Thursday, 2 April 2015

Predicting response to steroids

Rakusa M, Cano SJ, Porter B, Riazi A, Thompson AJ, Chataway J, Hardy TA. A Predictive Model for Corticosteroid Response in Individual Patients with MS Relapses. PLoS One. 2015 Mar 18;10(3):e0120829.

MATERIALS AND METHODS:We analysed individual patient randomised controlled trial data (n=98) based on age, gender, baseline disability scores [physician-observed: expanded disability status scale (EDSS) and patient reported: multiple sclerosis impact scale 29 (MSIS-29)], and the time intervals between symptom onset or referral and treatment.
RESULTS:Based on two a priori selected cut-off points (improvement in EDSS ≥ 0.5 and ≥ 1.0), we found that variables which predicted better response to corticosteroids after 6 weeks were younger age and lower MSIS-29 physical score at the time of relapse .
CONCLUSIONS:This pilot study suggests two clinical variables which may predict the majority of the response to corticosteroid treatment in patients undergoing an MS relapse. The study is limited in being able to clearly distinguish factors associated with treatment response or spontaneous recovery and needs to be replicated in a larger prospective study.

The Multiple Sclerosis Impact Scale (MSIS-29) is a measure of the physical and psychological impact of MS from the patient’s perspective (a copy of the MSIS-29 can be found click here). Low scores in the MSIS-29 and youth predicted the best response to steroids. This group of people are more likely to have a bigger "neurological compensatory reserve" and thus tolerate neurological insults better..

During the relapse an MSers is subject to the effects of the inflammatory penumbra. If  evidence of benefit occurs in the optic neuritis trial, it will suggest that there are additional ways to limit nerve damage as a consequence of the relapse over and above that caused by steroid use.

3 comments:

  1. I had a look at the MSIS-29 assessment form. What are the various impact "rankings" used if the scores in each section are aggregated, and how are the impacts described for completed assessments?

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  2. re. ' During the relapse an MSers is subject to the effects of the inflammatory penumbra. If evidence of benefit occurs in the optic neuritis trial, it will suggest that there are additional ways to limit nerve damage as a consequence of the relapse over and above that caused by steroid use'.

    I get the feeling from seeing my MRI scans that my lesion load (size and number of lesions) increased during my relapse due to the stress and anxiety of having the relapse and other stressful factors. Such as the stress and anxiety of it being my first MRI scan, I was very nervous, anxious and stressed before and during the scan. The stress and anxiety increased the lesion load. I am now much more familiar with the MRI scanner so feel more relaxed, I even feel asleep during a scan a year ago. Some relapses such as optic neuritis are stressful symptoms. So wouldn't it be obvious to try and assess and treat these type of stressful relapses early? I want to save all the nerves I can.

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    Replies
    1. Dear Doctors, I urgently think (and insist) there needs to be an overhaul of some relapse treatment guidelines. If the whole point is to help reduce relapases, save nerves and reduce deterioration as much as possible then this needs to be done ASAP.
      Has anyone else come to that conclusion too??

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