Highlights
- •68.6% Of progressive patients showed no significant change in EDSS from baseline.
- •31.4% Of progressive patients worsened.
- •For those patients that had T25FW data available, 30% worsened while 55% showed no change.
Abstract
Objectives
Determine the likelihood of worsening clinical status in the near-term course of progressive
MS and evaluate the predictive validity of our diagnostic impression of progressive
forms of MS.
Methods
Retrospective review of charts from 175 patients seen between 2000 and 2007 who were
diagnosed with either primary or secondary progressive multiple sclerosis. Data extracted
included demographic factors, neurological examination findings to determine EDSS,
timed 25 foot walk (T25FW) when available, duration of symptoms, clinical course as
documented on initial visit, and history of disease-modifying agent (DMA) use. Significant
change in EDSS was defined as a change of one point or more from initial to final
clinical evaluation. Significant change in T25FW was defined as a ±20% difference
from baseline.
Results
Of the 175 charts reviewed, 35 patients met criteria and had sufficient documentation
to allow for EDSS abstraction. Twenty-four patients (68.6%) showed no significant
change in EDSS from baseline while eleven patients (31.4%) worsened and none improved.
For those patients that had T25FW data available, 6 out of 20 (30%) patients worsened
while 11 (55%) showed no change. Three patients (15%) improved.
Conclusion
In this observational study at a tertiary care MS center, patients classified as progressive
MS did not progress as often, or as rapidly, as previous studies have suggested. Greater
than two-thirds of patients in this cohort, did not increase 1 step on the EDSS.
Keywords>
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The search for responsive clinical endpoints in primary progressive multiple sclerosis.Multiple Sclerosis. 2009; 15: 715-720
- Natural history of multiple sclerosis: a unifying concept.Brain. 2006; 129: 606-616
- The clinical epidemiology of multiple sclerosis.Neuroimaging Clinics of North America. 2008; 18: 589-622
- Relapses and progression of disability in multiple sclerosis.New England Journal of Medicine. 2000; 343: 1430-1438
- The natural history of multiple sclerosis: a geographically based study. 5. The clinical features and natural history of primary progressive multiple sclerosis.Brain. 1999; 122: 625-639
- Natural history of primary progressive multiple sclerosis.Multiple Sclerosis. 2004; 10: S8-S15
- EDSS reliability.Neurology. 1991; 41: 332
- Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial.Annals of Neurology. 2009; 66: 460-471
- Kurtzke scales revisited: the application of psychometric methods to clinical intuition.Brain. 2000; 123: 1027-1040
- Clinical impact of 20% worsening on timed 25-foot walk and 9-hole peg test in multiple sclerosis.Multiple Sclerosis. 2006; 12: 594-598
- Responsiveness and predictive value of EDSS and MSFC in primary progressive MS.Neurology. 2008; 70: 1084-1091
- Heterogeneity of multiple sclerosis pathogenesis: implications for diagnosis and therapy.Trends in Molecular Medicine. 2001; 7: 115-121
- Interferon beta-1a in primary progressive MS: an exploratory, randomized, controlled trial.Neurology. 2003; 60: 44-51
- Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Committee in clinical Trials of New Agents in MS.Neurology. 1996; 46: 907-911
- Overview of European pilot study of interferon 1b in primary progressive multiple sclerosis.Multiple Sclerosis. 2004; 10: S62-S64
- Diagnostic criteria for multiple sclerosis: 2005 revisions to the McDonald criteria.Annals of Neurology. 2005; 58: 840-846
- Prognostic factors in a multiple sclerosis incident cohort with twenty-five years of follow-up.Brain. 1993; 116: 117-134
- Quantitative functional measures in MS: what is a reliable change?.Neurology. 2002; 58: 1294-1296
- The natural history of primary progressive MS in British Columbia, Canada.Neurology. 2005; 65: 1919-1923
- Natural history of multiple sclerosis: risk factors and prognostic indicators.Current Opinion in Neurology. 2007; 20: 269-274
- PROMiSe Trial Study Group. The PROMiSe trial: baseline data review and progress report.Multiple Sclerosis. 2004; 10 (discussion S71-2.): S65-71
- Glatiramer acetate in primary progressive multiple sclerosis: results of a multinational, multicenter, double-blind, placebo-controlled trial.Annals of Neurology. 2007; 61: 14-24
Article info
Publication history
Published online: July 22, 2013
Accepted:
May 22,
2013
Received in revised form:
April 23,
2013
Received:
February 26,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
