Treatment choices and neuropsychological symptoms of a large cohort of early MS

Bismarck, Olga von; Dankowski, Theresa; Ambrosius, Björn; Heßler, Nicole; Antony, Gisela; Ziegler, Andreas; Hoshi, Muna-Miriam; Aly, Lilian; Luessi, Felix; Groppa, Sergiu; Klotz, Luisa; Meuth, Sven G.; Tackenberg, Björn; Stoppe, Muriel; Bergh, Florian Then; Tumani, Hayrettin; Kümpfel, Tania; Stangel, Martin; Heesen, Christoph; Wildemann, Brigitte; Paul, Friedemann; Bayas, Antonios; Warnke, Clemens; Weber, Frank; Linker, Ralf A.; Ziemann, Ulf; Zettl, Uwe K.; Zipp, Frauke; Wiendl, Heinz; Hemmer, Bernhard; Gold, Ralf; Salmen, Anke

doi:10.1212/nxi.0000000000000446

Cited by 58 publications

(67 citation statements)

References 37 publications

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“…Thirdly, baseline data from our patient group are well in line with previous cohorts following up on patients after a first demyelinating event with a preponderance of women, a mean age between 20 and 40 and optic neuritis or spinal sensory symptoms as presenting topography . In good accordance with other studies and data on the early efficacy of disease modifying drugs from initial trials as well as follow‐up studies , over 50% of patients are already treated after the first demyelinating event.…”

Section: Discussionsupporting

confidence: 89%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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Background and purpose For the diagnosis of relapsing–remitting multiple sclerosis (RRMS), the revised 2017 McDonald criteria include cerebrospinal fluid specific oligoclonal bands as a new criterion for dissemination in time. Amongst other things, one expectation of the new criteria is to marginalize the diagnosis of clinically isolated syndrome (CIS), thus allowing for a faster and at the same time still reliable diagnosis of RRMS. Methods In this study, data from an unselected patient cohort with a typical CIS and dissemination in space at a large German Multiple Sclerosis Center from 2013 to 2016 were re‐analysed to compare differences in diagnosing RRMS with the 2017 versus 2010 McDonald criteria in everyday practice. Results Out of a cohort of 290 patients presenting with a typical first demyelinating event, 52% (152 patients) with the diagnosis of RRMS and 48% (138 patients) with the diagnosis of CIS according to the 2010 McDonald criteria were identified. The application of the 2017 McDonald criteria in the same patients increased the number of definite RRMS to 94% (273), thus leaving only 6% of patients with the diagnosis of CIS. The reason for this shift was the presence of cerebrospinal fluid specific oligoclonal bands which was found in 92.7% of the total population and in all patients with 2017 McDonald RRMS. Over a mean follow‐up of 1.5 years, 50% of patients formerly diagnosed with CIS who are now RRMS also fulfilled the 2010 McDonald criteria. Conclusions Our data support the use of the 2017 McDonald criteria for a more sensitive, but not that specific, diagnosis of RRMS in everyday practice.

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Section: Discussionsupporting

confidence: 89%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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“…All patients provided written informed consent. Inclusion and exclusion criteria as well as assessment plans are laid out in detail elsewhere [ 18 ]. In short, inclusion required a recent diagnosis of either CIS or RRMS according to Barkhof [ 19 ] or 2005 McDonald [ 20 ] criteria, respectively; exclusion criteria implied previous intake of disease-modifying therapies (DMTs), other neurological or psychiatric conditions as well as progressive courses of MS. Assessment involved sociodemographic data, detailed neurological status, medication status regarding DMTs, standardized cranial MRI evaluation regarding signs of disease burden, collection of biomaterial as well as neuropsychological screenings and self-report questionnaires.…”

Section: Methodsmentioning

confidence: 99%

“…Here, we aimed to investigate whether CI and its short-term progression can be effectively predicted by a single marker or combinations of conventional demographic, clinical and MRI parameters that are readily available to clinicians at the time of diagnosing MS. We were further interested in the relative importance of these potential risk factors both for CI as well as for its longitudinal change. To this end, we analyzed cognitive screening data from the German National MS cohort (NationMS) of patients with initial diagnosis of either MS or CIS [ 18 ]. We assumed standard sociodemographic data, established clinical markers of MS disease burden and/or conventional MRI parameters at baseline to be predictive for CI.…”

Section: Introductionmentioning

confidence: 99%

Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS)

et al. 2018

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Background Cognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis. Methods Neuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes. Results At baseline, 22% of patients had CI (impairment in ≥2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year. Conclusions Identification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction. Electronic supplementary material The online version of this article (10.1007/s00415-018-9142-y) contains supplementary material, which is available to authorized users.

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“…Fatigue is a frequent and burdensome complaint even in the early disease stages of multiple sclerosis (MS) (1,2), and there is a need for more effective treatment options (3). Although fatigue has been related to disability status, depressive symptoms, and brain connectivity in MS, there is no consensus on its etiology and the definitions of the constructs are still evolving (4,5).…”

Section: Introductionmentioning

confidence: 99%

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

et al. 2020

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Background: Fatigue in multiple sclerosis (MS) is conceived as a multidimensional construct. Objectives: This study aims to describe the changes of balance and gait parameters after 6 min of walking (6 MW) as potential quantitative markers for perceptions of state fatigue and trait fatigue in MS. Methods: A total of 19 patients with MS (17 with fatigue) and 24 healthy subjects underwent static posturography, gait analysis, and ratings of perceived exertion before and after 6 MW. Results: 6 MW was perceived as exhaustive, but both groups featured more dynamic comfortable speed walking after 6 MW. Shorter stride length at maximum speed and increased postural sway after 6 MW indicated fatigability of balance and gait in MS group only. While most changes were related to higher levels of perceived exertion after 6 MW (state fatigue), higher fatigue ratings (trait fatigue) were only associated with less increase in arm swing at comfortable speed. Further analysis revealed different associations of trait fatigue and performance fatigability with disability and motor functions. Performance fatigability was most closely related to the Expanded Disability Status Scale, while for trait fatigue, the strongest correlations were seen with balance function and handgrip strength. Conclusions: Fatigability of performance was closely related to perceptions of exertion after 6 MW (state fatigue) and disability in MS but distinct from fatigue ratings, conceived as trait fatigue. Our study identified postural sway, arm swing during gait, and hand grip strength as unexpected potential motor indicators of fatigue ratings in MS.

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Treatment choices and neuropsychological symptoms of a large cohort of early MS

Cited by 58 publications

References 37 publications

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS)

Association Between Fatigue and Motor Exertion in Patients With Multiple Sclerosis—a Prospective Study

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