristic curve analysis identified serum NfL level as the most efficient marker for distinguishing aRRMS from bRRMS. DISCUSSION This proof-of-concept study comparing benign and aggressive RRMS groups reinforces the potential role of baseline NfL serum levels as a promising long-term disability prognostic marker. In contrast, serum GFAP, total tau, and CHI3L1 levels demonstrated a lower or no ability to differentiate between the long-term outcomes of RRMS.
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Affiliation(s)
- Pablo Arroyo Pereiro
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Isabel León Moreno
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Laura Bau
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Elisabet Matas
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Lucía Romero-Pinel
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Pol Andrés-Benito
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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Rhodes JS, Aumon A, Morin S, Girard M, Larochelle C, Brunet-Ratnasingham E, Pagliuzza A, Marchitto L, Zhang W, Cutler A, Grand'Maison F, Zhou A, Finzi A, Chomont N, Kaufmann DE, Zandee S, Prat A, Wolf G, Moon KR. Gaining Biological Insights through Supervised Data Visualization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.22.568384. [PMID: 38293135 PMCID: PMC10827133 DOI: 10.1101/2023.11.22.568384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Dimensionality reduction-based data visualization is pivotal in comprehending complex biological data. The most common methods, such as PHATE, t-SNE, and UMAP, are unsupervised and therefore reflect the dominant structure in the data, which may be independent of expert-provided labels. Here we introduce a supervised data visualization method called RF-PHATE, which integrates expert knowledge for further exploration of the data. RF-PHATE leverages random forests to capture intricate featurelabel relationships. Extracting information from the forest, RF-PHATE generates low-dimensional visualizations that highlight relevant data relationships while disregarding extraneous features. This approach scales to large datasets and applies to classification and regression. We illustrate RF-PHATE's prowess through three case studies. In a multiple sclerosis study using longitudinal clinical and imaging data, RF-PHATE unveils a sub-group of patients with non-benign relapsingremitting Multiple Sclerosis, demonstrating its aptitude for time-series data. In the context of Raman spectral data, RF-PHATE effectively showcases the impact of antioxidants on diesel exhaust-exposed lung cells, highlighting its proficiency in noisy environments. Furthermore, RF-PHATE aligns established geometric structures with COVID-19 patient outcomes, enriching interpretability in a hierarchical manner. RF-PHATE bridges expert insights and visualizations, promising knowledge generation. Its adaptability, scalability, and noise tolerance underscore its potential for widespread adoption.
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Ahvenjärvi H, Niiranen M, Simula S, Hämäläinen P, Surcel HM, Remes AM, Ryytty M, Krüger J. Fatigue and health-related quality of life depend on the disability status and clinical course in RRMS. Mult Scler Relat Disord 2023; 77:104861. [PMID: 37442075 DOI: 10.1016/j.msard.2023.104861] [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] [Received: 01/05/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fatigue is a prominent and disabling symptom of multiple sclerosis (MS), impairing quality of life. The disease course of relapsing remitting MS (RRMS) is individual. OBJECTIVES We aimed to study the effects of demographic and clinical characteristics, as well as lifestyle risk factors on experienced fatigue and health-related quality of life (HRQoL) among RRMS patients, comparing benign and severe disease types. METHODS Altogether 198 Finnish RRMS patients were recruited for this real-life cross-sectional study. Self-reported questionnaires were used to evaluate fatigue and HRQoL by using Fatigue Scale for Motor and Cognitive Functions and 15D health-related quality of life questionnaires. Patients were categorized into subgroups based on the current disability status measured by the Expanded Disability Status Scale (EDSS) cut-off value of 4.5, and by retrospective clinical course divided into benign and aggressive RRMS. RESULTS All in all, 73% of the RRMS patients suffered from fatigue. Lower HRQoL had a strong correlation with more prominent fatigue (r = -0.719). Higher EDSS was associated with more prominent fatigue and lower HRQoL in the whole RRMS cohort. Older age at the disease onset was associated with more prominent fatigue and decreased HRQoL in the groups of aggressive RRMS and EDSS > 4.5. In the groups of EDSS ≤ 4.5 and benign RRMS, a higher number of used disease-modifying treatments (DMTs) was associated with more pronounced fatigue and reduced HRQoL. In addition, higher BMI was associated with lower HRQoL in patients with benign RRMS. Side effects (45 %) and lack of efficacy (26 %) were the most common reasons for discontinuing a DMT. Cessation due to side effects was the only reason that was significantly associated with more prominent fatigue and lower HRQoL. Use of nicotine products, gender, or disease duration were not associated with fatigue or HRQoL. CONCLUSIONS Individuals with severe RRMS and higher EDSS scores are more prone to experience fatigue and lower HRQoL. In addition, fatigue and lower HRQoL are more commonly observed among RRMS patients with older age at disease onset and in those with multiple DMT switches.
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Affiliation(s)
- Henrik Ahvenjärvi
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland
| | - Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sakari Simula
- Southern Savo Hospital District, Department of Neurology, Porrassalmenkatu 35-37, FI-50100 Mikkeli, Finland
| | - Päivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Vaihemäentie 10, FI-21250 Masku, Finland; Department of Psychology, FI-20014 University of Turku, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, P.O. Box 8000, FI-90014 University of Oulu, Finland; Biobank Borealis of Northern Finland, Northern Ostrobothnia Hospital District, P.O. Box 10, FI-90029 Oulu University Hospital, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Clinical Neurosciences, P.O. Box 4, Yliopistonkatu 3, FI-00014 University of Helsinki, Finland
| | - Mervi Ryytty
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Finland; Medical Research Center, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, P.O. Box 10, FI-90029 OYS, Oulu, Finland.
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Rzepiński Ł, Kucharczuk J, Tkaczyńska M, Parisi V, Grzybowski A. Swept-Source Optical Coherence Tomography Thresholds in Differentiating Clinical Outcomes in a Real-World Cohort of Treatment-Naïve Multiple Sclerosis Patients. Brain Sci 2023; 13:brainsci13040591. [PMID: 37190556 DOI: 10.3390/brainsci13040591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
This study aimed to determine whether peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell–inner plexiform layer (GCIPL) thickness thresholds for single-time-point swept-source optical coherence tomography (SS-OCT) measures can differentiate the clinical outcomes of treatment-naïve people with multiple sclerosis (pwMS). A total of 275 patients with the clinically isolated syndrome (n = 23), benign MS (n = 8), relapsing–remitting MS (n = 185), secondary progressive MS (n = 28), primary progressive MS (n = 31), and with no history of optic neuritis were included. The mean Expanded Disability Status Scale (EDSS) score was 3.0 ± 1.6. The cut-off values of pRNFL (87 µm and 88 µm) and GCIPL (70 µm) thicknesses have been adopted from previous studies using spectral-domain OCT. PwMS with pRNFL ≤87 µm and ≤88 µm had a longer disease duration, more advanced disability, and more frequently progressive MS variants compared to those with greater pRNFL thicknesses. In distinguishing pwMS with disability greater than or equal to the mean EDSS score (EDSS ≥ 3) from those with less severe disability, GCIPL thickness <70 µm had the highest sensitivity, while pRNFL thickness ≤87 µm had the greatest specificity. The optimal cut-off values differentiating patients with EDSS ≥ 3 from those with less severe disability was 63 µm for GCIPL thickness and 93.5 µm for pRNFL thickness. In conclusion, pRNFL and GCIPL thickness thresholds for single-time-point SS-OCT measurements may be helpful in differentiating the disability status of treatment-naïve pwMS.
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Affiliation(s)
- Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
- Sanitas—Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Jan Kucharczuk
- Department of Ophthalmology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
| | - Magda Tkaczyńska
- Department of Surgery, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Mickiewicza 24/3B, 60-836 Poznan, Poland
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Al-Hawasi A, Lagali N, Fagerholm P, Huang-Link Y. Longitudinal Optical Coherence Tomography Measurement of Retinal Ganglion Cell and Nerve Fiber Layer to Assess Benign Course in Multiple Sclerosis. J Clin Med 2023; 12:jcm12062240. [PMID: 36983241 PMCID: PMC10054631 DOI: 10.3390/jcm12062240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
A benign form of multiple sclerosis (BMS) is not easily diagnosed, but changes of the retinal ganglion cell layer-inner plexiform layer (GCL-IPL) and retinal nerve fiber layer (RNFL) may be sensitive to the disease. The aim of this study was to use optical coherence tomography (OCT) to investigate longitudinal changes of GCL-IPL and RNFL in BMS. Eighteen patients with BMS and 22 healthy control (HC) subjects were included, with a mean follow-up period of 32.1 months in BMS and 34.3 months in HC. Mean disease duration in BMS was 23.3 years, with 14 patients left untreated. Unilateral optic neuritis (ON) was found in eight patients. Non-ON eyes showed thinner GCL-IPL layer in the BMS group relative to HC (p < 0.001). The thinning rate of GCL-IPL in non-ON BMS, however, was −0.19 ± 0.15 µm/year vs. 0 ± 0.11 µm/year for HC (p = 0.573, age-adjusted). Thinning rate of RNFL in non-ON BMS was −0.2 ± 0.27 µm/year vs. −0.05 ± 0.3 µm/year for HC (p = 0.454, age adjusted). Conclusions: Thinning rate of the GCL-IPL and RNFL in BMS is similar to the healthy population but differs from the thinning rate in relapsing-remitting MS, presenting a non-invasive OCT-based criterion for assessing a benign course in multiple sclerosis.
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Affiliation(s)
- Abbas Al-Hawasi
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden
- Correspondence:
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Per Fagerholm
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Yumin Huang-Link
- Division of Neurology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden
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Niiranen M, Koikkalainen J, Lötjönen J, Selander T, Cajanus A, Hartikainen P, Simula S, Vanninen R, Remes AM. Grey matter atrophy in patients with benign multiple sclerosis. Brain Behav 2022; 12:e2679. [PMID: 35765699 PMCID: PMC9304852 DOI: 10.1002/brb3.2679] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brain atrophy appears during the progression of multiple sclerosis (MS) and is associated with the disability caused by the disease. METHODS We investigated global and regional grey matter (GM) and white matter (WM) volumes, WM lesion load, and corpus callosum index (CCI), in benign relapsing-remitting MS (BRRMS, n = 35) with and without any treatment and compared those to aggressive relapsing-remitting MS (ARRMS, n = 46). Structures were analyzed by using an automated MRI quantification tool (cNeuro®). RESULTS The total brain and cerebral WM volumes were larger in BRRMS than in ARRMS (p = .014, p = .017 respectively). In BRRMS, total brain volumes, regional GM volumes, and CCI were found similar whether or not disease-modifying treatment (DMT) was used. The total (p = .033), as well as subcortical (p = .046) and deep WM (p = .041) lesion load volumes were larger in BRRMS patients without DMT. Cortical GM volumes did not differ between BRRMS and ARRMS, but the volumes of total brain tissue (p = .014) and thalami (p = .003) were larger in patients with BRRMS compared to ARRMS. A positive correlation was found between CCI and whole-brain volume in both BRRMS (r = .73, p < .001) and ARRMS (r = .80, p < .01). CONCLUSIONS Thalamic volume is the most prominent measure to differentiate BRRMS and ARRMS. Validation of automated quantification of CCI provides an additional applicable MRI biomarker to detect brain atrophy in MS.
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Affiliation(s)
- Marja Niiranen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine - Radiology, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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Niiranen M, Kontkanen A, Jääskeläinen O, Tertsunen HM, Selander T, Hartikainen P, Huber N, Solje E, Haapasalo A, Kokkola T, Lohioja T, Herukka SK, Simula S, Remes AM. Serum GFAP and NfL levels in benign relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2021; 56:103280. [PMID: 34627002 DOI: 10.1016/j.msard.2021.103280] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to investigate serum glial fibrillary acidic protein (GFAP) and serum neurofilament light chain (NfL) levels as potential discriminative biomarkers between benign relapsing-remitting multiple sclerosis (BRRMS) and aggressive relapsing-remitting MS (ARRMS). METHODS Serum GFAP and NfL levels were analyzed in patients with BRRMS (n = 34), ARRMS (n = 29), and healthy controls (n = 14) by using Single Molecule Array (Simoa). Patients with ARRMS had been treated with highly effective disease-modifying treatments (DMT) (fingolimod or natalizumab). RESULTS Serum GFAP levels in both BRRMS (median 210.19 pg/ml, IQR 163.69-287.19) and in ARRMS (median 188.60 pg/ml, IQR39.23-244.93) were significantly higher (p = 0.035 and p = 0.034, respectively) compared to healthy controls (median 117.93 pg/ml, IQR 60.28-183.83). Serum GFAP levels did not differ between BRRMS and ARRMS. There were no statistical differences in NfL levels between BRRMS, ARRMS and healthy controls. GFAP level was significantly higher (p = 0.04) in BRRMS without DMT (median 216.04 pg/ml, IQR 188.60-274.79) than in those BRRMS patients who had used DMT (median 196.26 pg/ml, IQR 133.33-325.54). CONCLUSIONS We found elevated levels of serum GFAP in both BRRMS and ARRMS compared to healthy controls, reflecting astrocytic activation. Serum NfL did not differ between BRRMS and ARRMS, probably due to the stable inflammatory phase of the disease and effective DMT use in ARRMS. Single serum NfL and GFAP measurements cannot separate a patient with BRRMS from effectively treated ARRMS after a long history of the disease, thus consecutive samples are needed in the follow-up.
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Affiliation(s)
- Marja Niiranen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland.
| | - Aleksi Kontkanen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Olli Jääskeläinen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Hanna-Mari Tertsunen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland
| | - Nadine Huber
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eino Solje
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tarja Lohioja
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland
| | - Sanna-Kaisa Herukka
- Neuro Center, Neurology Outpatient Clinic, Kuopio University Hospital, P.O. BOX 100, Kuopio FI-70029, Finland; Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
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Rzepiński Ł, Kucharczuk J, Maciejek Z, Grzybowski A, Parisi V. Spectral-Domain Optical Coherence Tomography Assessment in Treatment-Naïve Patients with Clinically Isolated Syndrome and Different Multiple Sclerosis Types: Findings and Relationship with the Disability Status. J Clin Med 2021; 10:jcm10132892. [PMID: 34209692 PMCID: PMC8268329 DOI: 10.3390/jcm10132892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 01/08/2023] Open
Abstract
This study evaluates the peripapillary retinal nerve fiber layer (pRNFL) thickness and total macular volume (TMV) using spectral-domain optical coherence tomography in treatment naïve patients with the clinically isolated syndrome (CIS) and different multiple sclerosis (MS) types. A total of 126 patients (15 CIS, 65 relapsing-remitting MS, 14 secondary progressive MS, 11 primary progressive MS, 21 benign MS) with or without optic neuritis (ON) history and 63 healthy age-similar controls were assessed. Concerning controls' eyes, pRNFL thickness was significantly reduced in CIS-ON eyes (p < 0.01), while both TMV and pRNFL thickness was decreased in all MS eyes regardless of ON history (p < 0.01). Significant differences in pRNFL thickness and TMV between MS variants were observed for non-ON eyes (p < 0.01), with the lowest values in benign and secondary progressive disease type, respectively. The pRNFL thickness was inversely correlated with Expanded Disability Status Scale (EDSS) score in non-ON subgroups (p < 0.01), whereas TMV was inversely correlated with EDSS score in both ON and non-ON subgroups (p < 0.01). Concluding, pRNFL thinning confirms optic nerve damage in CIS-ON eyes and appears to be disproportionately high with respect to the disability status of benign MS patients. The values of TMV and pRNFL in non-ON eyes significantly correspond to MS course heterogeneity and patients' disability than in ON eyes.
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Affiliation(s)
- Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland;
- Neurology Department, Sanitas—Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
- Correspondence:
| | - Jan Kucharczuk
- Department of Ophthalmology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland;
| | - Zdzisław Maciejek
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland;
- Neurology Department, Sanitas—Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland;
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Mickiewicza 24/3B, 60-836 Poznan, Poland
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Hegedüs K, Kárpáti J, Iljicsov A, Simó M. Neuropsychological characteristics of benign multiple sclerosis patients: A two-year matched cohort study. Mult Scler Relat Disord 2019; 35:150-155. [PMID: 31376686 DOI: 10.1016/j.msard.2019.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The definition of benign multiple sclerosis (BMS) is still debated. It is mainly based on physical status, however, there is an attempt to involve cognitive functioning or paraclinical factors in order to avoid unnecessary long-term treatment with disease-modifying therapies and to identify these subjects in the early stages of the disease. Therefore the aim of our two-year follow-up study was to investigate the pattern of cognitive functioning and depression in patients with BMS compared to treated relapsing-remitting MS (RRMS) patients and healthy controls. METHODS A group of 22 BMS patients was tested against matched RRMS patients and healthy controls. All individuals underwent neuropsychological evaluation exploring mood and the cognitive domains most frequently impaired in MS. MS patients were retested at two-year follow-up. RESULTS In terms of cognitive functions there were no differences between BMS and RRMS patients either at baseline or at two-year follow-up. Compared to healthy controls BMS patients showed poorer performance in long-term visuo-spatial memory and information processing speed, whereas, complex attention, working memory, long-term verbal memory - despite slower verbal learning - and executive function were found to be intact. RRMS patients showed significant difference in complex attention, long-term visual memory and information processing speed. Cognitive impairment differed in the patient groups in terms of severity. Both patient groups were depressed compared to controls, but significant differences were found only between BMS and healthy individuals. CONCLUSION The results of our study confirm that cognitive functions and mood can be affected in MS independent of disease course and disease modifying treatment. The "benign" label should be treated as only a reference to physical status and non-motor symptoms should be routinely monitored. Without receiving therapy it is an existing entity with longstanding minimal disability.
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Affiliation(s)
- Katalin Hegedüs
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary.
| | - Judit Kárpáti
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
| | - Anna Iljicsov
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
| | - Magdolna Simó
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
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Wiberg M, Murley C, Tinghög P, Alexanderson K, Palmer E, Hillert J, Stenbeck M, Friberg E. Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time. BMJ Open 2019; 9:e024836. [PMID: 31300492 PMCID: PMC6629418 DOI: 10.1136/bmjopen-2018-024836] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate earnings among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS, and if identified differences were associated with educational levels and types of occupations. Furthermore, to assess the proportions on sickness absence (SA) and disability pension (DP) in both groups. DESIGN Population-based longitudinal cohort study, 10 years before until 5 years after MS diagnosis. SETTING Working-age population using microdata linked from nationwide Swedish registers. PARTICIPANTS Residents in Sweden in 2004 aged 30-54 years with MS diagnosed in 2003-2006 (n=2553), and references without MS (n=7584) randomly selected by stratified matching. OUTCOME MEASURES Quartiles of earnings were calculated for each study year prior to and following the MS diagnosis. Mean earnings, by educational level and type of occupation, before and after diagnosis were compared using t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. The proportions on SA and/or DP, by educational level and type of occupation, for the diagnosis year and 5 years later were compared. RESULTS Differences in earnings between PwMS and references were observed beginning 1 year before diagnosis, and increased thereafter. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28 000, p<0.05), and 5 years after diagnosis, this difference had more than doubled (p<0.05). These differences remained after including educational level and type of occupation. Overall, the earnings of PwMS with university education and/or more qualified occupations were most like their reference peers. The proportions on SA and DP were higher among PwMS than the references. CONCLUSIONS The results suggest that the PwMS' earnings are lower than the references' beginning shortly before MS diagnosis, with this gap increasing thereafter. Besides SA and DP, the results indicate that educational level and type of occupation are influential determinants of the large heterogeneity of PwMS' earnings.
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Affiliation(s)
- Michael Wiberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Edward Palmer
- Uppsala Center for Labor Studies, Department of Economics, Uppsala University, Uppsala, Sweden
| | - Jan Hillert
- Division of Neurology, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Stenbeck
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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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.
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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
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12
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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.
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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.
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13
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Ton AMM, Vasconcelos CCF, Alvarenga RMP. Benign multiple sclerosis: aspects of cognition and neuroimaging. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:394-401. [PMID: 28658410 DOI: 10.1590/0004-282x20170043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022]
Abstract
The existence of a benign multiple sclerosis (BMS) form is a controversial subject. Recent studies of these patients reveal different levels of cognitive impairment, despite the apparent preservation of motor function. The objective of this study was to review and analyze a number of publications that discuss the general aspects of this disease form, such as the definition criteria, prevalence, and clinical and neuroimaging markers. A systematic review of published data on BMS up to October 2015 was performed. Thirty-one published articles were analyzed. The estimated frequency of BMS varied between 6% and 73%. Cognitive impairment was recognized as affecting 17% to 47% of the subjects and presented significant correlation with neuroimaging, such as brain atrophy, increased lesion volume in T2 magnetic resonance assay, and regional grey matter atrophy. The current criteria overestimated the frequency of BMS and, for that reason, this highlights the importance of validating the diagnostic methods practiced.
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Zivadinov R, Cookfair DL, Krupp L, Miller AE, Lava N, Coyle PK, Goodman AD, Jubelt B, Lenihan M, Herbert J, Gottesman M, Snyder DH, Apatoff BR, Teter BE, Perel AB, Munschauer F, Weinstock-Guttman B. Factors associated with benign multiple sclerosis in the New York State MS Consortium (NYSMSC). BMC Neurol 2016; 16:102. [PMID: 27416843 PMCID: PMC4946222 DOI: 10.1186/s12883-016-0623-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This retrospective analysis explored prognostic factors associated with a benign multiple sclerosis (BMS) disease course at baseline and over the 4-year follow-up. METHODS Patients from the centralized New York State Multiple Sclerosis Consortium registry were classified as having BMS according to 3 different criteria centered on disease duration and disability. Additional analyses explored prognostic factors associated with BMS using the most conservative disability criteria (Expanded Disability Status Scale ≤2 and disease duration ≥10 years). RESULTS Among 6258 patients who fulfilled eligibility criteria, 19.8 % to 33.3 % were characterized as having BMS, at baseline depending on classification criteria used. Positive prognostic factors for BMS at baseline included female sex (p < 0.0001) and younger age at onset (p < 0.0001); negative prognostic factors included progressive-onset type of MS and African-American race. Of the 1237 BMS patients (per most conservative criteria), 742 were followed for a median of 4 years to explore effect of disease-modifying treatment (DMT) on benign status. DMT (p = 0.009) and longer disease duration (p = 0.007) were the only significant positive predictors of maintaining BMS at follow-up. The protective effect was stronger for patients taking DMT at both enrollment and follow-up (OR = 0.71; p = 0.006). CONCLUSIONS There is a need for development of more reliable prognostic indicators of BMS. Use of DMT was significantly associated with maintaining a benign disease state.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. .,Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
| | - Diane L Cookfair
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Lauren Krupp
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aaron E Miller
- The Corinne Goldsmith Dickinson Center of Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA
| | - Neil Lava
- Department of Neurology, Albany Medical School, Multiple Sclerosis Center, Albany, NY, USA
| | - Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Andrew D Goodman
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Burk Jubelt
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Joseph Herbert
- Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Malcolm Gottesman
- Department of Neuroscience, Winthrop University Hospital, Mineola, NY, USA
| | - David H Snyder
- Department of Neurology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Barbara E Teter
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | | | - Frederick Munschauer
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
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15
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Gajofatto A, Turatti M, Bianchi MR, Forlivesi S, Gobbin F, Azzarà A, Monaco S, Benedetti MD. Benign multiple sclerosis: physical and cognitive impairment follow distinct evolutions. Acta Neurol Scand 2016; 133:183-91. [PMID: 26009804 DOI: 10.1111/ane.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare. OBJECTIVE To study the evolution of physical disability and cognitive performance of a group of patients with BMS followed at an University Hospital Multiple Sclerosis Center. METHODS A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing-remitting course, disease duration ≥ 10 years, and expanded disability status scale [EDSS] score ≤ 2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5-5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥ 1 point (or 0.5 point if baseline EDSS score = 5.5). RESULTS At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0-2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5-5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups. CONCLUSIONS Patients with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in patients with BMS given the distinct pathways followed by disease progression in cognitive and physical domains.
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Affiliation(s)
- A. Gajofatto
- Department of Neurological and Movement Sciences; University of Verona; Verona Italy
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - M. Turatti
- UO Neurologia; Casa di Cura Privata Pederzoli; Peschiera del Garda Italy
| | - M. R. Bianchi
- Department of Neurological and Movement Sciences; University of Verona; Verona Italy
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - S. Forlivesi
- Department of Neurological and Movement Sciences; University of Verona; Verona Italy
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - F. Gobbin
- Department of Neurological and Movement Sciences; University of Verona; Verona Italy
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - A. Azzarà
- Istituto Auxologico Italiano; Milano Italy
| | - S. Monaco
- Department of Neurological and Movement Sciences; University of Verona; Verona Italy
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - M. D. Benedetti
- UOC Neurologia dU; Azienda Ospedaliera Universitaria Integrata; Verona Italy
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Raggi A, Covelli V, Schiavolin S, Scaratti C, Leonardi M, Willems M. Work-related problems in multiple sclerosis: a literature review on its associates and determinants. Disabil Rehabil 2015. [DOI: 10.3109/09638288.2015.1070295] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Huang-Link YM, Fredrikson M, Link H. Benign Multiple Sclerosis is Associated with Reduced Thinning of the Retinal Nerve Fiber and Ganglion Cell Layers in Non-Optic-Neuritis Eyes. J Clin Neurol 2015; 11:241-7. [PMID: 26022460 PMCID: PMC4507378 DOI: 10.3988/jcn.2015.11.3.241] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose It is exceedingly difficult to differentiate benign multiple sclerosis (BMS) from relapsing-remitting multiple sclerosis (RRMS) based on clinical characteristics, neuroimaging, and cerebrospinal fluid tests. Optical coherence tomography (OCT) allows quantification of retinal structures, such as the retinal nerve fiber layer (RNFL) thickness, at the optic disc and the ganglion cell layer (GCL) at the macula, on a micrometer scale. It can also be used to trace minor alterations and the progression of neurodegeneration, help predict BMS, and influence the choice of therapy. To utilize OCT to detect the extent of changes of the optic disk and macular microstructure in patients with BMS and RRMS compared to healthy controls (HCs), with special focus on changes related to the presence/absence of optic neuritis (ON). Methods Spectral-domain OCT was applied to examine eyes from 36 patients with multiple sclerosis (MS), comprising 11 with BMS and 25 with RRMS, and 34 HCs. Results The RNFL and GCL were significantly thinner in eyes previously affected by ON, irrespective of the type of MS (i.e., BMS or RRMS), than in HCs. Significant thinning of the GCL was also observed in non-ON RRMS (and not non-ON BMS) compared to HCs. Correspondingly, a significant association between disease duration and thinning rates of the RNFL and GCL was observed only in non-ON RRMS (-0.54±0.24 and -0.43±0.21 µm/year, mean±SE; p<0.05 for both), and not in non-ON BMS (-0.11±0.27 and -0.24±0.24 µm/year). Conclusions The RNFL and GCL were thinner in both ON- and non-ON MS, but the change was more pronounced in ON MS, irrespective of the MS subtype studied herein. GCL thinning and the thinning rate of both the GCL and RNFL were less pronounced in non-ON BMS than in non-ON RRMS. These findings may help to predict the course of BMS.
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Affiliation(s)
- Yu Min Huang-Link
- Division of Neurology, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden. yumin.link@ regionostergotland.se
| | - Mats Fredrikson
- Department of Occupational and Environmental Medicine and Linkoping Academic Research Center (LARC), Linköping University, Linköping, Sweden
| | - Hans Link
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Shahrbanian S, Auais M, Duquette P, Anderson K, Mayo NE. Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis. Pain Res Manag 2013; 18:e94-e100. [PMID: 24093124 PMCID: PMC3805355 DOI: 10.1155/2013/829464] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) experience some of the highest unemployment rates among all groups of chronic illnesses. Pain has been found to be a common reason for sick leave or early retirement in healthy populations or other groups with chronic illness; however, there is little awareness regarding the effect of pain on the work status of individuals with MS. OBJECTIVES To estimate the extent to which individuals with pain differ in employment status compared with those without pain among MS patients. METHODS An extensive systematic review of the scientific literature was performed within the framework of the Cochrane Collaboration to identify studies focusing on the effect of pain on employment in individuals with MS. The following databases were searched: PubMed, EMBASE, PsychInfo, Web of Science, MD Consult and Elsevier, and Science Direct. The methodological quality of studies was assessed using the McMaster Critical Review Form. RESULTS Ten articles met the inclusion criteria and were included in the systematic review. Of these studies, five that exhibited clinical, methodological and statistical homogeneity were included in the meta-analysis. The between-groups (pain + versus pain -) pooled random OR of being employed was 0.7 (strong), and was significantly different from unity (95% CI 0.5 to 0.9; P=0.001). CONCLUSIONS The results of the present study indicated that individuals with MS who experience pain were significantly more likely to report a decreased employment rate than individuals with MS who were pain free.
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Affiliation(s)
- Shahnaz Shahrbanian
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec
| | - Mohammad Auais
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec
| | - Pierre Duquette
- Notre-Dame Hospital (CHUM), University of Montreal, Montreal, Quebec
| | - Katie Anderson
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec
| | - Nancy E Mayo
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec
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Abstract
Although the definition of benign multiple sclerosis (BMS) remains controversial, it is generally applied to a subgroup of MS patients showing little disease progression, with minimal disability decades after disease onset, and is based mainly on changes in motor function. Recent studies, however, reveal that deterioration of cognitive function, fatigue, pain, and depression also occur in BMS patients, causing negative impact on work and social activities, despite complete preservation of motor function. Using conventional MRI techniques, lesion load observed in BMS is similar to levels in other disease subtypes; however, newer quantitative MRI techniques show less tissue damage, as well as greater repair and compensatory efficiency following MS injury. Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of nonmotor symptoms and imaging studies. Clearly, the definition of BMS currently applied in clinical practice requires reassessment.
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Abstract
BACKGROUND Benign multiple sclerosis (MS), traditionally defined as Expanded Disability Status Scale (EDSS) score ≤3 and ≥15-year disease duration, is thought to follow a milder clinical course. We determined the extent of visual pathway axonal loss by optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness in a benign MS cohort and examined the relation to vision and quality of life (QOL). METHODS In this longitudinal study of vision in MS at 3 academic centers, a subset of patients with EDSS, visual function, OCT, and QOL assessments was analyzed. Low- and high-contrast letter acuity was performed to assess visual function. RNFL thickness was determined using time-domain OCT. QOL scales included the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and Short Form-36 Health Survey. RESULTS Among 68 patients (135 eyes) studied longitudinally, 13 (26 eyes) had benign MS using criteria of EDSS score ≤3 and ≥15-year disease duration. Benign MS eyes had as much RNFL thinning (-3.6 μm, P = 0.0008 vs baseline, paired t test) as typical MS eyes (-3.3 μm, P < 0.0001). Both groups had significant low-contrast acuity loss. History of optic neuritis (ON) was more frequent in benign MS (69% vs 33% of eyes). History of ON distinguished benign vs typical MS (P = 0.002) and correlated with RNFL thickness at baseline (P = 0.002) and disease duration (P = 0.03) but not EDSS (P = 0.32, logistic regression). NEI-VFQ-25 scores were also worse for benign MS, accounting for age (75 ± 21 vs 88 ± 11, P = 0.005). CONCLUSION Patients with benign MS have RNFL axonal loss that is as marked as that of typical MS and have reduced vision and QOL. While overall neurologic impairment is mild, visual dysfunction, not well captured by the EDSS, accounts for a substantial degree of disability in benign MS.
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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.
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Affiliation(s)
- E Leray
- Epidemiology Department, EHESP School of Public Health, Rennes, France
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Skoog B, Runmarker B, Winblad S, Ekholm S, Andersen O. A representative cohort of patients with non-progressive multiple sclerosis at the age of normal life expectancy. Brain 2012; 135:900-11. [DOI: 10.1093/brain/awr336] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kampman MT, Steffensen LH, Mellgren SI, Jørgensen L. Effect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trial. Mult Scler 2012; 18:1144-51. [PMID: 22354743 DOI: 10.1177/1352458511434607] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High vitamin D levels may reduce the risk of relapses and disease progression in multiple sclerosis. METHODS This 96-week randomised controlled trial was designed to assess the effect of vitamin D(3) supplementation on bone mineral density in persons with multiple sclerosis. Supplementation with 20,000 IU vitamin D(3) weekly raised median serum 25-hydroxy vitamin D (25[OH]D) to 121 nmol/L. The modified intention to treat analysis included 35 persons in the vitamin D(3) group and 33 in the placebo group. Participants were age 21 to 50 years and fully ambulatory (median Expanded Disability Status Scale (EDSS) 2.5). We studied the effect of supplementing vitamin D(3) on the exploratory outcomes annualised relapse rate (ARR), EDSS, multiple sclerosis functional composite (MSFC) components, grip strength, and fatigue. RESULTS After 96 weeks, there was no significant difference between groups in ARR (absolute difference 0.10, 95% CI -0.07 to 0.27; p = 0.25), EDSS (absolute difference -0.01, 95% CI -0.35 to 0.35; p = 0.97), MSFC components, grip strength, or fatigue. CONCLUSION Supplementation with 20,000 IU vitamin D(3) weekly did not result in beneficial effects on the measured multiple sclerosis-related outcomes. This study was not powered to address clinical outcomes, but none of the results were suggestive of an effect in this unselected population of fully ambulatory persons with multiple sclerosis.
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Affiliation(s)
- Margitta T Kampman
- Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway.
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24
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Correale J, Peirano I, Romano L. Benign multiple sclerosis: a new definition of this entity is needed. Mult Scler 2011; 18:210-8. [DOI: 10.1177/1352458511419702] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: To study a cohort of benign multiple sclerosis (BMS) patients beyond physical disability, including the evaluation of cognitive and social function, as well as fatigue, pain and MRI studies. Methods: A cohort of 342 patients was prospectively followed for 10.9 ± 0.71 years. Forty-three patients (12.5%) met the BMS diagnosis criteria [Expanded Disability Status Scale (EDSS) < 3 after at least 10 years’ disease duration], undergoing full neurological examination every 6 months. Neuropsychological status, pain, fatigue, social functioning and work-related disability, as well as brain MRIs, were assessed yearly. Results: By the end of follow-up, 20 of 43 BMS patients (47%) had suffered cognitive impairment and 23 (53.3%) referred depression. Furthermore, 21 (48.8%) reported significant changes in pain intensity, with fatigue and environmental severity scores significantly increasing over time in 33–35% of patients. Finally, 32 BMS patients (74%) showed significant increase in the number of new or enlarging T2 lesions, gadolinium-enhanced lesions, and persistent black holes, without changes in EDSS. Thirty-five of 43 patients (81%) fulfilling the BMS diagnostic criteria showed significant worsening of cognitive function, fatigue, pain or depression during the 10-year follow-up. Conclusions: Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of non-motor symptoms and imaging studies, to help physicians improve diagnostic accuracy as well as therapeutic decision-making in this subgroup of MS patients.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Isabel Peirano
- Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Lucas Romano
- Neurology Department, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Reynolds R, Roncaroli F, Nicholas R, Radotra B, Gveric D, Howell O. The neuropathological basis of clinical progression in multiple sclerosis. Acta Neuropathol 2011; 122:155-70. [PMID: 21626034 DOI: 10.1007/s00401-011-0840-0] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 05/18/2011] [Indexed: 01/01/2023]
Abstract
Multiple sclerosis is the major inflammatory condition affecting the central nervous system (CNS) and is characterised by disseminated focal immune-mediated demyelination. Demyelination is accompanied by variable axonal damage and loss and reactive gliosis. It is this pathology that is thought to be responsible for the clinical relapses that often respond well to immunomodulatory therapy. However, the later secondary progressive stage of MS remains largely refractory to treatment and it is widely suggested that accumulating axon loss is responsible for clinical progression. Although initially thought to be a white matter (WM) disease, it is increasingly apparent that extensive pathology is also seen in the grey matter (GM) throughout the CNS. GM pathology is characterised by demyelination in the relative absence of an immune cell infiltrate. Neuronal loss is also seen both in the GM lesions and in unaffected areas of the GM. The slow progressive nature of this later stage combined with the presence of extensive grey matter pathology has led to the suggestion that neurodegeneration might play an increasing role with increasing disease duration. However, there is a paucity of studies that have correlated the pathological features with clinical milestones during secondary progressive MS. Here, we review the contributions that the various types of pathology are likely to make to the increasing neurological deficit in MS.
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Affiliation(s)
- Richard Reynolds
- Wolfson Neuroscience Laboratories, Division of Experimental Medicine, UK Multiple Sclerosis Tissue Bank, Centre for Neuroscience, Imperial Faculty of Medicine College London, Hammersmith Hospital Campus, UK.
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Current World Literature. Curr Opin Neurol 2011; 24:300-7. [DOI: 10.1097/wco.0b013e328347b40e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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