Clinical and Demographic Predictors of Long-term Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Langer‐Gould, Annette; Popat, Rita A.; Huang, Stella; Cobb, Kristin; Fontoura, Paulo; Gould, Michael K.; Nelson, Lorene M.

doi:10.1001/archneur.63.12.1686

Cited by 208 publications

(160 citation statements)

References 30 publications

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“…Relapses presenting with pyramidal tract and sphincter disorders have a poor long-term prognosis when compared with relapses without involvement of these systems (39,40,41,42).…”

mentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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“…Relapses presenting with pyramidal tract and sphincter disorders have a poor long-term prognosis when compared with relapses without involvement of these systems (39,40,41,42).…”

mentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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“…Findings of the current study suggested that VitD level was significantly related to duration of disease [9]. VitD deficiency in patients with MS may be due to less exposure to sunlight because of their illness rather than a less exposure to sunlight relationship.…”

Section: Discussionmentioning

confidence: 57%

Quality of Life-Spasticity-Fatigue Score in Patients With Multiple Sclerosis and Serum Vitamin D Level

Özkan

2016

J Neurol Res

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Background: Vitamin D (VitD) is being increasingly studied in multiple sclerosis (MS). Association of VitD deficiency and MS risk, progression, disability and severity has been shown in previous studies. Our objective was to prospectively investigate if 25-hydroxyvitamin D (25(OH)D) levels are associated with duration of disease, the number of joint involvement, level of spasticity, and quality of life (QoL) in MS.

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“…Individualizing treatments in this way has the potential to help avoid patients' receiving an unsuitable therapy, leading to potential cost benefits. In terms of clinical markers, current information suggests that higher EDSS or Multiple Sclerosis Functional Composite scores at baseline; 89,90 incomplete recovery from the first neurological attack; 91 shorter time to second attack; 91 sphincter, bladder, or bowel symptoms at disease onset;…”

Section: Perspectives For Managed Care Organizations On the Burden Ofmentioning

confidence: 99%

“…91 cerebellar involvement; 91 increased relapse frequency prior to study enrollment; 91 male sex; 91 and older age 91 are all associated with increased risk of disability progression in patients with RRMS. The imaging markers-"black holes" on magnetic resonance imaging at baseline, 92 baseline or early CNS atrophy, 93,94 and baseline activity with T 2 lesions, active T 2 lesions, and/or gadolinium-enhancing [95][96][97][98] lesions-appear to be associated with disability progression.…”

Section: Perspectives For Managed Care Organizations On the Burden Ofmentioning

confidence: 99%

Perspectives for Managed Care Organizations on the Burden of Multiple Sclerosis and the Cost-Benefits of Disease-Modifying Therapies

Owens¹,

Olvey

Skrepnek

et al. 2013

JMCP

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Clinical and Demographic Predictors of Long-term Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Abstract: To identify clinical and demographic factors associated with long-term disability in patients with relapsing-remitting multiple sclerosis.

Cited by 208 publications

References 30 publications

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Quality of Life-Spasticity-Fatigue Score in Patients With Multiple Sclerosis and Serum Vitamin D Level

Perspectives for Managed Care Organizations on the Burden of Multiple Sclerosis and the Cost-Benefits of Disease-Modifying Therapies

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