Relapses in Multiple Sclerosis and Correlation With Clinical and Biological Parameters: Presented at EFNS
10th Congress of the European Federation of Neurological Societies, Glasgow. 8th September 2006
The correlation of clinical and biological parameters with relapse in patients with multiple sclerosis (MS) demonstrates the prognostic importance of specific predictive relapse-related factors, according to a study presented here at the 10th Congress of the European Federation of Neurological Societies (EFNS).
"A lot of studies have described the evolution of multiple sclerosis, but only this study describes the clinical characteristics of multiple sclerosis, where we have looked at the length, the severity and the probability of recovery," said investigator Laura Collimedaglia, MD, neurologist, Neurology Clinic, Università del Piemonte Orientale "A. Avogadro" and Ospedale Maggiore della Carità, Novara, Italy.
With relapse being the pivotal feature of relapsing-remitting MS (RR-MS), Dr. Collimedaglia and colleagues conducted a study to look for correlations between these clinical characteristics and the potential clinical and biological predictors for relapse prognosis in these patients, she said during her September 4th presentation.
Seventy-one consecutive patients were recruited, who displayed clinically isolated syndrome or had a first diagnosis of RR-MS according to the McDonald criteria.
These patients were clinically evaluated every 6 months and at every relapse, as defined by the modified Schumacher criteria. The patient symptoms and signs were grouped to match up with the Kurtzke Functional System (FS), and for each FS the patient was asked to define the date of onset, maximum worsening (nadir), onset of improvement, and maximum improvement.
The patients with relapses were divided according to the completeness of recovery (with or without sequelae), while predictive factors were divided as relapse-related and patient-related, and recorded on ad-hoc-prepared forms.
The severity ("gain" of each relapse) was calculated for each FS, as the difference between the score on the day of the nadir and the score before the onset of relapse. These were summed and categorised into very mild (0-1), mild (2), moderate (3) and severe (4 or greater).
During the 2 years of follow-up, there were 71 first relapses, 51 second, 30 third, and 50 following. Sequelae were seen in 67 relapses (33%).
The probability of acquiring residual disability was first analysed according to the relapse-related factors, where the significant predictive factors were: number of clinical symptoms (bi-symptomatic, P <.0001; multisymptomatic, P <.0001); type of clinical symptoms (cerebellar, P <.0001; brain stem, P <.0001); severity (mild, P <.0001; moderate, P <.0001); total relapse duration (intermediate, P <.0001; long, P <.0001); and age at first relapse (30-39 years, P <.01; 40 years or greater, P <.005).
The researchers then performed stepwise logistic regression analysis to evaluate the influence of the relapse-related variables on the development of sequelae. The significant factors at this level were: number of symptoms (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.6-8.5; P <.0001); severity >1 point (OR, 21.3; 95% CI, 2.7-169.7; P <.002); age at onset (OR, 2.7; 95% CI, 1.4-5.5; P <.004; and duration of 30 days or more (OR, 3.3; 95% CI, 1.5-7.1; P <.003).
Thus, Dr. Collimedaglia indicated, this study demonstrates that a description of the clinical features of relapses and the identification of predictive factors for nonrecovery do indeed have prognostic importance and should therefore be used to drive the treatment of patients with RR-MS.
[Presentation title: Relapses in Multiple Sclerosis and Correlation With Clinical and Biological Parameters. Abstract P2239]