Predicting progression at baseline

Progression & brain atrophy begets progression. #MSBlog #MSResearch

Epub: Lavorgna et al. Clinical and magnetic resonance imaging predictors of disease progression in multiple sclerosis: a nine-year follow-up study. Mult Scler. 2013 Jul.

OBJECTIVE: The objective of this paper is to identify clinical or magnetic resonance imaging (MRI) predictors of long-term clinical progression in a large cohort of MSers.

METHODS: A total of 241 relapsing-remitting (RR) MSers were included in a nine-year follow-up (FU) study. The reference MRIs were acquired at baseline (BL) as part of a multicenter, cross-sectional, clinical-MRI study. Volumetric MRI metrics were measured by a fully automated, operator-independent, multi-parametric segmentation method. Clinical progression was evaluated as defined by: conversion from RR to secondary progressive (SP) disease course; progression of Expanded Disability Status Scale (EDSS); achievement and time to reach EDSS 4.

RESULTS: The researchers concluded that conversion from RR to SP (OR 0.79; CI 0.7-0.9), progression of EDSS (OR 0.85; CI 0.77-0.93), achievement of EDSS 4 (OR 0.8; CI 0.7-0.9), and time to reach EDSS 4 (HR 0.88; CI 0.82-0.94) were all predicted by BL gray matter (GM) volume and, except for progression of EDSS, by BL EDSS (respectively: (OR 2.88; CI 1.9-4.36), (OR 2.7; CI 1.7-4.2), (HR 3.86; CI 1.94-7.70)).

CONCLUSIONS: BL GM volume and EDSS are the best long-term predictors of disease progression in RRMSers with a relatively long and mild disease.

"This study illustrates several points I have been trying to highlight on this blog. That despite feeling well and being fully functional MS may be shredding your brain. If you have evidence of this early on in the course of your disease, as measured by brain atrophy on MRI, in particular gray matter atrophy, you need to be more active with your treatment."

"Another observation is that if you are doing badly and have disability already you are more likely to progress further in the near future. In other words progression begets progression. This can be explained in terms of reduced brain reserve; if you are already disabled this indicates that you probably have already exhausted your reserve capacity in a particular neurological system, in other words you have a reduced capacity to compensate if any further inflammatory shredding occurs in that system."

"The problem we have is that very few neurologists are actually using brain atrophy to assess MSers at baseline. At the Royal London Hospital we are about to start doing this formally in our clinic. We will also be hosting a meeting on this issue later this year to see what needs to be done to get other neurologists to start incorporating brain atrophy measurements into routine MS clinical practice. It is clear from the survey results below that MSers want this issue taken seriously."

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