Predictors of severity and outcome of multiple sclerosis relapses

Abstract

Background Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). The most common type of MS is the relapsing–remitting MS (RRMS) where relapses are the main component of the disease course. However, the relationship between the characteristics of the relapses on one hand and their severity and outcome on the other hand has not been fully characterized. Objectives To explore the characteristics of relapses among a cohort of Egyptian MS patients and their relation to the severity and outcome of the disease. Subjects and methods We analyzed 300 attacks from 223 patients in a retrospective study to identify demographic, clinical and paraclinical (laboratory and radiological) factors affecting: 1- Severity of relapses (the difference between the EDSS at the day of maximum worsening and the EDSS before the onset of the attack). 2- Outcome of relapses (the difference between the EDSS at the day of maximum improvement and the EDSS before the onset of the relapse). Results Severe attacks were most likely to occur in patients who are males, single, presenting with poly-symptomatic presentation, slower tempo of evolution of attack symptoms, longer duration of the attack, absence of DMTs at the time of the attack. The risk of having a severe relapse is more than 3 times when the patient is single. Regarding attack outcome, poorly recovered attacks were more common in patients with older age at disease onset and at attack onset, male sex, higher number of relapses, longer duration of illness prior to the attack, severe relapses, polysymptomatic presentation, associated cognitive symptoms, slower tempo of symptom evolution, longer duration of the attack, patients on OCPs, smoking, and presence of black holes in brain MRI. The risk of having relapses with partial or no recovery is more than five times when the patient has black holes in brain MRI and more than 4 times when the patient is a smoker. Conclusion Bearing in mind the demographic characteristics as well as the clinical and paraclinical characteristics of each attack and their relation to attack severity and outcome are a key to understanding the individual disease course of every patient and hence tailoring the best therapeutic plan suitable for his individual needs. In other words, prompt, rapid intervention in male patients, polysymptomatic attacks, slower tempo of evolution of attack symptoms and longer duration of the attack should be adopted since these factors are predictive of severe relapses as well as poor relapse outcome.

Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

“…The severity of relapse and residual findings are other clinical parameters to consider in follow-up, treatment intervention, and long-term treatment decisions. Moreover, studies by Naldi, Baghizadeh et al have shown that relapses involving polysymptomatic presentation tend to be more severe, and both parameters are considered poor prognostic factors [21][22][23][24][25] . In our study, recovery from an attack predicted an EDSS score of 4, and in those with a polysymptomatic onset, the proportion of those with an EDSS score of 4 was also higher.…”

Sex differences in multiple sclerosis relapse presentation and outcome: a retrospective, monocentric study of 134 relapse events

“…Risk factors of poor relapse recovery have been described and include male sex, higher age at relapse, longer disease duration, and relapse characteristics such as motor and cerebellar involvement. 9 – 11 Data on paraclinical markers, for example, black holes in brain magnetic resonance imaging (MRI) seem less robust. 10 …”

“… 9 – 11 Data on paraclinical markers, for example, black holes in brain magnetic resonance imaging (MRI) seem less robust. 10 …”

“…As an example, in relapse-onset MS, male sex has been found to be associated with faster disability accrual in an MSBase analysis, 12 but not in the German MS registry. 3 Likewise, male sex was associated with worse relapse recovery, 10 but not identified as a generalizable indicator of aggressive MS or significantly influencing MS severity scale (MSSS) modeling. 13 , 14 Interestingly, sex differences in relapse presentation seem robust over different study settings with more motor and cerebellar involvement in men and more sensory and visual symptoms in women.…”

“… 3 , 9 Taken together, these data with poorer relapse recovery and more motor involvement in men might suggest a general effect of male sex on higher disability progression 11 indicating that additional factors must play a role. Among the latter surely are patient age, disease duration, and disease-modifying treatment (DMT), 2 , 10 , 13 but also individual and possibly gender-influenced behavioral factors, especially smoking 15 – 20 and obesity. 21 …”