Physical and Cognitive Functioning After 3 Years Can Be Predicted Using Information From the Diagnostic Process in Recently Diagnosed Multiple Sclerosis

Abstract

ABSTRACT. de Groot V, Beckerman H, Uitdehaag BM, Hintzen RQ, Minneboo A, Heymans MW, Lankhorst GJ, Polman CH, Bouter LM, on behalf of the Functional Prognostication and Disability (FuPro) Study Group. Physical and cognitive functioning after 3 years can be predicted using information from the diagnostic process in recently diagnosed multiple sclerosis. Arch Phys Med Rehabil 2009;90:1478-88.Objective: To predict functioning after 3 years in patients with recently diagnosed multiple sclerosis (MS).Design: Inception cohort with 3 years of follow-up. At baseline, predictors were obtained from medical history taking, neurologic examination, and magnetic resonance imaging (MRI).Setting: Neurology outpatient clinic. Participants: Patients with MS (Nϭ156); 146 with complete follow-up.Interventions: Not applicable. Main Outcome Measures: Inability to walk at least 500m, impaired dexterity, cognitive impairments, incontinence, inability to drive a car or use public transportation, social dysfunction, and reliance on a disability pension.Results: Clinical prediction rules were constructed for the models that were well calibrated (sufficient agreement between predicted and observed outcomes, based on visual inspection of calibration curves) and that showed sufficient discrimination (area under the receiver operation characteristic curve Ͼ.70) after internal bootstrap validation. The models for the inability to walk at least 500m, impaired dexterity, and cognitive impairments were well calibrated. Discrimination was sufficient for all 7 models, except the one predicting social dysfunction (.67). The inability to walk at least 500m was predicted by the perceived ability to walk, impairment of the cerebellar tract, and the number of MRI lesions in the spinal cord. Impaired dexterity was predicted by the perceived ability to use the hands, impairments of the pyramidal, cerebellar, and sensory tracts, and the T2-weighted infratentorial lesion load. Cognitive impairment was predicted by age, gender, the perceived ability to concentrate, and the T2-weighted supratentorial lesion load.Conclusions: Inability to walk at least 500m, impaired dexterity, and cognitive impairments can be predicted with predictors that are derived from medical history taking, neurologic examination, and MRI shortly after a definite diagnosis of MS has been made.Key Words: Cohort studies; Disability evaluation; Multiple sclerosis; Prognosis; Rehabilitation.© by the American Congress of Rehabilitation MedicineM ULTIPLE SCLEROSIS is characterized by variable neurologic symptomatology that differs not only between patients but also within patients over time. This variability makes predicting the clinical course of the disease difficult, posing a significant challenge for physicians treating patients with MS and causing patients to feel uncertain about their future. This uncertainty negatively influences their quality of life.1,2 Well-validated prognostic models can aid physicians in making decisions about certain (preventive) treatments for patients with MS o...

Interleukin-1β and Interleukin-1 Receptor Antagonist Appear in Grey Matter Additionally to White Matter Lesions during Experimental Multiple Sclerosis

“…Thus the observed presence of IL-1β in WM and GM regions within the CNS of our cr-EAE rats may contribute to oligodendrocyte damage, demyelination and subsequent axonal loss and thus could account for several of the neurological symptoms described in EAE, including paralysis [78], [79], enhanced pain sensation [79]–[81] and loss of vision [82]–[85]. Similarly, in MS patients, impaired vision, sensory and motor functions are symptoms that can manifest themselves by lesions within the optic tract [86], [87], tracts within the brain stem [88], [89], cerebellum [90] and spinal cord [91]–[94], respectively [95].…”

Pathological differences between white and grey matter multiple sclerosis lesions

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The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis

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