Was George Wrong? Relapse Matter

When CCSVI was in its hayday, the believers would question the immune theory and trot out the suggestion that having relapses didn't matter.

Perhaps not surprising it they had read the Work from The George Ebers Lab

Early relapses, onset of progression, and late outcome in multiple sclerosis. Scalfari A, Neuhaus A, Daumer M, Deluca GC, Muraro PA, Ebers GC. JAMA Neurol. 2013; 70:214-22

"Our results indicate dissociation between early inflammatory attacks and onset of the SP phase and further question the validity of relapse frequency as a surrogate marker for late disability".

This new paperTomassini V, Fanelli F, Prosperini L, Cerqua R, Cavalla P, Pozzilli C. Predicting the profile of increasing disability in multiple sclerosis. Mult Scler. 2018 Aug 2:1352458518790397

BACKGROUND: Effective therapeutic strategies to preserve function and delay progression in multiple sclerosis (MS) require early recognition of individual disease trajectories.
OBJECTIVES: To determine the profiles of disability evolution, identify their early predictors and develop a risk score of increasing disability.
METHODS: We analysed demographic, clinical and magnetic resonance imaging (MRI) data from patients with relapsing MS, Expanded Disability Status Scale (EDSS) score of 3.0-4.0 and follow-up ≥ 2 years. Attaining EDSS = 6.0 defined increasing disability; relapses and/or MRI defined disease activity.
RESULTS: In total, 344 out of 542 (63.5%) patients reached EDSS ≥ 6.0; of these, 220 (64.0%) showed disease activity. In patients with activity, the number of relapses before reaching EDSS 3.0-4.0 predicted increasing disability; age > 45 at baseline predicted increasing disability without activity. Combining age and number of relapses increased the risk of and shortened the time to EDSS = 6.0.
CONCLUSION: Increasing disability is frequently associated with persistent activity. The high number of relapses identifies early those patients worsening in the presence of activity. Age predicts increasing disability in the absence of activity. The presence of both factors increases the risk of developing severe disability. As this study likely describes the transition to progression, our findings contribute to improving patient management and stratification in trials on progressive MS.

Score = 0, if the patient was ≤45 years and experienced ≤6 relapses before reaching an EDSS of 3.0–4.0;

Score = 1, if the patient was >45 years or, alternatively, experienced >6 relapses before reaching an EDSS of 3.0–4.0;

Score = 2, if the patient was >45 years and experienced >6 relapses before reaching an EDSS of 3.0–4.0.


To further evidence that relapses are not good, Don't have them.

More effective treatments were associated with a better outlook