Wednesday, 11 April 2018

Brain damage in MS predicts long-term unemployment

Do you love your brain? 


After reading this post you will love it even more. 


In this 12-year follow-up study of a trial cohort of MSers, brain volume loss, T1 lesion volume (black holes) and T2 lesion volume (white blobs) were the best MRI predictors of worsening employment status over the 12-year follow-up period. Amazingly having just one extra millilitre of T1 lesion volume was associated with a 53% greater risk of worsening employment status. Similarly, a brain volume decrease of 1% increased the risk of worsening employment status by 22%. 

To remind you T1 black holes are the more destructive lesions and result in the so-called  Swiss cheese brain; i.e. peppered by holes left behind by the more destructive MS lesions. 

Please remind yourself that preventing end-organ, or brain, damage should become the primary therapeutic target in MS. It is a no-brainer. 

Please note that biomarkers of brain damage come after the event, i.e. they are a consequence of unchecked MS disease activity. Once you have acquired the damage it can't be fixed. This is why we need to prevent the damage from occurring in the first place. This is why it is so important to treat MS early and effectively. 

We need to view the use of DMTs in MS as a preventive strategy to protect the brain so that we maximise the brain health of the person with MS for their whole life. We have to make sure we get you, our patients, to old age with a brain that has enough reserve to cope with the ageing process. Quality of life in old age is what it should be about. Do you agree? You can disagree.


Kadrnozkova et al.  Combining clinical and magnetic resonance imaging markers enhance prediction of 12-year employment status in multiple sclerosis patients. J Neurol Sci. 2018 May 15;388:87-93.

BACKGROUND: Multiple sclerosis (MS) is frequently diagnosed in the most productive years of adulthood and is often associated with worsening employment status. However, reliable predictors of employment status change are lacking.

OBJECTIVE: To identify early clinical and brain magnetic resonance imaging (MRI) markers of employment status worsening in MS patients at 12-year follow-up.

METHODS: A total of 145 patients with early relapsing-remitting MS from the original Avonex-Steroids-Azathioprine (ASA) study were included in this prospective, longitudinal, observational cohort study. Cox models were conducted to identify MRI and clinical predictors (at baseline and during the first 12 months) of worsening employment status (patients either (1) working full-time or part-time with no limitations due to MS and retaining this status during the course of the study, or (2) patients working full-time or part-time with no limitations due to MS and switching to being unemployed or working part-time due to MS).

RESULTS: In univariate analysis, brain parenchymal fraction, T1 and T2 lesion volume were the best MRI predictors of worsening employment status over the 12-year follow-up period. MS duration at baseline (hazard ratio (HR) = 1.10, 95% confidence interval (CI) 1.03-1.18; p = 0.040) was the only significant clinical predictor. Having one extra milliliter of T1 lesion volume was associated with a 53% greater risk of worsening employment status (HR = 1.53, 95% CI 1.16-2.02; p = 0.018). A brain parenchymal fraction decrease of 1% increased the risk of worsening employment status by 22% (HR = 0.78, 95% CI 0.65-0.95; p = 0.034).

CONCLUSION: Brain atrophy and lesion load were significant predictors of worsening employment status in MS patients. Using a combination of clinical and MRI markers may improve the early prediction of an employment status change over long-term follow-up.

ProfG    

5 comments:

  1. Yes but also there needs to be jobs available that are part time (16 hours a week, so can claim working tax credits), local and meaningful.
    It's not easy finding local, part time work that is an ok wage and not too physical.

    ReplyDelete
  2. so how did subjectively assessing BVL suddenly become a reliable benchmark, when you keep reminding us on this blog that the assessment is far from a gold standard?

    1% is very sensitive to measurement error.

    ReplyDelete
    Replies
    1. But this is a study and not an individual patient. At a group level the variability is not an issue as it averages itself out. You simply power the study size to deal with the measurement variability / error.

      Delete
  3. What Dmt´s have the best brain atrophy results over 12-year follow-up

    period in your view?

    Obrigado

    ReplyDelete
  4. I love my CNS but my body says otherwise.

    ReplyDelete

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