The transition from relapsing-remitting MS to irreversible disability: clinical evaluation

Trojano, María; Paolicelli, Damiano; Bellacosa, A.; Cataldo, Stefania

doi:10.1007/s10072-003-0171-6

Cited by 30 publications

(22 citation statements)

References 16 publications

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“…In comparison to other trajectories, SPMS patients caused the highest costs for ancillary therapy, special equipment, hospital inpatient stays, and patient copayments. Considering indirect costs and the high risk of developing a secondary progressive course of the disease [3], the need to improve treatment options for those patients becomes obvious.…”

Section: Discussionmentioning

confidence: 99%

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Economic Burden in a German Cohort of Patients with Multiple Sclerosis

Reese

John²,

Wienemann³

et al. 2011

Eur Neurol

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Aims: To estimate costs of multiple sclerosis (MS) in a German cohort according to severity of the disease and clinical symptoms. Methods: 144 patients were recruited from an MS outpatient clinic. Costs were calculated according to current German health-economic guidelines from the perspective of the social health insurance system. Patients were either interviewed or completed a questionnaire. Cost assessment covered a 3-month period. Health outcomes were: Expanded Disability Status Scale, MS Functional Composite, Functional Assessment of MS, fatigue, depression (Beck Depression Inventory II) and patients’ socioeconomic status. Multivariate linear regression identified independent cost predictors. Results: Total quarterly costs per patient were EUR 10,329 (95% CI 9,357–11,390). Direct costs were EUR 5,344 for the social health insurance system and EUR 140 for the patient. Drugs represented the major share of direct costs (and 35% of total costs); indirect costs accounted for 47% of total costs. Univariate and multivariate analyses identified age, disability, fatigue and depression as independent predictors for total, indirect or drug costs. Conclusion: MS represents a high economic burden, with direct costs exceeding indirect costs. To reduce costs, research should focus on prevention that slows down progression of MS. Rehabilitation and symptomatic treatment may have merits in decreasing indirect costs.

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Section: Discussionmentioning

confidence: 99%

“…Years after onset, some RRMS patients develop a secondary-progressive course (SPMS), defined by slow neurological deterioration without causal relationship to relapses [3]. A minority of patients (15%) has primary progressive MS (PPMS), characterized by a progressive and usually nonrelapsing course [4].…”

Section: Introductionmentioning

confidence: 99%

Economic Burden in a German Cohort of Patients with Multiple Sclerosis

Reese

John²,

Wienemann³

et al. 2011

Eur Neurol

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“…When carrying out an assessment, it is important to include immobility as a risk factor and it is suggested that a sustained EDSS of ≥6 (see Table 1) [79] should trigger BMD measurement by DXA. An EDSS of 6 is an appropriate cutoff as it is an established landmark in irreversible disability progression [80][81][82], fracture risk continues to rise with higher levels [39] and the use of a cane is itself a recognised risk factor for falls in MS [44,45]. The presence of a prior fragility fracture is a particularly important risk factor and may prompt treatment initiation without BMD measurement if the latter is not readily available.…”

Section: Assessment Of Bone Healthmentioning

confidence: 99%

Bone health in multiple sclerosis

Gibson

Summers

2011

Osteoporos Int

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People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.

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“…3 As these cycles continue, patients accumulate disability from incomplete remissions, leading 50% into the secondary-progressive (SP) phase of the disease within 15 years. 3, 4 This phase is characterized by increasing permanent disability, fewer relapses, less inflammation and more pronounced neurodegeneration entailing chronic increase in motor, sensory and cognitive deficits and 5–10 year reduction in life expectancy. 5 …”

Section: Introductionmentioning

confidence: 99%

Global N-acetylaspartate concentration in benign and non-benign multiple sclerosis patients of long disease duration

Achtnichts

Gonen

Rigotti

et al. 2013

European Journal of Radiology

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BACKGROUND and OBJECTIVE To examine whether clinically benign multiple sclerosis patients (BMS) show similar losses of their global N-acetylaspartate (NAA) neuronal marker relative to more clinically disabled patients of similar disease duration. METHODS The whole-brain NAA concentration (WBNAA) was acquired with whole-head non-localizing proton MR spectroscopy. Fractional brain parenchymal volume (fBPV), T2 and T1 lesion loads, were obtained from the MRI in: (i) 24 BMS patients: 23.1±7.2 years disease duration, median Expanded Disability Status Scale (EDSS) score of 2.0 (range: 0–3); (ii) 26 non-benign MS patients (non-BMS), 24.5±7.4 years disease duration, median EDSS of 4.0 (range: 3.5–6.5); (iii) 15 healthy controls. RESULTS Controls’ 12.4±2.3 mM WBNAA was significantly higher than the BMS’s and non-BMS’s 10.5±2.4 and 9.9±2.1mM (both p<0.02), but the difference between the patients’ groups was not (p>0.4). Likewise, the controls’ 81.2±4.5% fBPV exceeded the BMS and non-BMS’s 77.0±5.8% and 76.3±8.6% (p<0.03), which were also not different from one another (p>0.7). BMS patients’ T1 hypointense lesion load, 2.1±2.2 cm3, was not significantly different than the non-BMS’s 4.1±5.4 cm3 (p>0.08) and T2 hyperintense loads: 6.0±5.7cm3 and 8.7±7.8 cm3, were also not different (p>0.1). CONCLUSIONS WBNAA differentiates normal controls from MS patients but does not distinguish BMS from more disabled MS patients of similar disease duration. Nevertheless, all MS patients who remain RR for 15+ years suffered WBNAA loss similar to the average RR MS population at fourfold shorter disease duration suggesting relative global neuronal sparing or leveling-off of the neurodegeneration rate.

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The transition from relapsing-remitting MS to irreversible disability: clinical evaluation

Cited by 30 publications

References 16 publications

Economic Burden in a German Cohort of Patients with Multiple Sclerosis

Economic Burden in a German Cohort of Patients with Multiple Sclerosis

Bone health in multiple sclerosis

Global N-acetylaspartate concentration in benign and non-benign multiple sclerosis patients of long disease duration

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