Wednesday, 14 May 2014

Relapse Types in MS

Kalincik T et al. on behalf of the MSBase Study Group.Risk of relapse phenotype recurrence in multiple sclerosis. Mult Scler. 2014 Apr. [Epub ahead of print]

OBJECTIVES:The aim was to analyse risk of relapse phenotype recurrence in multiple sclerosis and to characterise the effect of demographic and clinical features on this phenotype.
METHODS:Information about relapses was collected using MSBase, an international observational registry. Associations between relapse phenotypes and history of similar relapses or patient characteristics were tested.
RESULTS:Among 14,969 eligible patients (89,949 patient-years), 49,279 phenotypically characterised relapses were recorded. Visual (blurred vision, blindness) and brainstem (double vision, altered sensation in the face ataxia relapses occurred more frequently in early disease and in younger patients. Sensory (numbness) relapses were more frequent in early or non-progressive disease. Pyramidal (weakness), sphincter (incontience) and cerebellar (balance co-ordination) relapses were more common in older patients and in progressive disease. Women presented more often with sensory or visual symptoms. Men were more prone to pyramidal, brainstem and cerebellar relapses. Importantly, relapse phenotype was predicted by the phenotypes of previous relapses. (OR = 1.8-5, p = 10-14). Sensory, visual and brainstem relapses showed better recovery than other relapse phenotypes. Relapse severity increased and the ability to recover decreased with age or more advanced disease.
CONCLUSION: Relapse phenotype was associated with demographic and clinical characteristics, with phenotypic recurrence significantly more common than expected by chance.

Sometimes bits of the iceberg surface and you notice it. This paper describes the type of symptoms that may develop when a relapse occurs and these are related to where in your central nervous system things are occurring. The data suggests that your preceding relapses may be a reasonable indicator of what may happen again down the line. As you get older and the longer you have had MS the less recovery you will have so,further evidences that having relapses is not a good thing and best deal with them if you can.


  1. These things always confuse me. Whilst I am female and presented with sensory, optic neuritis and brain stem lesion activity, 7 years from CIS to full blown MS, I was also diagnosed at age 51 and more or less fully recovered. I have had some balance issues, albeit slight but an indication of cerebellar activity.. I guess a lot of us fall into the middle of the good/bad prognosis although I would imagine my age at onset is possibily my biggest worry.

    1. Remember these are generalisations and no hard fact. I only put it up because an MSer from MS life asked for it

  2. I have problems with understanding the table - from which point on one counts the 5 years to disability or the relapse rate? From the full-blown first attack? That would be about 4 years now and the prognosis looks rather bad because of more relapses and physical progression

    BUT if I take into consideration that I might have been having MS (unnoticed) from age 14 or 24 that would be 20 or 10 years from first (unnoticed) CIS - that changes the scenario of a prognosis.

    I still think I will be progressing further but the rate of progression changes depending on which scenario one chooses.

    Your thoughts Docs?

    1. Quite correct the 5 years relates I think from diagnosis but as you say I bet for many people disease has been around for many years and as mentioned above these are generalisations and not specifics and probably this data relates to the pre-DMT era. Things will change with treatments.

  3. The Germans just posted this as news on their MS site: it relates to UV effect. I think it would be good to make a post on this and the consequences for MSers (like is it worth to buy those UVB lamps etc.)?

    Breuer J, Schwab N, Schneider-Hohendorf T, Marziniak M, Mohan H, Bhatia U, Groß CC, Clausen BE, Weishaupt C, Luger TA, Meuth SG, Loser K, Wiendl H. UVB light attenuates the systemic immune response in CNS autoimmunity. Annals of Neurol. 2014 [Epub 28 Apr 2014]


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