Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains

Abstract

<jats:p> Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible. </jats:p>

The effects of supervised versus home Pilates-based core stability training on lower extremity muscle strength and postural sway in people with multiple sclerosis

“…Even early-phase MS is accompanied by considerable impairments across multiple domains, such as strength, balance, and physical functions compared to healthy controls. 35 Therefore, we also included those with low EDSS scores. To ensure that PBCST is suitable for patients with all levels of disability specified in the inclusion criteria, many different versions of exercises from simple to difficult have been created and progressed according to the individual, which basically target the same structures.…”

Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice

“…Nearly 2.8 million people worldwide suffer from multiple sclerosis (MS), a chronic demyelinating disease of the central nervous system representing the main nontraumatic cause of disability in young adults [ 1 ]. Balance and walking impairments are among the most common deficits in people with MS (PwMS), arising early in the disease course [ 2 , 3 , 4 ] and gradually progressing over time [ 5 ], leading to loss of independence and quality of life [ 6 ]. In particular, balance deficits seem to begin earlier than walking dysfunctions, as demonstrated by previous studies showing the presence of static and dynamic balance impairments even in PwMS who walked normally [ 7 , 8 , 9 , 10 , 11 ].…”

“…However, these trainings are usually administered to PwMS who are already in the moderate stages of the disease (i.e., EDSS: 3–6) and, on average, five to fifteen years after diagnosis when symptoms and functional impairments are clearly evident [ 18 ]. By contrast, the recent literature highlights the importance of beginning rehabilitation interventions early in the disease course to supplement pharmacological therapy and potentially postpone and/or slow down MS-related functional decline [ 3 , 18 , 19 ]. In this context, the sensitive detection of subtle impairments, in particular balance deficits, seems a crucial point to planning tailored preventive exercise interventions from the very early stages of the disease [ 3 ].…”

Multimethodological validation of the modified fatigue impact scale in a Danish population of people with Multiple Sclerosis

“…Multiple sclerosis (MS) is a chronic, progressive inflammatory and degenerative disease affecting the central nervous system, characterized by a complex pathogenesis and heterogenous symptoms across physical, cognitive, and neuropsychological domains (Filippi et al, 2018;Thrue et al, 2020). Fatigue is the most common symptom reported by patients with multiple sclerosis (MS) (Rommer et al, 2019), and it is known to have a detrimental impact on patients perception of health and quality of life (Green et al, 2017;Amato et al, 2001).…”