Predictors of attack severity

Naldi et al. Predictors of attack severity and duration in multiple sclerosis: a prospective study.Open Neurol J. 2011;5:75-82. Epub 2011 Dec 23.

To evaluate predictors of severity and duration of early Multiple Sclerosis (MS) attacks.

METHODS:We analyzed 248 attacks in 95 patients in a prospective study. Severity: the difference between the EDSS score at the day of maximum worsening and the EDSS score before the onset of the attack. Duration: the time between the date of onset of the first symptom and the date of maximum improvement of the last symptom.

RESULTS:The number of involved Functional Systems (FS), FS type (brainstem -The brain stem has integrative functions and is involved in control of heart and breathing functions, awareness, and consciousness). Thus, brain stem damage is a very serious and often life-threatening problem and pyramidal-that include control of skilled voluntary movement), and total attack duration were linked to severity. Number of FS involved, FS type (sphincteric-such as those that control continence and sensory-feeling and pain), and severity of the attack were related to duration.

Neither severity nor duration were correlated to other predictors: gender, age and season at attack onset, speed of onset, infections in the preceding month, age at first attack, season of birth and first attack, cerebrospinal fluid examination, first brain MRI, recovery from the first attack. The probability of a second moderate/severe or long attack was not influenced by severity or duration of the first.

CONCLUSION: Functional systems affected are predictive of severity and duration of early MS attacks. Severity and duration of the first attack do not predict severity and duration of the second.

The area of the brain and spinal cord that is affected during a relapse, is going to determine how severe and how long the relapse is going to be, but this is not predictive of what will happen next.

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  • I thought continence problems were due to lesions in the spinal cord in the areas where the nerves are that control the bowel/bladder functions. Are lesions in the brain also affecting this?

  • Yes I would agree that lesions in spinal cord are central to this. However there are centres in the brain that are also invloved in urination, sensation etc etc etc.

    Sensation signals leave the bladder and go up the spinal cord to the brain and then action signals go back down the spinal cord to the bladder. Lesions in any point can have influences.

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