#ClinicSpeak: a low EDSS hides a lot

Don't be lulled into a false sense of security with a low EDSS. #ClinicSpeak #MSBlog

Every now and then you get a reminder of how debilitating MS can be and how crude, or crap, the EDSS really is in capturing the impact of MS.  

The study below analysed gait in adolescents with MS (~15 years of age) with average disease duration of less than 2 years, in other words early MS, and a low EDSS 1.7 (no discernible or outwardly visible disability). The remarkable finding in this study is that despite low disability as measured by the EDSS the results show that adolescents MSers walked slower with a wider base of support compared with age-matched healthy control subjects. You may say big deal these changes are too subtle to matter, but scale this up to other neuronal systems including cognition and you can imagine the impact, or potential impact, this would have on these MSers functioning. Adolescents are at a stage in their lives were they need to function at school and on the sports field. Being able to compete and fitting in is important for their development. These adolescent MSers are unlikely to be excel on the sports field, which is brutal when it comes to natural selection. Hopefully, the classroom will allow them some comfort. 

All this makes me realise that we are disadvantaging so many young people with this disease. The possibility that MS may be preventable makes me angry. Why haven't we started prevention studies? Why does science take so long to get going and achieve things? 

If I was a parent with a child with MS I would find this piece of research frightening. All I can say to reassure you is that with the emergence of highly effective treatments and a change in our treatment paradigm to treat-2-target of NEDA we will hopefully save your children from the full brunt of the disease. 

Kalron et al. Gait Characteristics in Adolescents With Multiple Sclerosis. Pediatr Neurol. 2016 Dec 22. pii: S0887-8994(16)30723-8.

BACKGROUND: Multiple sclerosis is a progressive autoimmune disease of the central nervous system. A presentation of multiple sclerosis before age 18 years has traditionally been thought to be rare. However, during the past decade, more cases have been reported.

PATIENT DESCRIPTION: We examined gait characteristics in 24 adolescents with multiple sclerosis (12 girls, 12 boys). Mean disease duration was 20.4 (S.D. = 24.9) months and mean age was 15.5 (S.D. = 1.1) years. The mean expanded disability status scale score was 1.7 (S.D. = 0.7) indicating minimal disability. Outcomes were compared with gait and the gait variability index value of healthy age-matched adolescents.

RESULTS: Adolescents with multiple sclerosis walked slower with a wider base of support compared with age-matched healthy control subjects. Moreover, the gait variability index was lower in the multiple sclerosis group compared with the values in the healthy adolescents: 85.4 (S.D. = 8.1) vs 96.5 (S.D. = 7.4).

CONCLUSIONS: We present gait parameters of adolescents with multiple sclerosis. From a clinical standpoint, our data could improve management of walking dysfunction in this relatively young population.

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