Saturday, 19 August 2017

Prognosis Spinal attacks from onset

Tiftikcioglu BI, Ilgezdi I, Zorlu Y, Sener U, Tokucoglu F. Long-term disability and progression in spinal onset multiple sclerosis. Acta Neurol Belg. 2017 Aug 10. doi: 10.1007/s13760-017-0828-1. [Epub ahead of print]

The aim of this study is to investigate the long-term effects of the initial spinal cord (SC) involvement in MS patients. In this retrospective, single-center study, 824 patients with definite MS were screened. A total of 348 patients were excluded for ambiguous documentation of the initial relapse, pediatric onset, diagnosis of primary progressive disease, irregular assessments or visits causing doubt on the onset of progression time, and clinical follow-up duration less than 12 months. Eventually, 476 MS patients were included. Data regarding the demographics, initial symptoms, the degree of recovery from the initial relapse, neuroimaging, cerebrospinal fluid analysis, long-term disability, and progression were collected from the medical registry. The mean duration of follow-up was 7.49 ± 5.30 years. The percentage of patients entering the progressive disease course was 23.3 in the whole group. A total of 157 patients (33.0%) had SC involvement during the first clinical relapse. These patients were significantly older at disease onset (31.69 ± 10.18 vs. 29.55 ± 9.49; p = 0.028), had higher rates of progression (32.5 vs. 18.8%; p = 0.001), and had higher disability scores in long-term follow-up (3.41 ± 2.19 vs. 2.62 ± 1.81; p < 0.001). Mean age at the transition of progressive phase was 41.4 ± 11.2 years. The degree of recovery from the initial relapse significantly affected the long-term disability. The poor recovery from the initial relapse was associated with older onset age and higher EDSS scores. Being older than 40 years during MS onset and poor recovery from the initial relapse exerted an increased risk for progression. The initial SC involvement was related to a more severe relapse with less chance of complete recovery and higher risk for progression.


You can read this so I don't think I need to interpret, but it is not surprising that if the lesions are concentrated in the spinal cord then they will impact on disability which is a product of lower limb mobility.

7 comments:

  1. Could you interpret please?
    "Mean age at the transition of progressive phase was 41.4 ± 11.2 years. The degree of recovery from the initial relapse significantly affected the long-term disability. The poor recovery from the initial relapse was associated with older onset age and higher EDSS scores."
    If there was poor recovery from the initial relapse, doesn't that mean the pwMS were already in the "progressive phase"? Isn't this exactly what the "progressive phase" means - having residual disability after a relapse has ended?

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    Replies

    1. Progressive phase is slow worsening without obvious relapses.

      Transition phase is where the slow worsening was noticed is at 41 years old.

      However poor recovery from relapse is a sign of future likely hood of progression because it means that the nerve tract has sustained considerable damage that was not repairable and so the nerve reserve for that pathway is exhausted and so every bit of further nerve loss is more likely to be noticable

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    2. "nerve tract has sustained considerable damage that was not repairable and so the nerve reserve for that pathway is exhausted"

      Is spasticity damage to a nerve tract or just to individual neurons ? Are the nerve tracts to hands and legs isolated
      from each other ? Cause if the hands had surplus reserve couldn't they route some to the feet to restore function.

      One of the 6 patients in Pender's autologous trial had
      16 years of spasticity resolve which I would have thought
      not possible from the time point of view alone.

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    3. I suspect that it is damage to tract rather than single nerve in ani als there is total loss of nerves by about 40% before spasticity shows itself.

      The arm and leg tracts have distinct innervation, so hands are not reseve for legs and vice versa.

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    4. Aparently you can regrow neurons after Spinal cord injury and stroke
      http://www.cell.com/neuron/abstract/S0896-6273(17)30685-2

      For Prof. Mouse

      (not to do with black swans....lolll)
      Sharing is caring
      Obrigado

      Luis

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  2. My initial attack was on the spinal cord. I recovered well. But I believe the attack started the slow onset of spasticity. This obviously effected my walking. I dont know if this is classified as progression of the disease or was it just that the spasticity initiated from the first attack was taking its time in showing its full self. In my first scan in 2011 the lesion was bad and long and the neuro was wondering how I was able to stand and walk about. This lesion has completely resolved itself on MRI which had proven to be a real mystery. Strength in leg is better too but the spasticity remains.

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