Relapses

BACKGROUND: Demyelinating events in relapsing-remitting multiple sclerosis (RRMS) can involve several locations in the central nervous system. We sought to determine if initial clinical demyelinating event (IDE) location predicts subsequent clinical relapse locations in early RRMS.

METHODS: We identified all RRMS patients from two large MS clinics who were seen within one year of disease onset. Logistic regression was performed with the outcome defined as the second or third exacerbation location and the predictor defined as IDE +/- second event location.

RESULTS: 195 patients with at least two clinical exacerbations were identified. There was an increased odds of a patient's second relapse occurring in the spinal cord if the IDE was in the spinal cord (OR=3.79, 95% CI [2.06, 7.00], p<0.001. There was more than a six-fold increase in the odds of a patient's second relapse occurring in the optic nerve if the IDE was in the optic nerve (OR=6.18, 95% CI [2.90, 13.18], p<0.001). These associations remained similar after adjusting for treatment and patient characteristics. If the IDE and second event were both in the same location (spinal cord, optic nerve, or brainstem/cerebellum), the third event was likely to remain in that location.

CONCLUSION: Patients with RRMS have relatively localized clinical relapses. It remains to be determined if genetic or biologic processes are responsible for this pattern.

Mowry EM, Deen S, Malikova I, Pelletier J, Bacchetti P, Waubant E. - University of California, San Francisco, United States.

Source: Pubmed PMID: 19066192 (07/01/08)

Acute relapses in patients with relapsing-remitting multiple sclerosis (MS) rarely lead to disability, according to a retrospective chart review presented here at the American Neurological Association (ANA) 133rd Annual Meeting.

Loren Rolak, MD, Marshfield Clinic, Marshfield, Wisconsin, explained that many patients with MS fear they "might wake up paralyzed" from an acute relapse.

To assess the likelihood of severe disability from an acute relapse, Dr. Rolak examined the clinical course of 1,078 patients with relapsing-remitting MS over the last 14 years from his own database of patients with MS treated at Marshfield Clinic.

The patients in the database had a total of 2,587 attacks (mean of 2.4 attacks per patient, range: 1-14 attacks over 1-34 years). Only 7 of 1,078 patients (0.6%) had an attack that resulted in severe disability, defined as an Expanded Disability Status Scale (EDSS) score of 6 or more sustained for longer than 6 months.

Two of the 7 patients who had an attack that resulted in severe disability presented with an acute severe attack at the time of their diagnosis with MS. Of the remaining 5 patients, 2 were taking interferon beta-1b, which did not prevent the severe disability. The other 3 were not taking interferon or glatiramer-acetate therapy.

Genetic analysis failed to reveal any association between major histocompatibility complex class II DR beta 1 (HLA-DRB1) or nitric oxide synthase (NOS2A) genotypes and severe disability from an acute relapse.

Dr. Rolak concluded, "These results allow me to reassure my patients that a relapse with severe disability is extremely unlikely -- whether or not they are treated with disease-modifying therapy. Consequently, the fear of irreversible disability should not influence their decision to take interferons or other treatment."

Source: Doctor's Guide Channels (25/09/08)

The information could help doctors prescribe the right drugs to stop this happening.

Many multiple sclerosis patients, particularly in the early stages of the disease, do not suffer constant symptoms.

Attacks of the disease, called 'relapses', can bring nerve-related symptoms such as  fatigue, poor coordination and paralysis.

However most patients find that, at first, these symptoms can disappear, with a gap of months or even years before they come back.

This presents problems for doctors, who are trying to give the patient a firm diagnosis, and an idea of what to expect.

Antibody Sign

The tests, which look for signs of an immune reaction to particular proteins, may help. A team of researchers from Austria tested patients who had suffered what they believed to be their first attack of MS symptoms. Their blood was tested once the symptoms had disappeared.

Those who had the antibodies - signs that the immune system has been activated against these proteins - were much more likely to suffer a second attack within months.

In all, 95% of those who had the antibodies experienced a relapse, usually within eight months. In contrast, among those who tested negative, only a quarter had suffered a relapse, even years later. Even these relapsed patients on average took four years to have a second attack.

Drug Treatment

There are no cures for multiple sclerosis, even if the disease is caught early, but there are treatments which studies suggest can increase the period of time in between relapses.

A positive blood test could mean that the patient is a good candidate for these drugs, whereas someone who has a negative result could stay off the drugs and avoid the side effects involved.

Stephen Reingold, from the US National Multiple Sclerosis Society, said, "You may end up with a benefit there - at least a short-term benefit. But we don't know if treatment at that stage will make any difference 15 or 20 years from now."

Source: New England Journal of Medicine (10/07/03)

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