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We all want to know what is going to be our future with this disease. No one knows for sure, but in a study released last week, researchers have found significant clues that are tied directly to disability and those that have no impact. Some of their findings debunk long-held beliefs (no, men are not worse off), offer reassurance (pregnancy has no influence), and surprise (depression is a risk factor for disability). And some of their findings are staggering.
The most sobering statement: "A patient developing SPMS has a 500-fold higher risk of being severely disabled within 10 years after MS onset as compared to a patient remaining relapsing-remitting."
For those RRMSers not on therapy, this post on delaying the onset of secondary progression by leading neuro and professor Gavin Giovannoni is valuable food for thought.
http://multiple-sclerosis-research.b...is+Research%29
The abstract from the journal article in PLoS One is below along with a link the full, free article complete with detailed graphics. - D
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PLoS One. 2016 Jul 8;11(7):e0158978. doi: 10.1371/journal.pone.0158978. eCollection 2016.
Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study.
Bsteh G1, Ehling R1, Lutterotti A1,2, Hegen H1, Di Pauli F1, Auer M1, Deisenhammer F1, Reindl M1, Berger T1.
Abstract
BACKGROUND:
Multiple sclerosis (MS) has a highly heterogenic course making prediction of long term outcome very difficult.
OBJECTIVE:
The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset.
METHODS:
This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5), moderate (EDSS 3.0-5.5) or severe (EDSS ≥6.0) disability were calculated to correct for confounders.
RESULTS:
Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0-1580.1); p<0.001). Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23-0.77; p = 0.005), while depression (HR 3.59; CI 1.14-11.24; p = 0.028) and cognitive dysfunction (HR 4.64; CI 1.11-19.50; p = 0.036) 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability.
CONCLUSION:
We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms.
FULL ARTICLE WITH GRAPHS
http://journals.plos.org/plosone/art...l.pone.0158978
The most sobering statement: "A patient developing SPMS has a 500-fold higher risk of being severely disabled within 10 years after MS onset as compared to a patient remaining relapsing-remitting."
For those RRMSers not on therapy, this post on delaying the onset of secondary progression by leading neuro and professor Gavin Giovannoni is valuable food for thought.
http://multiple-sclerosis-research.b...is+Research%29
The abstract from the journal article in PLoS One is below along with a link the full, free article complete with detailed graphics. - D
-----------------
PLoS One. 2016 Jul 8;11(7):e0158978. doi: 10.1371/journal.pone.0158978. eCollection 2016.
Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study.
Bsteh G1, Ehling R1, Lutterotti A1,2, Hegen H1, Di Pauli F1, Auer M1, Deisenhammer F1, Reindl M1, Berger T1.
Abstract
BACKGROUND:
Multiple sclerosis (MS) has a highly heterogenic course making prediction of long term outcome very difficult.
OBJECTIVE:
The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset.
METHODS:
This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5), moderate (EDSS 3.0-5.5) or severe (EDSS ≥6.0) disability were calculated to correct for confounders.
RESULTS:
Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0-1580.1); p<0.001). Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23-0.77; p = 0.005), while depression (HR 3.59; CI 1.14-11.24; p = 0.028) and cognitive dysfunction (HR 4.64; CI 1.11-19.50; p = 0.036) 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability.
CONCLUSION:
We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms.
FULL ARTICLE WITH GRAPHS
http://journals.plos.org/plosone/art...l.pone.0158978