BACKGROUND: Gait impairment is a common symptom in multiple sclerosis (MS) patients, but there is a lack of evidence about gait performance in the group of MS patients with no apparent disability. The aim of our study was to evaluate gait characteristics in MS patients with no apparent impairment of walking and with an Expanded Disability Status Scale (EDSS 0-1.5), and to determine whether any abnormalities are detectable by common clinical tests. METHODS: This was an observational study of 64 MS patients with an EDSS 0-1.5 and 47 age- and sex-matched healthy controls. We measured their performance in the timed 25-foot walk test (T25FWT) and the 2-minute walk test (2MWT). The spatiotemporal parameters of gait were measured using a GAITRite instrument. RESULTS: MS patients with no apparent disability (EDSS 0-1.5) performed worse in T25FWT and 2MWT than normal controls. During the self-selected walking speed test on GAITRite, MS patients had a prolonged double support phase, and during the fast walking speed test, they had lower cadence and decreased step length.
- MeSH
- Adult MeSH
- Humans MeSH
- Gait Disorders, Neurologic classification diagnosis MeSH
- Neurologic Examination MeSH
- Disability Evaluation * MeSH
- Multiple Sclerosis classification diagnosis MeSH
- Walking Speed MeSH
- Case-Control Studies MeSH
- Health Status * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
BACKGROUND: Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear. OBJECTIVE: The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms. METHODS: This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores. RESULTS: The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = -0.06, p < 0.001). Neither presentation was associated with changes in relapse risk. CONCLUSION: Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.
BACKGROUND: Some studies comparing primary and secondary progressive multiple sclerosis (PPMS, SPMS) report similar ages at onset of the progressive phase and similar rates of subsequent disability accrual. Others report later onset and/or faster accrual in SPMS. Comparisons have been complicated by regional cohort effects, phenotypic differences in sex ratio and management and variable diagnostic criteria for SPMS. METHODS: We compared disability accrual in PPMS and operationally diagnosed SPMS in the international, clinic-based MSBase cohort. Inclusion required PPMS or SPMS with onset at age ≥18 years since 1995. We estimated Andersen-Gill hazard ratios for disability accrual on the Expanded Disability Status Scale (EDSS), adjusted for sex, age, baseline disability, EDSS score frequency and drug therapies, with centre and patient as random effects. We also estimated ages at onset of the progressive phase (Kaplan-Meier) and at EDSS milestones (Turnbull). Analyses were replicated with physician-diagnosed SPMS. RESULTS: Included patients comprised 1872 with PPMS (47% men; 50% with activity) and 2575 with SPMS (32% men; 40% with activity). Relative to PPMS, SPMS had older age at onset of the progressive phase (median 46.7 years (95% CI 46.2-47.3) vs 43.9 (43.3-44.4); p<0.001), greater baseline disability, slower disability accrual (HR 0.86 (0.78-0.94); p<0.001) and similar age at wheelchair dependence. CONCLUSIONS: We demonstrate later onset of the progressive phase and slower disability accrual in SPMS versus PPMS. This may balance greater baseline disability in SPMS, yielding convergent disability trajectories across phenotypes. The different rates of disability accrual should be considered before amalgamating PPMS and SPMS in clinical trials.
Cíl: Potíže s chůzí jsou častým a závažným symptomem RS. Validovaný dotazník pro zhodnocení poruch chůze u pacientů s RS v českém jazykovém prostředí chybí. Cílem studie proto bylo vytvořit a validovat českou verzi dotazníku 12-Item Multiple Sclerosis Walking Scale (MSWS-12). Jedná se o jednoduchý anamnestický nástroj sestávající z 12 otázek. Materiál a metodika: Česká verze dotazníku MSWS-12 byla vytvořena metodou zpětného překladu a validována na souboru 50 pacientů s RS a 25 zdravých dobrovolníků. Dotazník byl administrován opakovaně s odstupem jednoho týdne za účelem hodnocení opakovatelnosti a reprodukovatelnosti. Chůze byla objektivně hodnocena pomocí testů Timed Up and Go (TUG) a Timed 25-Foot Walk (T25FW). Výsledky byly korelovány také s Expanded Disability Status Scale (EDSS) a Four-Stage Balance Test (FSBT). Výsledky: Skóre MSWS-12 dosáhlo u zdravých kontrol hodnot 12,4 ± 0,7 bodů. U pacientů s RS byly hodnoty významně vyšší (p < 0,001) a dosahovaly v průměru 24,0 ± 11,8 bodů. Hodnoty skóre MSWS-12 úzce korelovaly s objektivními testy chůze i disabilitou, tj. s TUG testem (r = 0,788; p < 0,001), T25FW testem (r = 0,878; p < 0,001), EDSS (r = 0,878; p < 0,001) i FSBT (r = 0,831; p < 0,001). Opakovatelnost MSWS-12 hodnocená pomocí Pearsonovy korelace byla vynikající (r = 0,96; p < 0,001). Hodnota Cronbachova alfa odrážející reprodukovatelnost dosáhla 0,983, což prokazuje vysokou vnitřní konzistenci dotazníku. Závěr: Česká verze dotazníku MSWS-12 prokázala velmi dobrou validitu v hodnocení poruch chůze u pacientů s RS a vynikající reprodukovatelnost a vnitřní konzistenci.
Aim: Walking difficulties are a common and serious symptom of MS. A validated questionnaire for the evaluation of gait disorders in patients with MS in the Czech language is missing. The aim of this study was to create and validate the Czech version of the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) questionnaire, a simple anamnestic tool consisting of 12 questions. Materials and methods: The Czech version of the MSWS-12 questionnaire was created by the forward-backward translation method and validated in 50 MS patients and 25 healthy volunteers. The questionnaire was administered repeatedly one week apart to assess repeatability and reproducibility. Walking was objectively assessed using the Timed Up and Go (TUG) test and the 25 Foot Walk (T25FW) test. The results were correlated also with the Expanded Disability Status Scale (EDSS) and the Four-Stage Balance Test (FSBT). Results: Healthy controls scored 12.4 ± 0.7 points in the MSWS-12. In patients with MS, the values were significantly higher (P < 0.001) and reached 24.0 ± 11.8 points in average. The MSWS-12 score values closely correlated with walking tests and level of disability. i.e., the TUG test (r = 0.788; P < 0.001), T25FW test (r = 0.878; P < 0.001), EDSS (r = 0.878; P < 0.001), and FSBT (r = 0.831; P < 0.001). The repeatability assessed by Pearson´s correlation was 0.96 (P < 0.001). The reproducibility value of Cronbach’s alpha reached 0.983, which demonstrates the high internal consistency of the questionnaire. Conclusion: The Czech version of the MSWS-12 questionnaire showed very good validity in the evaluation of gait disorders in MS patients, and excellent reproducibility and internal consistency.
Cílem naší práce je upozornit na přítomnost deprese u nemocných s roztroušenou sklerózou mozkomíšní (RS). Náhodně vytvořený soubor 42 pacientů s RS (11 mužů a 31 žen) s průměrným EDSS 3,2 u mužů a 2,77 u žen jsme podrobili psychiatrickému vyšetření. Stav nemocných byl hodnocen pomocí psychiatrických posuzovacích škál: Hamiltonovy škály úzkosti (HAMA), Hamiltonovy psychiatrické stupnice pro posuzování deprese (HAMD), Stupnice Montgomeryho a Aspergové pro posouzení deprese (MADRS), vyplnili psychosomatický dotazník SCL-90 a HAD (Hospital Anxiety and Depression Scale), kognitivní schopnosti byly hodnoceny prostřednictvím Wechsler Adult Intelligence Scale (WAIS-R), neurologický deficit škálou úrovně invalitidy u RS - Expanded Disability Status Scale (EDSS). Deprese byla prokázána u 33 % nemocných, anxieta u 29 %, přičemž obecně muži reagovali na chronické onemocnění spfíe depresivně, u žen dominovala úzkost. Nejvyšší hodnota ve škále deprese u mužů a anxiety u žen byla při našem vyšetření zaznamenána u primárně progredientní formy při hodnotě EDSS 4,5. Po 1. atace (klinicky izolovaný syndrom) je velmi intenzivně prožívána úzkost u obou pohlaví. U 5 Z 12 osob byl zaznamenán lehký kognitivní deficit. Menší procento depresivních nemocných v našem souboru ve srovnání s literaturou, kde je uváděno 40-45 %, je patrně způsobeno malým souborem a výběrem pacientů s nižším EDSS kvůli dostupnosti psychiatrického vyšetření. Přesto je toto procento dosti vysoké na to, abychom mysleli na koexistenci deprese u RS a adekvátně a včas ji léčili.
The aim of research was to draw attention to the presence of depression in patients suffering from multiple sclerosis (MS). A randomly created set of 42 patients with MS (11 males and 31 females) with the average EDSS of 3.2 in men and 2.77 in women underwent psychiatrie examinations. The patients' states were evaluated using psychiatric assessing scales: Hamilton Anxiety Scale (HAMA), Hamilton Depression Seale (HAMD), Montgomery-Asperg Depression Rating Scale (MADRS), a psychosomatic questionnaire SCL-90 and HAD (Hospital Anxiety and Depression Scale) were completed, cognitive abilities were assessed by means of Wechsler Adult Intelligence Scale (WAIS-R), neurological deficit with a scale of disability level in MS - Expanded Disability Status Scale (EDSS). Depression was proved in 33 % of patients, anxiety in 29 %, when generally men's responses to a chronic disease were more depressive, while anxiety prevailed in women. The highest value in the scale of depression in men and anxiety in women was recorded by our examinations in primarily progressive form at the value of 4.5 of EDSS. After the first attack (a clinically isolated syndrome), anxiety is experienced with high intensity in both sexes. A slight cognitive deficit was recorded in 5 out of 12 subjects. If compared with literature giving 40-45 % of depressive patients, the lower percentage of those in our set is probably caused by a less numerous set and selection of patients with the lower EDSS due to the availability of psychiatric investigations. Nevertheless, this percentage is quite high to think about coexistence of depression in MS and to treat it adequately and in time.
PURPOSE: To describe functioning and disability in patients with multiple sclerosis (MS) according to the model endorsed by the International Classification of Functioning Disability and Health (ICF). METHODS: Adult patients with MS were consecutively enrolled. The Expanded Disability Status Scale (EDSS), the WHO Disability Assessment Schedule II (WHO-DAS II) and the ICF checklist were administered in individual sessions. Descriptive analyses were performed to report on EDSS and WHO-DAS II scores. ICF categories reported as a problem by more than 20% of patients were described in detail. RESULTS: One hundred patients (70 females, mean age 41.7), 73 with relapsing-remitting MS were enrolled. Mean WHO-DAS II score was 10.6 and 58 ICF categories were selected: 23 Body Functions and Structures, 21 Activities and Participation and 14 Environmental Factors. CONCLUSIONS: The ICF can be successfully implemented in clinical and rehabilitation of patients with MS, because it enables to describe its multiple facets. Little differences between capacity and performance in ICF categories connected with activities of daily living, and presence of technical aids and other environmental factors are reported. On the contrary, in categories related to relationships, performance was worse than capacity thus revealing attitudinal barriers.
- MeSH
- Activities of Daily Living MeSH
- Adult MeSH
- Checklist MeSH
- Middle Aged MeSH
- Humans MeSH
- International Classification of Diseases MeSH
- Adolescent MeSH
- Disability Evaluation MeSH
- Multiple Sclerosis physiopathology rehabilitation MeSH
- Social Environment MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVE: To test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis (MS), we modeled disability outcomes in 14,717 patients. METHODS: We studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year, and exposed to MS therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the cumulative hazards of 12-month confirmed increase and decrease in disability, Expanded Disability Status Scale (EDSS) step 6, and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously readjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability, and MRI activity. RESULTS: A total of 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval [CI] 0.43-0.82, p = 0.0016), worsening of disability (0.56, 0.38-0.82, p = 0.0026), and progress to EDSS step 6 (0.33, 0.19-0.59, p = 0.00019). Among 1,085 patients with ≥15-year follow-up, the treated patients were less likely to experience relapses (0.59, 0.50-0.70, p = 10-9) and worsening of disability (0.81, 0.67-0.99, p = 0.043). CONCLUSION: Continued treatment with MS immunotherapies reduces disability accrual by 19%-44% (95% CI 1%-62%), the risk of need of a walking aid by 67% (95% CI 41%-81%), and the frequency of relapses by 40-41% (95% CI 18%-57%) over 15 years. This study provides evidence that disease-modifying therapies are effective in improving disability outcomes in relapsing-remitting MS over the long term. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that, for patients with relapsing-remitting MS, long-term exposure to immunotherapy prevents neurologic disability.
- MeSH
- Adult MeSH
- Fingolimod Hydrochloride therapeutic use MeSH
- Glatiramer Acetate therapeutic use MeSH
- Immunologic Factors therapeutic use MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Interferon-beta therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Natalizumab therapeutic use MeSH
- Disability Evaluation MeSH
- Disease Progression MeSH
- Proportional Hazards Models MeSH
- Multiple Sclerosis, Relapsing-Remitting drug therapy physiopathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVE: This study evaluated the effect of relapse phenotype on disability accumulation in multiple sclerosis. METHODS: Analysis of prospectively collected data was conducted in 19,504 patients with relapse-onset multiple sclerosis and minimum 1-year prospective follow-up from the MSBase cohort study. Multivariable linear regression models assessed associations between relapse incidence, phenotype and changes in disability (quantified with Expanded Disability Status Scale and its Functional System scores). Sensitivity analyses were conducted. RESULTS: In 34,858 relapses recorded during 136,462 patient-years (median follow-up 5.9 years), higher relapse incidence was associated with greater disability accumulation (β = 0.16, p < 0.001). Relapses of all phenotypes promoted disability accumulation, with the most pronounced increase associated with pyramidal (β = 0.27 (0.25-0.29)), cerebellar (β = 0.35 (0.30-0.39)) and bowel/bladder (β = 0.42 (0.35-0.49)) phenotypes (mean (95% confidence interval)). Higher incidence of each relapse phenotype was associated with an increase in disability in the corresponding neurological domain, as well as anatomically related domains. CONCLUSION: Relapses are associated with accumulation of neurological disability. Relapses in pyramidal, cerebellar and bowel/bladder systems have the greatest association with disability change. Therefore, prevention of these relapses is an important objective of disease-modifying therapy. The differential impact of relapse phenotypes on disability outcomes could influence management of treatment failure in multiple sclerosis.
- MeSH
- Chronic Disease MeSH
- Adult MeSH
- Interferon-beta therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Persons with Disabilities statistics & numerical data MeSH
- Disability Evaluation MeSH
- Disease Progression MeSH
- Prospective Studies MeSH
- Recurrence * MeSH
- Multiple Sclerosis drug therapy physiopathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Roztroušená skleróza (RS) je chronické onemocnění centrální nervové soustavy. Typický je pro ni autoimunitní zánět, postupná demyelinizace a neurodegenerace. Charakter zánětu a zastoupení zmíněných procesů je variabilní v čase i interindividuálně. Existují však určité společné znaky umožňující rozdělení RS do jednotlivých fenotypů. Neexistence přesné hranice nicméně činí stanovení přechodu do sekundární progrese komplikovaným. Základem je klinické hodnocení a kontakt s pacientem. Posouzení disability pomocí škály EDSS (Expanded Disability Status Scale) je vhodné doplnit minimálně screeningovým testem kognice. Významný pokrok posledních let přináší nové léčebné možnosti i u progresivních forem RS. Ačkoliv u nich dominuje neurodegenerace, je přítomna i zánětlivá aktivita, kterou můžeme terapeuticky ovlivnit.
Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is characterized by autoimmune inflammation, progressive demyelination and neurodegeneration. The characteristics of inflammation and the representation of these processes are variable over time and interindividual. Nevertheless, certain specific common features allow the division of MS into several phenotypes. However, the absence of a precise boundary makes determining the transition to secondary progression complicated. Clinical examination and the contact with the patient is fundamental. Evaluation of disability using EDSS should be enriched at least with a screening test of cognition. Significant progress in recent years has provided new treatment options for progressive forms of MS. Although neurodegeneration predominates, there is also an inflammatory activity that we can impact.
- Keywords
- siponimod,
- MeSH
- Anti-Inflammatory Agents MeSH
- Chronic Disease MeSH
- Phenotype MeSH
- Cognitive Dysfunction MeSH
- Humans MeSH
- Disease Progression MeSH
- Multiple Sclerosis * diagnosis drug therapy classification MeSH
- Mental Status and Dementia Tests MeSH
- Inflammation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
