Faculty Opinions recommendation of Long-term disability progression of pediatric-onset multiple sclerosis.

Author(s):  
Guido Cavaletti
Neurology ◽  
2019 ◽  
Vol 92 (24) ◽  
pp. e2764-e2773 ◽  
Author(s):  
Kyla A. McKay ◽  
Jan Hillert ◽  
Ali Manouchehrinia

ObjectiveTo evaluate long-term disability progression in pediatric-onset multiple sclerosis (POMS) and compare to adult-onset multiple sclerosis (AOMS).MethodsThis was a retrospective cohort study using prospectively collected clinical information from the Swedish MS Registry. Clinical features were compared and Kaplan-Meier and Cox proportional hazards regression were used to assess the risk of reaching sustained Expanded Disability Status Scale (EDSS) 3, 4, and 6 in POMS (multiple sclerosis [MS] onset <18 years) and AOMS (MS onset ≥18 years).ResultsA total of 12,482 persons were included; 549 (4.4%) were classified as POMS. The POMS cohort took longer to reach all 3 disability milestones from their MS onset, but did so at a younger age than the AOMS cohort. Primary progressive course (hazard ratio [HR] 4.63; 95% confidence interval [CI] 1.46–14.7), higher relapse rate in the first 5 years of disease (HR 5.35; 95% CI 3.37–8.49), and complete remission from the initial relapse (HR 0.41; 95% CI 0.18–0.94) were associated with an altered risk of progression to EDSS 4 among POMS cases. The same pattern emerged for the risk of reaching EDSS 3 and 6.ConclusionsPatients with pediatric-onset MS follow a distinctive clinical course, which should be considered in the treatment and management of the disease.


2019 ◽  
Vol 76 (9) ◽  
pp. 1028 ◽  
Author(s):  
Kyla A. McKay ◽  
Ali Manouchehrinia ◽  
Lindsay Berrigan ◽  
John D. Fisk ◽  
Tomas Olsson ◽  
...  

2010 ◽  
Vol 12 (4) ◽  
pp. 147-154 ◽  
Author(s):  
Said Masri ◽  
Andreas Blodau ◽  
Norbert Zessack ◽  
Michael Lang ◽  

Patients with multiple sclerosis (MS) may change immunomodulatory therapies if efficacy is considered inadequate or if adverse drug reactions occur. Identifying potential candidates for therapy adjustment is an important aspect of treatment optimization. This study aimed to evaluate the safety and efficacy of interferon beta-1a (IFNβ-1a), 44 μg subcutaneously (SC) three times weekly, in patients with relapsing MS following a change from another long-term therapy and to identify potential candidates for therapy adjustment. Patients were followed for 12 months. Candidates for therapy adjustment were identified using a three-scale model of treatment efficacy (relapses, disability progression, and magnetic resonance imaging). For 76.4% of patients, insufficient efficacy of the previous therapy was the main reason for changing to IFNβ-1a 44 μg. At baseline, 70.6% of patients fulfilled the criteria for recommendation for therapy adjustment; after 12 months on IFNβ-1a 44 μg, this percentage decreased to 16.6%. The incidence of adverse events (AEs) decreased between week 4 (40.6% of patients) and month 12 (12.8%). Influenza-like symptoms were the most common AE, occurring in 28.3% of patients. This study supports IFNβ-1a, 44 μg SC three times weekly, as a therapeutic option for patients in need of therapy adjustment.


2020 ◽  
Vol 6 (4) ◽  
pp. 205521732096451
Author(s):  
Marco Kaufmann ◽  
Claude Vaney ◽  
Laura Barin ◽  
Xinglu Liu ◽  
Viktor von Wyl

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.


2019 ◽  
Vol 26 (11) ◽  
pp. 1381-1391 ◽  
Author(s):  
Iris Dekker ◽  
Madeleine H Sombekke ◽  
Lisanne J Balk ◽  
Bastiaan Moraal ◽  
Jeroen JG Geurts ◽  
...  

Objective: The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS). Methods: We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2. Disability progression after 6 and 11 years was measured using the Expanded Disability Status Scale (EDSS) and EDSS-plus (including 25-foot walk and 9-hole peg test). Patients with spinal cord or infratentorial lesions were compared for the risk of 6- and 11-year disability progression to patients without spinal cord or infratentorial lesions, respectively. Subsequently, patients with lesions on both locations were compared to patients with only spinal cord or only infratentorial lesions. Results: Baseline spinal cord lesions show a higher risk of 6-year EDSS progression (odds ratio (OR): 3.6, p = 0.007) and EDSS-plus progression (OR: 2.5, p = 0.028) and 11-year EDSS progression (OR: 2.8, p = 0.047). Patients with both infratentorial and spinal cord lesions did not have a higher risk of 6-year disability progression than patients with only infratentorial or only spinal cord lesions. Conclusion: The presence of early spinal cord lesions seems to be a dominant risk factor of disability progression. Simultaneous presence of early infratentorial and spinal cord lesions did not undisputedly predict disability progression.


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