Vascular comorbidity is associated with more rapid disability progression in MS
[URL="https://www.ncbi.nlm.nih.gov/m/pubmed/2 ... %2Frelated"][U]Vascular comorbidity[/U][/URL] is associated with more rapid disability progression in multiple sclerosis
[QUOTE]
[B]CONCLUSIONS:[/B]
Vascular comorbidity, whether present at symptom onset, diagnosis, or later in the disease course, is associated with a substantially increased risk of disability progression in multiple sclerosis. The impact of treating vascular comorbidities on disease progression deserves investigation.[/QUOTE]
MS Progression Time Predicts Disability
-
Marsei
Asymptomatic spinal cord lesions do not predict the time to disability
Asymptomatic spinal cord lesions do not predict the time to disability
[URL="https://www.readbyqxmd.com/read/2910632 ... -sclerosis"][U]Asymptomatic spinal cord lesions[/U][/URL] do not predict the time to disability in patients with early multiple sclerosis - onderzoek VU
[QUOTE][B]BACKGROUND[/B]: The presence of asymptomatic spinal cord (SC) lesions in patients with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) predicts conversion to clinically definite multiple sclerosis (CDMS). The relation between asymptomatic SC abnormalities and disability progression warrants further investigation.
[B]OBJECTIVE[/B]: To determine the prognostic value of asymptomatic SC lesions in CIS and early RRMS with respect to the time to disability development.
[B]METHODS[/B]: Clinical and demographic data, brain and SC magnetic resonance imaging (MRI) were collected of CIS or early RRMS patients. Two main analyses were performed. For the first analysis, patients were divided into two groups: (1) patients with asymptomatic SC lesions and (2) patients without SC lesions and patients with symptomatic SC lesions. The second analysis excluded patients with symptomatic SC lesions. Incidence curves were used to analyse differences between these groups in time to the development of disability and time to a second relapse.
[B]RESULTS[/B]: A total of 178 patients were included, and 42 patients (23.6%) had asymptomatic SC lesions. No significant differences were found on the time to disability development or the time to a second event.
[B]CONCLUSION[/B]: Asymptomatic SC lesions early in the disease course do not predict the time to disability development in patients diagnosed with CIS or early RRMS.[/QUOTE]
[URL="https://www.readbyqxmd.com/read/2910632 ... -sclerosis"][U]Asymptomatic spinal cord lesions[/U][/URL] do not predict the time to disability in patients with early multiple sclerosis - onderzoek VU
[QUOTE][B]BACKGROUND[/B]: The presence of asymptomatic spinal cord (SC) lesions in patients with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) predicts conversion to clinically definite multiple sclerosis (CDMS). The relation between asymptomatic SC abnormalities and disability progression warrants further investigation.
[B]OBJECTIVE[/B]: To determine the prognostic value of asymptomatic SC lesions in CIS and early RRMS with respect to the time to disability development.
[B]METHODS[/B]: Clinical and demographic data, brain and SC magnetic resonance imaging (MRI) were collected of CIS or early RRMS patients. Two main analyses were performed. For the first analysis, patients were divided into two groups: (1) patients with asymptomatic SC lesions and (2) patients without SC lesions and patients with symptomatic SC lesions. The second analysis excluded patients with symptomatic SC lesions. Incidence curves were used to analyse differences between these groups in time to the development of disability and time to a second relapse.
[B]RESULTS[/B]: A total of 178 patients were included, and 42 patients (23.6%) had asymptomatic SC lesions. No significant differences were found on the time to disability development or the time to a second event.
[B]CONCLUSION[/B]: Asymptomatic SC lesions early in the disease course do not predict the time to disability development in patients diagnosed with CIS or early RRMS.[/QUOTE]
-
Marsei
Do spinal cord lesions matter in patients with CIS and early MS?
Do spinal cord lesions matter in patients with CIS and early MS?
Do [URL="http://journals.sagepub.com/doi/full/10 ... eContainer"][U]spinal cord lesions[/U][/URL] matter in patients with clinically isolated syndrome and early MS?
[QUOTE]Asymptomatic spinal cord lesions are found in 30%–50% of people with a clinically isolated syndrome (CIS).
[/QUOTE]
[QUOTE]Because typical short-segment spinal cord lesions are a relatively specific finding to MS, spinal cord MRI may also assist in differential diagnosis, and may be helpful in avoiding misdiagnosis.
Two recent studies have suggested that spinal cord lesions in CIS patients may not only be helpful in making diagnosis of MS, but may also provide additional prognostic information. [/QUOTE]
[QUOTE]In a study involving 131 CIS patients with a non-spinal CIS who had brain and spinal MRI within 3 months of presentation, asymptomatic spinal cord lesions were the strongest MRI predictor of physical disability after 5 years.
Similarly, in another study of 207 prospectively recruited CIS patients with brain and spinal imaging with 3 months of disease onset, spinal cord lesions were associated with an increased risk of reaching Expanded Disability Status Scale (EDSS) 3 or more over a follow-up period of almost 3 years, even after adjusting for brain MRI findings and other relevant prognostic markers. The prognostic value of spinal cord lesions was highest in patients with a non-spinal CIS.
Collectively, these studies suggest that asymptomatic spinal cord lesions seen at the time of presentation with CIS are associated with an increased risk of physical disability, at least in the short to medium term, and may provide much needed prognostic information to help counsel patients about their risk of future disability.
In this issue of Multiple Sclerosis Journal, Dekker and colleagues investigate the impact of asymptomatic spinal cord lesions in a cohort of patients recruited within 12 months of presentation with CIS. More than half of the patients already had a diagnosis of MS using the McDonald 2010 criteria at the time of study entry. MRI scans of the brain and spinal cord were obtained at “baseline” (within 12 months of disease onset) and the patients were followed up prospectively for the development of disability. Over a median follow-up period of 6 years, no difference was seen in the time to reaching EDSS 3 and 6, or confirmed worsening in timed 25-foot walk and 9-hole peg test speeds, in patients with and without asymptomatic spinal cord lesions. The authors conclude that the prognostic significance of asymptomatic spinal cord lesions in patients with CIS and early MS is uncertain.
The author’s findings do contrast with other recent work and this might reflect differences in the patient population studied, the analytical approach, or both. In the current study, over 96% of patients had an abnormal brain MRI at presentation, compared with 65%–80% in other studies. The higher proportion of patients with normal brain MRI in previous studies might have accentuated the prognostic value of asymptomatic spinal lesions: this group of patients is at much lower risk for the development of MS and disability, and asymptomatic spinal cord lesions are uncommon in patients with a normal brain MRI.
The authors approach to the analyses might also potentially account for the negative results. In their main analyses, Dekker and colleagues compare the time to disability worsening in patients with asymptomatic spinal cord lesions at study entry to a comparator group without asymptomatic spinal cord lesions. The comparator group was very heterogeneous and included the following:
(1) patients with a non-spinal CIS with normal spinal MRI,
(2) patients with spinal cord syndromes with a normal spinal MRI, and
(3) patients with spinal cord syndromes with an abnormal spinal MRI.
In total, more than three quarters of the patients in the comparator group presented with a spinal cord syndrome, had a spinal cord relapse prior to study entry, or both. Therefore, in reality, the authors compare the time to disability worsening in patients with CIS or early MS with (predominantly) symptomatic spinal cord lesions to a group with asymptomatic spinal cord lesions. The fact that there was no difference in the time to disability worsening in this study might suggest that early spinal cord damage in relapse-onset MS, whether symptomatic or asymptomatic, may have similar functional consequences and carry a similar risk of future disability.
Whether routine spinal cord MRI should be done in all patients with CIS and early MS is controversial. Current European and North American guidelines only recommend spinal cord imaging in selected patient groups.The additional diagnostic value of spinal cord MRI is known to be modest, at least for providing evidence of dissemination in space in patients with typical clinical presentations suggestive of MS. Although other recent work has suggested a prognostic role for spinal cord imaging in patients with CIS and early MS, the findings of Dekker and colleagues will add to the ongoing uncertainty over the diagnostic and prognostic value of spinal cord MRI in this patient group.[/QUOTE]
Do [URL="http://journals.sagepub.com/doi/full/10 ... eContainer"][U]spinal cord lesions[/U][/URL] matter in patients with clinically isolated syndrome and early MS?
[QUOTE]Asymptomatic spinal cord lesions are found in 30%–50% of people with a clinically isolated syndrome (CIS).
[/QUOTE]
[QUOTE]Because typical short-segment spinal cord lesions are a relatively specific finding to MS, spinal cord MRI may also assist in differential diagnosis, and may be helpful in avoiding misdiagnosis.
Two recent studies have suggested that spinal cord lesions in CIS patients may not only be helpful in making diagnosis of MS, but may also provide additional prognostic information. [/QUOTE]
[QUOTE]In a study involving 131 CIS patients with a non-spinal CIS who had brain and spinal MRI within 3 months of presentation, asymptomatic spinal cord lesions were the strongest MRI predictor of physical disability after 5 years.
Similarly, in another study of 207 prospectively recruited CIS patients with brain and spinal imaging with 3 months of disease onset, spinal cord lesions were associated with an increased risk of reaching Expanded Disability Status Scale (EDSS) 3 or more over a follow-up period of almost 3 years, even after adjusting for brain MRI findings and other relevant prognostic markers. The prognostic value of spinal cord lesions was highest in patients with a non-spinal CIS.
Collectively, these studies suggest that asymptomatic spinal cord lesions seen at the time of presentation with CIS are associated with an increased risk of physical disability, at least in the short to medium term, and may provide much needed prognostic information to help counsel patients about their risk of future disability.
In this issue of Multiple Sclerosis Journal, Dekker and colleagues investigate the impact of asymptomatic spinal cord lesions in a cohort of patients recruited within 12 months of presentation with CIS. More than half of the patients already had a diagnosis of MS using the McDonald 2010 criteria at the time of study entry. MRI scans of the brain and spinal cord were obtained at “baseline” (within 12 months of disease onset) and the patients were followed up prospectively for the development of disability. Over a median follow-up period of 6 years, no difference was seen in the time to reaching EDSS 3 and 6, or confirmed worsening in timed 25-foot walk and 9-hole peg test speeds, in patients with and without asymptomatic spinal cord lesions. The authors conclude that the prognostic significance of asymptomatic spinal cord lesions in patients with CIS and early MS is uncertain.
The author’s findings do contrast with other recent work and this might reflect differences in the patient population studied, the analytical approach, or both. In the current study, over 96% of patients had an abnormal brain MRI at presentation, compared with 65%–80% in other studies. The higher proportion of patients with normal brain MRI in previous studies might have accentuated the prognostic value of asymptomatic spinal lesions: this group of patients is at much lower risk for the development of MS and disability, and asymptomatic spinal cord lesions are uncommon in patients with a normal brain MRI.
The authors approach to the analyses might also potentially account for the negative results. In their main analyses, Dekker and colleagues compare the time to disability worsening in patients with asymptomatic spinal cord lesions at study entry to a comparator group without asymptomatic spinal cord lesions. The comparator group was very heterogeneous and included the following:
(1) patients with a non-spinal CIS with normal spinal MRI,
(2) patients with spinal cord syndromes with a normal spinal MRI, and
(3) patients with spinal cord syndromes with an abnormal spinal MRI.
In total, more than three quarters of the patients in the comparator group presented with a spinal cord syndrome, had a spinal cord relapse prior to study entry, or both. Therefore, in reality, the authors compare the time to disability worsening in patients with CIS or early MS with (predominantly) symptomatic spinal cord lesions to a group with asymptomatic spinal cord lesions. The fact that there was no difference in the time to disability worsening in this study might suggest that early spinal cord damage in relapse-onset MS, whether symptomatic or asymptomatic, may have similar functional consequences and carry a similar risk of future disability.
Whether routine spinal cord MRI should be done in all patients with CIS and early MS is controversial. Current European and North American guidelines only recommend spinal cord imaging in selected patient groups.The additional diagnostic value of spinal cord MRI is known to be modest, at least for providing evidence of dissemination in space in patients with typical clinical presentations suggestive of MS. Although other recent work has suggested a prognostic role for spinal cord imaging in patients with CIS and early MS, the findings of Dekker and colleagues will add to the ongoing uncertainty over the diagnostic and prognostic value of spinal cord MRI in this patient group.[/QUOTE]
-
Marsei
Can blood neurofilaments be used to monitor disease activity?
Can blood neurofilaments be used to monitor disease activity?
Can blood neurofilaments be used to monitor disease activity?
[QUOTE]
Are we ready for a simple blood test to monitor MS disease activity?
Neurofilaments are dynamic scaffolds that help to maintain the structure of nerve projections (axons). A widely-held view is that damage to neurons leads to a release of neurofilament components, which leak into the cerebral spinal fluid (CSF) and, subsequently, the bloodstream. In support of this idea, raised neurofilament levels are seen in the CSF of people with a broad range of central nervous system (CNS) conditions in which there is prominent damage to neurons. These include traumatic brain injury, motor neuron disease, and MS.
There is now strong evidence in MS that CSF neurofilament levels are raised compared to people without the disease, are raised following relapse and in association with MRI lesions, and may help to predict, from the onset, how aggressive the disease will be in a particular individual. Interestingly, CSF neurofilament levels also decrease following treatment with highly effective DMTs.
The clinical usefulness of these observations is limited by the fact that getting regular CSF to measure, means regular lumbar punctures. Even with atraumatic needles, LPs are still not pleasant. It would be much nicer for pwMS if we had reliable biomarkers that could be worked out from blood tests.
This is why there has been a big push to study neurofilament levels in the blood. A study published a few months ago demonstrated that blood levels of neurofilament light chain were higher in pwMS vs controls, and were associated with higher EDSS scores, more relapses, more MRI lesions, and had some value in predicting future relapses. [/QUOTE]
[QUOTE]As always, it'd be great to follow these people up for a while longer and see if NF-L can predict future disease activity in this cohort. [/QUOTE]
[QUOTE][B]Conclusions: [/B]Serum and CSF NFL levels were highly correlated, indicating that blood sampling can replace CSF taps for this particular marker. Disease activity and DMT had similar effects on serum and CSF NFL concentrations. Repeated NFL determinations in peripheral blood for detecting axonal damage may represent new possibilities in MS monitoring.[/QUOTE]
Can blood neurofilaments be used to monitor disease activity?
[QUOTE]
Are we ready for a simple blood test to monitor MS disease activity?
Neurofilaments are dynamic scaffolds that help to maintain the structure of nerve projections (axons). A widely-held view is that damage to neurons leads to a release of neurofilament components, which leak into the cerebral spinal fluid (CSF) and, subsequently, the bloodstream. In support of this idea, raised neurofilament levels are seen in the CSF of people with a broad range of central nervous system (CNS) conditions in which there is prominent damage to neurons. These include traumatic brain injury, motor neuron disease, and MS.
There is now strong evidence in MS that CSF neurofilament levels are raised compared to people without the disease, are raised following relapse and in association with MRI lesions, and may help to predict, from the onset, how aggressive the disease will be in a particular individual. Interestingly, CSF neurofilament levels also decrease following treatment with highly effective DMTs.
The clinical usefulness of these observations is limited by the fact that getting regular CSF to measure, means regular lumbar punctures. Even with atraumatic needles, LPs are still not pleasant. It would be much nicer for pwMS if we had reliable biomarkers that could be worked out from blood tests.
This is why there has been a big push to study neurofilament levels in the blood. A study published a few months ago demonstrated that blood levels of neurofilament light chain were higher in pwMS vs controls, and were associated with higher EDSS scores, more relapses, more MRI lesions, and had some value in predicting future relapses. [/QUOTE]
[QUOTE]As always, it'd be great to follow these people up for a while longer and see if NF-L can predict future disease activity in this cohort. [/QUOTE]
[QUOTE][B]Conclusions: [/B]Serum and CSF NFL levels were highly correlated, indicating that blood sampling can replace CSF taps for this particular marker. Disease activity and DMT had similar effects on serum and CSF NFL concentrations. Repeated NFL determinations in peripheral blood for detecting axonal damage may represent new possibilities in MS monitoring.[/QUOTE]