Wednesday, 24 October 2012

Research: Risk Factors for development of disability in South America

Damasceno A, Von Glehn F, Brandão CO, Damasceno BP, Cendes F Prognostic indicators for long-term disability in multiple sclerosis patients. J Neurol Sci. 2012 Oct 13. pii: S0022-510X(12)00523-0. doi: 10.1016/j.jns.2012.09.020. [Epub ahead of print]

BACKGROUND: Daily practice is still faced with uncertainty in predicting the long-term disability of multiple sclerosis (MS). Most information comes from northern hemisphere cohorts, but in South America this information is scarce, and race, genetic and environmental factors could play an important role in the heterogeneity observed in disease outcomes.

METHODS: We evaluated 197 patients attending our MS Center gathering clinical and demographic information. Outcome measures analyzed were time from first clinical symptom to EDSS of 6, 7 and 8. For survival analysis we employed Cox regression models and the Kaplan-Meier method.

RESULTS: Time to EDSS 6 was 25.83years (95% CI 15.36-36.31), and 36.25years (95% CI 20.72-51.78) for EDSS 7. Male sex was associated with a 4.63 and 4.69 fold increased risk to EDSS 6 and 7, respectively (p<0.001 and p=0.006). Motor and brainstem symptoms at onset were also associated with an 8.1 and 13.1 fold increased risk to EDSS 6, respectively (p=0.04 and p=0.01). The number of relapses in five and ten years of disease onset was associated with a slightly increased risk to EDSS 8 (1.28 and 1.19, respectively; p=0.032 and p=0.015).

CONCLUSIONS: Male patients presenting with frequent relapses, especially those with motor and brainstem involvement, deserve close observation and should be cautiously monitored to early signs of treatment failure.

This study demonstrates that south American MSers are not that disimilar for European Msers. We know that Male MSers are more likely to develop progressive MS and this is shown here but not the frequency of relapse had an influence on the development of disabilty as we have been saying for some time. Relapses are not good for you, so you should ensure that you are on treatment to get rid of relapses


  1. This is in keeping wih a number of similar studies in terms of mean time to EDSS 6 and 7 which demonstrate that the rate of disability progression is much slower than sometimes thought/suggested. If newly diagnosed MSers were told on diagnosis that the mean time to need assistance with walking would be c. 25-30 years and c. 35-40 to needing a wheelchair, I think that would provide some much needed reassurance as to their prospects for the future - and this survey doesn't account for the potential impact on those timelines of newer DMTs. That's not to say there won't be lots of potential difficulties on the way and an MS diagnosis should never be sugar-coated (and there will always be those who are the wrong side of 'average') but I don't think studies such as the above are referred to often enough in clinical practice. Given the mean age of diagnosis is mid-30's, that means people typically won't need a cane until in their 60's and wheelchair in their 70's which, whilst no doubt something to strive to find a way to avoid, is very different to suffering the same fate in one's 30's or 40's. By the time most newly diagnosed people today are reaching the mean time to EDSS 6 then the therapeutic landscape should (and I am confident with the continued good work of those like Team G, WILL) be unrecognisable. I'd be astonished if we don't see effective neuroprotective drugs in the next decade, never mind 25 years. I don't think it is a stretch to say that the vast majority of people (apart from the most aggressive) newly diagnosed with RRMS in the 2010's are likely to never have to face the prospect of permanenet wheelchair or even walking aid use in the future but maybe I'm just feeling optimistic this morning!

    1. If by the time I retire no-one with MS ends up in a wheelchair, I'll consider my career well spent. I think the combination of improved cost-eefective DMTs and hopefully very soon effective neuroprotectants. will mean that this goal is achievable. I fervently hope so.


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