A number of questions

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A number of questions

Postby Luongo » Fri Apr 12, 2013 5:12 pm

This forum seems to have more analytical members to it as opposed to being a pure support forum so I was wondering if anyone had some feelings on these questions...

1) Are the symptoms/areas affected in an attack indicative of what will happen in the future? That is to say, if someone has numbness in their toe as an initial symptom for MS, is it expected that all future attacks will involve the same nerves affecting that area of the body and that toe and subsequent foot and leg are most likely to be affected?

2) Is it true that the number of faculties affected in initial attacks are a barometer for disease progression? If a person's initial episode involves extremely minor symptoms affecting their eyes, numbness, and urinary problems, how does that prognosis compare for someone who has ONE symptom (let's say sight, for example) but this is a strong symptom and results in complete blindness. Are the minor attacks for a number of faculties still a worse prognosis than an extremely strong attack on a single faculty?

3) Is PPMS or SPMS inherently worse/more aggressive than RRMS? Like... PPMS may be a steady decline but could that steady decline still be slower than some cases of RRMS? Or are the progressive variants swifter as a rule?

4) Does anyone know of hard research in the difference between male and females with MS? I think the NMSS says something like 65% of PwMS will NOT need to use a wheelchair... but then I read somewhere else (for the life of me, I don't remember where, it was several years ago) that for men, a whopping 4/5ths WILL need to use a wheelchair... does anyone have insight on either of these statistics, or on the statistics of gender difference in general?

Thanks!
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Re: A number of questions

Postby NHE » Fri Apr 12, 2013 8:57 pm

Luongo wrote:This forum seems to have more analytical members to it as opposed to being a pure support forum so I was wondering if anyone had some feelings on these questions...

3) Is PPMS or SPMS inherently worse/more aggressive than RRMS? Like... PPMS may be a steady decline but could that steady decline still be slower than some cases of RRMS? Or are the progressive variants swifter as a rule?


This chart might help...
post131648.html#p131648
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Re: A number of questions

Postby centenarian100 » Mon Apr 15, 2013 2:19 pm

Luongo wrote:1) Are the symptoms/areas affected in an attack indicative of what will happen in the future? That is to say, if someone has numbness in their toe as an initial symptom for MS, is it expected that all future attacks will involve the same nerves affecting that area of the body and that toe and subsequent foot and leg are most likely to be affected?


I believe that the answer is that prior attacks do predict the type of future attack (i.e. transverse myelitis predicts transverse myelitis and optic neuritis predicts optic neuritis)to some extent, but I cannot find a source. Of course, any RRMS patient can have any attack anywhere at any time, so I'm not sure it's that important.

2) Is it true that the number of faculties affected in initial attacks are a barometer for disease progression? If a person's initial episode involves extremely minor symptoms affecting their eyes, numbness, and urinary problems, how does that prognosis compare for someone who has ONE symptom (let's say sight, for example) but this is a strong symptom and results in complete blindness. Are the minor attacks for a number of faculties still a worse prognosis than an extremely strong attack on a single faculty?


factors associated with worse prognosis: male sex, progressive form of disease, brain atrophy, T1 low intensity lesions on MRI brain ("black holes"), late age of onset, attacks other than optic neuritis/sensory relapses, early sphincter involvement, short interval between first two attacks, high spinal cord disease burden, poor recovery from early attacks.

However, it is difficult to accurately prognosticate in MS. Some patients doing well will later do poorly. Some patients doing poorly will unexpectedly stabilize/improve.

sources: http://onlinelibrary.wiley.com/doi/10.1 ... 4/abstract

http://www.ncbi.nlm.nih.gov/pubmed/17172607

3) Is PPMS or SPMS inherently worse/more aggressive than RRMS? Like... PPMS may be a steady decline but could that steady decline still be slower than some cases of RRMS? Or are the progressive variants swifter as a rule?


PPMS generally has a worse prognosis than SPMS which generally has a worse prognosis than RRMS (article on ppms: http://www.sciencedirect.com/science/ar ... 2207702430). There is tremendous variation between individuals and some patients with progressive MS can stabilize for long periods and some patients with RRMS can do very poorly and have an early malignant course.

4) Does anyone know of hard research in the difference between male and females with MS? I think the NMSS says something like 65% of PwMS will NOT need to use a wheelchair... but then I read somewhere else (for the life of me, I don't remember where, it was several years ago) that for men, a whopping 4/5ths WILL need to use a wheelchair... does anyone have insight on either of these statistics, or on the statistics of gender difference in general?


Males with MS have on average a later age of onset and higher risk of PPMS and worse disability prognosis. If I remember correctly, it is the increased risk of PPMS that drives the worse prognosis, so men with RRMS who are doing well may not necessarily have a poor prognosis.

Do you have a source for the 4/5ths statistic? I have never heard of that.
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Re: A number of questions

Postby Luongo » Mon Apr 15, 2013 4:41 pm

Wow! Thanks for all of that! I guess in the end everyone's MS is a dice throw... it's simultaneously relieving and terrifying.

The 4/5ths statistic was from a site called (I believe) MSSucks or something along those lines. I think the site went down a while ago and haven't been able to find it or anything that backs it up since... HOPEFULLY it's wrong or I remember it wrong because reading that crushed me for a long while.
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