Multiple Sclerosis: Relapses and Timing of Remissions

Abstract

Background: Relapse is a relatively sudden worsening of neurological status in multiple sclerosis patients. The aim of this paper is to describe the frequency and timing of the subsequent clinical remission, and factors linked to a possible lack of recovery. Methods: Two hundred and twenty-three relapses in 62 multiple sclerosis patients were examined retrospectively. Kurtzke’s Expanded Disability Status Scale (EDSS) scores were calculated every 3 months from 1 year before to 1 year after. Remission was defined as improvement vs. the EDSS as scored during the relapse. Recovery was defined as return to the EDSS as scored before the relapse. Results: The frequency of improvement was 78% at 3 months, 86% at 6, and lower in males (65 vs. 81%). The frequency of recovery was 55% at 3 months, 71% at 6. Kaplan-Meier curves showed stabilization after 6 months, with improvement in 90% of patients, 100% without further relapses. Relapses without recovery were only 30%; 15% excluding short-term relapses. Conclusions: Incomplete remissions do not appear to be linked to the evolution of the relapse, but to further relapses in the following months; in other words, to the short-term relapse rate.

The multiple sclerosis relapse experience: patient-reported outcomes from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry

“…Others have observed a greater frequency of improvement in EDSS scores among females (81%) compared with males (65%) at 3 months (OR, 2.33; 95% CI, 1.03–2.56; Mantel-Haenszel p = 0.024) [24], which is consistent with the lower odds of improvement for males overall and the lower percentages of improvement in corticosteroid-treated males in this analysis. However, Hirst and colleagues [4] reported no effect of sex on recovery in corticosteroid-treated patients.…”

Analysis of HLA DR2&DQ6 (DRB1*1501, DQA1*0102, DQB1*0602) Haplotypes in Iranian Patients with Multiple Sclerosis

“…Disease course, defined as relapsingremitting (RR) with at least two relapses with partial or full recovery, secondary progressive (SP) with initial relapsing-remitting course but the disability increases over time with or without overt relapses, primary progressive (PP) having had a steady progressive course or progressive-relapsing (PR) with continuous progression from the beginning, and several relapses over during the time (Iuliano et al 2007).Positive family history defined as occurrence of MS in first or second-degree relatives of patients. EDSS of the patients was assumed from 0 to 10 based on Kurtzke expanded disability status scale (Kurtzke 1983).…”

Timely relapse treatment in multiple sclerosis: health utility analysis of the NeuroDirect integrated pathway

“…Table 1. Relapses in MS(NICE, 2014) Patients with relapses can recover completely or partially, with estimates for the recovery rates for mobility related relapses being about 70% at 6 months, while the remaining third either require a longer time to recover or have an incomplete recovery (Iuliano et al, 2008). Relapse recovery can be facilitated by administration of high-dose corticosteroids (Goodin, 2014), which in UK practice are usually intravenous methylprednisolone (IVMP), 1 g/day for three days or oral methylprednisolone (OMP), 0.5 g/day for five days (NICE, 2014).…”