Factors predicting incomplete recovery from relapses in multiple sclerosis: a                 prospective study

Leone, Maurizio; Bonissoni, Sara; Collimedaglia, Laura; Tesser, Fabiana; Calzoni, S.; Stecco, Alessandro; Naldi, Paola; Monaco, Francesco

doi:10.1177/1352458507084650

Cited by 48 publications

(56 citation statements)

References 32 publications

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“…Several studies identified attacks (i.e. relapses or the initial clinical events) with the impact on sphincteric [123][124][125][126][127] or pyramidal function [124,126,128] as being predictive of poorer long-term disability outcomes, while the cerebellar and brainstem attacks showed mixed results (for review, see [129] ). In contrast, attacks with the features of optic neuritis were associated with relatively more favourable disability outcomes [127,128,130] .…”

Section: Prognostic Value Of Relapsesmentioning

confidence: 99%

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Kalinčík

2015

Neuroepidemiology

138

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Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies.

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Section: Prognostic Value Of Relapsesmentioning

confidence: 99%

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Kalinčík

2015

Neuroepidemiology

138

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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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“…57 Residual disability is seen in one third to half of all relapses [59][60][61][62] and is more likely if the relapse is severe, multifocal, initially slow to recover, and in people 30 years or older. 60 62 One study indicates that a lack of recovery from a relapse predicts incomplete remission of future relapses.…”

Section: Recovery From Individual Relapsementioning

confidence: 99%

Relapse in multiple sclerosis

Galea

Ward-Abel

Heesen

2015

BMJ

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Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study

Abstract: Factors predicting incomplete recovery are more closely linked to the characteristics of the single relapse (extension and duration of tissue damage) than to the patient's genetic and environmental background.

Cited by 48 publications

References 32 publications

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review

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

Relapse in multiple sclerosis

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