MS Severity

Abstract
Objective: To study the long-term outcome and persistence of two patterns of cervical spinal cord abnormality in early relapsing-remitting multiple sclerosis (RRMS).

Methods: RRMS patients with a spinal cord MRI performed during the first 3 years of the disease, a control MRI 5 years later and who have been followed up at least 10 years were included. Patients were grouped according the T2 spinal cord MRI into: (A) nodular pattern, if one or more focal lesions were present; and (B) diffuse pattern, defined as a poorly demarcated high signal area. The end point was defined as the time to reach an Expanded Disability Status Score (EDSS) of 4.0.

Results: Twenty-five patients were included; 12 in group A and 13 in group B. Three patients in group A and 9 in group B reached EDSS 4, in a mean time of 11 years in group A and 7 years in group B (log rank 10.3, p = 0.001). Multivariate Cox regression analysis assessing the risk of EDSS 4.0 including sex, age, number of relapses in the first 2 years, number of T2 brain lesions and spinal cord pattern showed higher risk for the diffuse pattern (hazard ratio 7.2, 95% confidence interval 1.4-36.4). Control MRI showed the persistence of the diffuse pattern in all patients, and the development of diffuse pattern in two patients with basal nodular lesions.

Conclusions: The diffuse abnormality in cervical spinal cord at the beginning of the disease is persistent and predicts a worse prognosis in RRMS patients.

Source: Pubmed PMID: 20573640 & Mult Scler. 2010 Jun 25. (01/07/10)

BACKGROUND: The multiple sclerosis severity scale (MSSS) adds the element of disease duration to the expanded disease status score (EDSS) and is designed to provide a measure of disease severity. We have used this tool to address two questions: Can it be used to predict the accrual of disability over time in individual patients? Do the currently available therapies have an impact upon disease severity over time?

METHODS: All patients who were followed and treated by a single neurologist in an MS center in the USA over a two year period were evaluated. The MSSS was retrospectively tabulated in 195 MS patients and the course and severity of the disease was analyzed in a sample of 10 randomly selected patients. 177/195 (94%) of patients received disease-modifying therapies for at least a year during the period that was evaluated.

RESULTS: The mean duration of symptoms in our patients was 9.7 years (range 0.3-26) with an EDSS mean score of 3.5 (range 0-9.5). The average MSSS rating for the entire cohort of 195 patients was 48.7, similar to that observed in the European cohort. In 9/10 patients, randomly selected and representative of the entire group, the MSSS assessments were consistent over time and irrespective of therapy with a range over 5-12 years of disease duration averaging only 11.3 points (range 3.7-18.8).

CONCLUSIONS: The MSSS may allow the prediction of disease severity over time, and is consistent with the lack of a major impact of disease-modifying drugs upon disease severity as measured by the MSSS. These results need to be verified in a larger cohort of patients.

Pachner AR, Steiner I. - Department of Neurology and Neurosciences, UMDNJ-New Jersey Medical School, Newark, NJ, USA.

Source: J Neurol Sci. 2009 Jan 10. (21/01/09)