Saturday, 23 April 2016

Relapses matter- Don't have them and save brain

Contribution of different relapse phenotypes to disability in multiple sclerosis.Stewart T, Spelman T, Havrdova E, Horakova D, Trojano M, Izquierdo G, Duquette P, Girard M, Prat A, Lugaresi A, Grand'Maison F, Grammond P, Sola P, Shaygannejad V, Hupperts R, Alroughani R, Oreja-Guevara C, Pucci E, Boz C, Lechner-Scott J, Bergamaschi R, Van Pesch V, Iuliano G, Ramo C, Taylor B, Slee M, Spitaleri D, Granella F, Verheul F, McCombe P, Hodgkinson S, Amato MP, Vucic S, Gray O, Cristiano E, Barnett M, Sanchez Menoyo JL, van Munster E, Saladino ML, Olascoaga J, Prevost J, Deri N, Shaw C, Singhal B, Moore F, Rozsa C, Shuey N, Skibina O, Kister I, Petkovska-Boskova T, Ampapa R, Kermode A, Butzkueven H, Jokubaitis V, Kalincik T; MSBase Study Group.
Mult Scler. 2016. pii: 1352458516643392. [Epub ahead of print]

METHODS:Analysis of prospectively collected data was conducted in 19,504 patients with relapse-onset multiple sclerosis and minimum 1-year prospective follow-up from the MSBase cohort study. Multivariable linear regression models assessed associations between relapse incidence, phenotype and changes in disability (quantified with Expanded Disability Status Scale and its Functional System scores). Sensitivity analyses were conducted.
RESULTS: In 34,858 relapses recorded during 136,462 patient-years (median follow-up 5.9 years), higher relapse incidence was associated with greater disability accumulation (β = 0.16, p < 0.001). Relapses of all phenotypes promoted disability accumulation, with the most pronounced increase associated with pyramidal (β = 0.27 (0.25-0.29)), cerebellar (β = 0.35 (0.30-0.39)) and bowel/bladder (β = 0.42 (0.35-0.49)) phenotypes (mean (95% confidence interval)). Higher incidence of each relapse phenotype was associated with an increase in disability in the corresponding neurological domain, as well as anatomically related domains.
CONCLUSION: Relapses are associated with accumulation of neurological disability. Relapses in pyramidal, cerebellar and bowel/bladder systems have the greatest association with disability change. Therefore, prevention of these relapses is an important objective of disease-modifying therapy. The differential impact of relapse phenotypes on disability outcomes could influence management of treatment failure in multiple sclerosis.

There has been a view being cycled round the MS community, notably by the anti-drug lobby, that relapses don't matter. 

I say tell this to the person who has had a devastating attack and has been left with permanent disability. 

This study sows that relapses matter and you don't want them.

Yes I know there is data implying that relapses don't matter they do, because they cause damage.

In the beasties the first attack cause 10-15% of  the nerves to be destroyed. This is compensated forso we struggle to see the effect. The next attack gets another 5% or nerves, the next another 5% and the next another 5% by which time secondary progression has set in and each nerve lost is critical. This is why you and your neuros should not accept the occurance of relapses. Time is Brain!.


  1. This question has been asked by many and multiply times here.. but without success.

    What IS considered a relapse? Is a mild numbling of a finger for a months w/o MRI activity a relapse?
    Or week of a leg weakness ?
    It's been said relapses are underreported… but how can they be reported if even the neurologists, as far as it seem from the patient side, do not have a strict guidelines what to count as relapse and what not to?

    1. Good question I will let ProfG try to answer this, as you are correct what is a relapse we know there are ten or more lesional events per clinical event. In the beasties we have clear guidelines

  2. A recent Shift MS video talks about needing 2 significant relapses in 2 years as a precursor for DMT's. Does this mean relapses which require steroids? I thought there was consensus now that activity can be defined by MRI grounds alone? The video also talks about most people starting on tier 1 DMTs such as interferon as a posed to more effective ones. To me this sounds like closing the door after the horse has bolted. More confused then ever.

    1. I agree who was it I won't post your answer

    2. Thanks for the name, I'll circulate details round the lab.
      Good to hear it was not from TeamG as we do not subscribe to the softly, softly..there, there we'll get you a nice wheel-chair approach

      You asked:
      Is the NHS England commissioning paper for DMT's likely to be updated soon do you know? It seems a bit out of date now when compared to the ABN guidelines.

      Maybe DrK knows this one

    3. DrK said Committee Dissolved I guess that means no in the near future.... maybe they were scared that might have to comment on repurposing


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