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Jackson DA, Nicholson R, Bergmann C, Wilken J, Kaczmarek O, Bumstead B, Buhse M, Zarif M, Penner IK, Hancock LM, Golan D, Doniger GM, Bogaardt H, Barrera M, Covey TJ, Gudesblatt M. Cognitive impairment in people with multiple sclerosis: Perception vs. performance - factors that drive perception of impairment differ for patients and clinicians. Mult Scler Relat Disord 2023; 69:104410. [PMID: 36399966 DOI: 10.1016/j.msard.2022.104410] [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: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurologists' perceptions of the presence of cognitive impairment (CI) in people with multiple sclerosis (PwMS) may not always align with findings of objective cognitive assessment. The accuracy of self-reported CI in PwMS can also be highly variable across individuals, and may not align with objective measurement of cognitive disturbances. Research suggests that additional factors impact perceived cognitive ability, such as depression and fatigue. Objective cognitive screening regardless of patient or neurologist perception has been recommended but still is often limited in routine care. Moreover, comprehensive neuropsychological assessment is even less routinely done. OBJECTIVE To explore how neurologists' perceptions of PwMS' CI compare to the perception of the patient by determining whether PwMS and their clinicians are accurate in detecting the presence and degree of CI as defined by a multi-domain validated computerized test battery in PwMS, as well as investigate what factors influence perception of CI in each group. METHODS PwMS completed a computerized multi-domain cognitive testing battery, and self-reported measures of disease impact (MSIS-29), fatigue (MFIS), and depression (BDI-II). Disability was assessed by the clinician using the Expanded Disability Status Scale (EDSS). Clinicians and patients also provided an estimation of cognitive deficits along a Likert scale. RESULTS In this cohort of PwMS (N=202, age range: 20 to 88, gender: 71% female), their level of accuracy in detecting attention deficits (k = -.028, p = .010) was low but statistically significant. In contrast, clinicians' accuracy in detecting global CI (k = -.037, p < .001) and a number of specific domain deficits was moderate. Fatigue (p < .001) and cognitive performance (p = .012) significantly predicted patient perceived cognitive deficits. Clinician perceived cognitive performance was significantly predicted by multiple factors: cognitive scores (p < .001), physical disability (p = .011), age (p = .021), and depression (p = .038). CONCLUSION The need to objectively screen for CI in PwMS, regardless of perception, can be aided by a better understanding of the agreement and discrepancies between the patient and clinician regarding perceived cognitive disturbances and the presence of CI defined by a multi-dimensional objective screening battery.
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Affiliation(s)
- Daija A Jackson
- The Chicago School of Professional Psychology, Washington, D.C., USA.
| | | | | | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
| | | | | | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- University of Wisconsin School of Medicine, Madison, WI, USA; William S. Middleton VA Medical Center, Madison, WI, USA
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Thomas J Covey
- Department of Neurology, Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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2
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Li Q, Wang B, Cheng B, Liu C, Li N, Dai G, Xiao H, Zhou L, ZhangBao J, Wang L, Zhao C, Lu J, Quan C, Li F. Efficacy and safety of rehabilitation exercise in neuromyelitis optica spectrum disorder during the acute phase: a prospective cohort study. Mult Scler Relat Disord 2022; 61:103726. [DOI: 10.1016/j.msard.2022.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
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Pike S, Cusick A, Wales K, Cameron L, Turner-Stokes L, Ashford S, Lannin NA. Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation-A systematic review. PLoS One 2021; 16:e0246288. [PMID: 33571238 PMCID: PMC7877653 DOI: 10.1371/journal.pone.0246288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. METHODS 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. RESULTS 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). CONCLUSIONS The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013190.
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Affiliation(s)
- Shannon Pike
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Wagga Wagga Ambulatory Rehabilitation Service, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie Wales
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Lynne Turner-Stokes
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, United Kingdom
- King’s College London, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- Centre for Nursing, Midwifery and Allied health led Research, University College London Hospitals, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Natasha A. Lannin
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Kaufmann M, Vaney C, Barin L, Liu X, von Wyl V. Long-term worsening of different body functions in persons with progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320964514. [PMID: 33110620 PMCID: PMC7557796 DOI: 10.1177/2055217320964514] [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: 07/07/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022] Open
Abstract
Background It is unclear whether EDSS is responsive to disability worsening in advanced
MS. Objective To explore the dynamics of disability worsening in persons with
advanced-stage MS (EDSS ≥5.5) using three disability worsening definitions
(EDSS, Rivermead Mobility Index (RMI), 9-Hole Peg Test (9-HPT)). Methods EDSS-, RMI- and 9-HPT-based disability worsening were assessed over a minimum
of two years in a cohort of 286 persons with advanced MS attending inpatient
rehabilitation using Kaplan-Meier Curves and multivariable Cox regression.
Furthermore, the correspondence between EDSS-, RMI- and 9-HPT-based
disability worsening was analyzed. Results Disability progression was observed in 49% (9-HPT), 52% (EDSS) and 53% (RMI),
with 9-HPT-based worsening slightly lagging behind. The Multiple Sclerosis
Severity Score (MSSS) was the only consistent factor predicting disability
worsening based on all three definitions (EDSS: hazard ratio 1.48
[1.30;1.68]; RMI: 1.12 [0.99;1.27]; 9-HPT: 1.36 [1.18;1.57]). Correspondence
between EDSS and the other definitions (9-HPT and RMI) was 44.3% and 55.7%
at time of EDSS progression and 65.1% and 72.5% overall, respectively. Conclusion In persons with advanced-stage MS, half still developed disability worsening
in different functional systems over a median of 6 years. MSSS seems a valid
predictor for disability worsening in all three outcome measures in advanced
MS.
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Affiliation(s)
- Marco Kaufmann
- Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Claude Vaney
- Berner Klinik Montana, Crans-Montana, Switzerland
| | - Laura Barin
- Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,FBK-IRVAPP, Research Institute for the Evaluation of Public Policies, Bruno Kessler Foundation, Trento, Italy
| | - Xinglu Liu
- Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Tacchino A, Ponzio M, Pedullà L, Podda J, Bragadin MM, Pedrazzoli E, Konrad G, Battaglia MA, Mokkink L, Brichetto G. Italian validation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Neurol Sci 2020; 41:3273-3281. [DOI: 10.1007/s10072-020-04363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
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The Relationship Between Multiple Sclerosis Symptom Severity Measures and Performance on Driving Variability Metrics in a Virtual Reality Simulator. Am J Phys Med Rehabil 2019; 99:278-284. [DOI: 10.1097/phm.0000000000001351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Alanazi AM, Al-Rashoud JR, Aljahani JM, Alotaibi AF, Althubaiti AM, Kojan SM, Aljumah MA, Abulaban AA. Exploring the outcome of multiple sclerosis among Saudi adult patients. A single-centered cross-sectional study at King Abdulaziz Medical City in Riyadh, Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2019; 24:168-175. [PMID: 31380815 PMCID: PMC8015509 DOI: 10.17712/nsj.2019.3.20180034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: To assess the outcome and impact of multiple sclerosis (MS) using validated Arabic versions of the Barthel index (BI) multiple sclerosis impact scale (MSIS-29), the modified Rankin scale (mRS), and the expanded disability status scale (EDSS). Methods: A cross-sectional study conducted at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia, during July-November 2017. All Saudi adult patients diagnosed with MS between 2000-2016 (269 patients) were included. Patients were contacted via phone calls and were assessed using a newly developed and validated multi-component questionnaire that included demographic data, disease course, and Arabic versions of the scales. Results: Out of 269 patients, 210 (78.2%) responded. The average patient age was 37.44±10.3 years. The majority were females (69.5%). Only, 51 (24.3%) patients reported worsening conditions. Annually, the average relapse rate was 2.28±1.91. In regard to patient outcomes, 120 (57.1%) showed no significant disability in mRS, 146 (69.5%) were ambulatory without aid in EDSS, and 185 (89.4%) were independent in BI scores. The average MSIS-29-PHYS score was 33.6±27.6 and MSIS-29-PSYCH score was 38.2±25.8. Modified Rankin scale and EDSS were significantly associated with the current use of disease-modifying therapy (DMT). Modified Rankin scale was negatively associated with delayed diagnosis. Barthel index showed significant association with medication compliance and the absence of attacks. Conclusion: Majority of patients had a favorable outcome that was linked with the use of DMT, compliance, early diagnosis, and absence of attacks.
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Affiliation(s)
- Azhar M Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
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8
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Steinheimer S, Dorn JF, Morrison C, Sarkar A, D'Souza M, Boisvert J, Bedi R, Burggraaff J, Kontschieder P, Dahlke F, Sellen A, Uitdehaag BMJ, Kappos L, Kamm CP. Setwise comparison: efficient fine-grained rating of movement videos using algorithmic support - a proof of concept study. Disabil Rehabil 2019; 42:2640-2646. [PMID: 30782055 DOI: 10.1080/09638288.2018.1563832] [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] [Indexed: 10/27/2022]
Abstract
Purpose: Clinical ordinal rating scales of movements, e.g., the Expanded Disability Status Scale, have poor intra- and interrater reliability, are insensitive to subtle differences and result in coarse-grained ratings compared to relative comparative rating methods. We therefore established video-based setwise comparison as a fine-grained, reliable and efficient rating method of motor dysfunction using algorithmic support.Materials and methods: Eight neurologists rated a set of 40 multiple sclerosis patient videos of the Finger-to-Nose-Test using both the newly developed setwise comparison and the established pairwise comparison techniques, which result in a continuous rating scale. Reliability was assessed by the intra-class correlation coefficient. Construct validity was estimated as Pearson's correlation between the continuous scale and severity ratings according to the Neurostatus scale for upper-extremity tremor/dysmetria and the Nine-hole-peg-test. Comparing the time needed for ratings assessed efficiency.Results: Intra-class correlation coefficient was 0.83 for setwise and 0.7 for pairwise comparison. Correlation to the tremor/dysmetria score of the Neurostatus was 0.86 for both rating procedures and correlation to the Nine-hole-peg-test was 0.64 (setwise) and 0.66 (pairwise). The time needed to rate 40 videos was 22.9 ± 6.9 minutes (setwise) and 77.8 ± 14.5 minutes (pairwise).Conclusions: Setwise comparison is an efficient, valid and reliable method for fine-grained rating of motor dysfunction that can be applied to larger datasets. It is substantially more efficient than pairwise comparison.Implications for rehabilitationDisability rating is crucial in clinical neurorehabilitation and in clinical trials.Humans are naturally inconsistent in rating items on ordinal scales leading to poor intra- and interrater reliability, insensitivity to subtle differences and coarse-grained ratings.Video-based setwise comparison is a new rating method enabling fine-grained, reliable and efficient ratings of motor dysfunction using algorithmic support.
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Affiliation(s)
- Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Marcus D'Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Germany
| | | | | | - Jessica Burggraaff
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | | | - Bernard M J Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
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9
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Barin L, Vaney C, Puhan MA, von Wyl V. Recommended outcome measures for inpatient rehabilitation of multiple sclerosis are not appropriate for the patients with substantially impaired mobility. Mult Scler Relat Disord 2018; 22:108-114. [PMID: 29655044 DOI: 10.1016/j.msard.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In multiple sclerosis (MS) rehabilitation, most currently used outcome measures were validated in patients with a relapsing remitting MS and mild to moderate impairments. We aimed to assess whether these measures were also adequate in more impaired patients, frequently encountered in those with progressive MS (PMS). METHODS Outcome measurements were extracted from medical records of 229 patients with PMS undergoing 3 weeks of routine inpatient rehabilitation between 2011 and 2015. We assessed the acceptability of Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW), 2-Minute Walk Test (2MWT), Rivermead Mobility Index (RMI) and the Functional Independence Measure (FIM) by analysing their statistical distributions, concurrent validity by comparing Spearman correlations with pre-specified hypotheses, and responsiveness across impairment status by calculating standardized response means. RESULTS Our concurrent validity hypotheses were mainly satisfied. However, all outcome measures had skewed distributions, showed low variability, and thus were inadequately discriminative. Moreover, 9HPT was never responsive across the impairment states, whereas the T25FW was responsive for mildly impaired patients, and the 2MWT for mild to moderate MS, respectively. Generic multi-items measures such as RMI and FIM-motor were adequately responsive for all severity levels. CONCLUSIONS Currently used outcome measures are inadequate for patients with impaired mobility, and there is a dire need of specifically designed outcome measures for routine care that are less burdensome and short-term responsive.
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Affiliation(s)
- Laura Barin
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland.
| | - Claude Vaney
- Berner Klinik Montana, Impasse Palace Bellevue, 3963 Crans-Montana, Switzerland.
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland.
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland.
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10
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Rabadi MH, Aston CE. Effect of Chronic Medical Conditions in Veterans with Multiple Sclerosis on Long-Term Disability. Med Sci Monit 2016; 22:2768-74. [PMID: 27494787 PMCID: PMC4978209 DOI: 10.12659/msm.900367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this observational study was to examine the effect of common chronic medical conditions (CMCs) on long-term disability (activity limitation) in veterans already diagnosed with multiple sclerosis (MS). Material/Methods We retrospectively reviewed the electronic charts of 124 veterans with MS who have been regularly followed in our MS clinic for 10 or more years. General linear model analysis examined whether MS-related severity as measured by the Expanded Disability Status Scale (EDSS) and the presence of CMCs affected long-term disability as measured by the total score on the Functional Independence Measure (TFIM). Results Commonly encountered CMCs were increased BMI (61%), hyperlipidemia (78%), hypertension (65%), current smokers (47%), and arthritis/arthralgia (24%). Results suggest that the number of CMCs was not predictive of final TFIM scores; of the variables examined, only initial EDSS score was predictive of final TFIM scores. Conclusions The presence of CMCs did not affect the long-term disability in veterans diagnosed with MS, this was due mainly to CMCs being closely monitored and co-treated with other medical specialties.
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Affiliation(s)
- Meheroz H Rabadi
- Department of Neurology, Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Christopher E Aston
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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Marziniak M, Ghorab K, Kozubski W, Pfleger C, Sousa L, Vernon K, Zaffaroni M, Meuth SG. Variations in multiple sclerosis practice within Europe – Is it time for a new treatment guideline? Mult Scler Relat Disord 2016; 8:35-44. [DOI: 10.1016/j.msard.2016.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/10/2016] [Indexed: 12/13/2022]
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12
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Karabudak R, Dahdaleh M, Aljumah M, Alroughani R, Alsharoqi IA, AlTahan AM, Bohlega SA, Daif A, Deleu D, Amous A, Inshasi JS, Rieckmann P, Sahraian MA, Yamout BI. Functional clinical outcomes in multiple sclerosis: Current status and future prospects. Mult Scler Relat Disord 2015; 4:192-201. [PMID: 26008936 DOI: 10.1016/j.msard.2015.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/23/2015] [Accepted: 03/14/2015] [Indexed: 11/29/2022]
Abstract
For decades, the Expanded Disability Status Scale (EDSS) has been the principal measure of disability in clinical trials in patients with multiple sclerosis (MS) and in clinical practice. However, this test is dominated by effects on ambulation. Composite endpoints may provide a more sensitive measure of MS-related disability through the measurement of additional neurological functions. The MS Functional Composite (MSFC) includes a walking test (25-ft walk) plus tests of upper extremity dexterity (9-hole peg test) and cognitive function (Paced Auditory serial Addition test [PASAT]). Replacing PASAT with the Symbol Digit Modality test, a more sensitive test preferred by patients, may improve the clinical utility of the MSFC. In addition, disease-specific measures of QoL may be used alongside the MSFC (which does not include measurement of QoL). Clinical data suggest that disease-modifying therapies may delay or prevent relapse, and better composite measures will be valuable in the assessment of disease activity-free status in people with MS.
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Affiliation(s)
- Rana Karabudak
- Hacettepe University Hospitals, Dept. of Neurology, Neuroimmunology Unit, Ankara, Turkey.
| | - Maurice Dahdaleh
- Department of Internal Medicine, Neurology Section, Arab Medical Center and Khalidi Hospital, Amman, Jordan
| | - Mohammed Aljumah
- King Abdullah International Medical Research Center, King Saud Ben Abdulaziz University for Health Sciences, NGHA, Riyadh, Saudi Arabia; Prince Mohammed bin Abdul-Aziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Kuwait; Division of Neurology, Dasman Diabetes Institute, Kuwait
| | - I Ahmed Alsharoqi
- Clinical Neurosciences Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Abdulrahman M AlTahan
- Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Saudi Arabia
| | - Saeed A Bohlega
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulkader Daif
- Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Saudi Arabia
| | - Dirk Deleu
- Department of Neurology (Medicine), Hamad Medical Corporation, Doha, Qatar
| | - Amer Amous
- Merck Serono Intercontinental Region, Dubai, United Arab Emirates
| | - Jihad S Inshasi
- Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority, United Arab Emirates
| | | | - Mohammed A Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran
| | - Bassem I Yamout
- Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
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Rossi S, Motta C, Studer V, Boffa L, De Chiara V, Castelli M, Barbieri F, Buttari F, Monteleone F, Germani G, Macchiarulo G, Weiss S, Centonze D. Treatment options to reduce disease activity after natalizumab: paradoxical effects of corticosteroids. CNS Neurosci Ther 2014; 20:748-53. [PMID: 24837039 PMCID: PMC6493126 DOI: 10.1111/cns.12282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022] Open
Abstract
AIM Natalizumab (NTZ) discontinuation leads to multiple sclerosis (MS) recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive patients. Here, we compared the clinical and imaging features of three groups of patients who discontinued NTZ treatment. METHODS We treated 25 patients with subcutaneous INFβ-1b (INF group), 40 patients with glatiramer acetate (GA group), and 40 patients with GA plus pulse steroid (GA+CS group). RESULTS Six of 25 patients (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P<0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P=0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation. CONCLUSION Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.
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Affiliation(s)
- Silvia Rossi
- Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, & Centro Europeo per la Ricerca sul Cervello (CERC)/Fondazione Santa Lucia, Rome, Italy
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14
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Saji N, Kimura K, Ohsaka G, Higashi Y, Teramoto Y, Usui M, Kita Y. Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study. Disabil Rehabil 2014; 37:331-7. [DOI: 10.3109/09638288.2014.918195] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoki Saji
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
| | - Goro Ohsaka
- Department of Rehabilitation Medicine, Hyogo Prefectural Rehabilitation Hospital, Tatsuno, Hyogo, Japan,
| | - Yasuto Higashi
- Department of Neurology, Himeji Central Hospital, Himeji, Hyogo, Japan,
| | - Yoichi Teramoto
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, Hyogo, Japan, and
| | - Masanobu Usui
- Department of Rehabilitation Medicine, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
| | - Yasushi Kita
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
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