[P01.138] Long Term Evolution of “Benign” Multiple Sclerosis Patients in the London Ontario Database Antonio Scalfari, Anneke Neuhaus, Martin Daumer, Paolo Muraro, George Ebers.
OBJECTIVE: Using
conversion to secondary progressive (SP) multiple sclerosis (MS) as
cutoff event for selecting patients with benign course, we tested which
baseline features affects the probability of becoming "no longer benign"
in the long term.
BACKGROUND: Clinical severity of MS is
extremely variable. Patients with not more than moderate disability
within 10-15 years from onset are regarded as "benign" however, lack of
consensus exists.
DESIGN/METHODS: Among patients in the London
Ontario database with benign course who had not experienced SP at 10
years from onset, binary logistic regression analysis assessed factors
affecting the probability of remaining "benign" after 20 years.
RESULTS:
Outcome at 20 years was known for 75% (n = 339/445) of those patients
benign at 10 years from onset. Females predominated (71 %), mean age at
onset was 26.8 years (S.D. 7.9) and most of patients had
mono-symptomatic onset (71%) characterized by sensory disturbances
(52.2%). Nearly half (166/339) had entered SP and were "no longer
benign". Eventually, among this subgroup 91.5% (152/166) reached DSS 6,
60.8% (101/166) DSS 8 and 16.8% (28/166) DSS 10 in 19.9, 31.2 and 49.7
mean years respectively. Female sex (OR = 1.68; p = 0.032) and younger
age at disease onset (age 21-30 Vs > 30: OR = 1.77, p = 0.02; age ≤
20 Vs > 30: OR = 3.36, p < 0.001) associated with a higher
probability of remaining benign at 20 years. Type and number of
neurological systems at onset and early (year 1 + year 2) relapse
frequency did not exert any predictive effect.
CONCLUSIONS: The
onset of the SP phase is the watershed event differentiating benign
cases. Lack of progression at 10 years from onset associated with about
50% probability of remaining benign 10 years later. Males and those
older at disease onset had higher risk to become "no longer benign".
Warning this presentation has not been properly peer reviewed.
This study shows that so called benign MS is not inactive MS and that many years down the line progression may develop. This is further evidence that some sort of slow-burning disease process grumbles on in the absence of relapsing disease. Therefore it is clear that we will need agents to hinder this process straight from disease onset. This may well be (and probably is) totally independent of (auto)immunity, but we know that even in simple autoimmunity in animals that slow-burning neurodegenerative processes can be kicked off even after one attack, in others it takes a few attacks before it becomes more rapidly self-sustaining.
Has it ever been possible for a scientist to regrow a neuron in the lab? Do you think one day we'll be able to regrow new neurons in the brain and spinal cord?
ReplyDeleteYes it is possible to grow a neuron in a lab, even we can do this and we are not a lab that specialises in such stuff. It is most easy to grow rodent cells because we know alot about the signals to make this happen. We can start with a stem cell and end up with a nerve. Human cells are more complex because less is know but possible.
ReplyDeleteCan you regrow nerves in peripheral nerves yes you can. We (my old lab) used to do this in people with leprosy about twenty years ago and used to cut out the damaged nerve and make a muscle tube for the nerves (axons) to sprout. we had one chap who had 16cm removed and the nerve grew and feeling returned in the foot.
To regrow a nerve down the length of the arms takes a very long time,we spend about 15-20years growing our nerves. The nerves in the feet would have huge distances to regrow. So this will take time unless we can accelerate this.
However now the current bummer at the moment we are not at the stage of regrowing human nerves in the brain/spinal cord. We have some data in the lab that you can get some regrowth in spinal nerves after injury. However it is early days. There are many hurdles to over come and this nerve growth relies on an intact nerve head (neuron). To replace nerves and then get them to grow and replace the lost connections is a hard task and there are many hurdles to overcome.
There is every reason to think at some time regrowth of central system nerves can occur but there are lots of things that will need to occur, but I could not put a time of this.
However you must remember this is not our field of skills and research output so we are not experts, the breakthrough could be tomoorrow. I will have to compose a list of things that need to happen to highlight the complexities.