Predicting the Course of MS,

Schlaeger R, Schindler C, Grize L, Dellas S, Radue EW, Kappos L, Fuhr P.Combined visual and motor evoked potentials predict multiple sclerosis disability after 20 years. Mult Scler. 2014 Feb. [Epub ahead of print]

BACKGROUND: The development of predictors of multiple sclerosis (MS) disability is difficult due to the complex interplay of pathophysiological and adaptive processes.

OBJECTIVE: The purpose of this study was to investigate whether combined evoked potential (EP)-measures allow prediction of MS disability after 20 years.

METHODS: We examined 28 patients with clinically definite MS according to Poser’s criteria with Expanded Disability Status Scale (EDSS) scores, combined visual and motor EPs at entry (T0), 6 (T1), 12 (T2) and 24 (T3) months, and a cranial magnetic resonance imaging (MRI) scan at T0 and T2. EDSS testing was repeated at year 14 (T4) and year 20 (T5). 

RESULTS: We found that s-EPT0 correlated with EDSST5 (rho=0.72, p<0.0001) and ΔEDSST5-T0 (rho=0.50, p=0.006). Backward selection resulted in the prediction model: E (EDSST5)=3.91-2.22×therapy+0.079×age+0.057×s-EPT0 (Model 1, R2=0.58) with therapy as binary variable (1=any disease-modifying therapy between T3 and T5, 0=no therapy). Neither EDSST0 nor T2-lesion or gadolinium (Gd)-enhancing lesion quantities at T0 improved prediction of EDSST5. The area under the receiver operating characteristic (ROC) curve was 0.89 for model 1.
CONCLUSIONS: These results further support a role for combined EP-measures as predictors of long-term disability in MS

There a large number of studies that suggest active disease early in the course of MS is an indicator of poorer future prognosis and this study suggests just that when they compare electrophysiological tests that could detect demyelination and nerve loss. But the problem is, that it does not give a definitive answer of where you will be in 20 years and so as a prediction tool it has to be better.

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