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    You are here : Home » MS Research News » Types Of MS

    Types Of MS

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    Effect of gender on late-onset multiple sclerosis

    Gender and MSAbstract

    Objectives: We aimed to examine the incidence and disease course of late-onset multiple sclerosis (LOMS) compared with adult-onset MS (AOMS) in our clinic cohort, stratified based on gender and race, since both have been reported as important modifiers of disease outcomes in MS.

    Methods: Patients with LOMS and AOMS were compared in terms of demographic characteristics and disease course characteristics. Combined effects were investigated with a logistic regression model. Time from disease onset to sustained Expanded Disability Status Scale (EDSS) score of 6 was investigated using an extension of log-rank test appropriate for interval-censored data.

    Results: Some 7.96% of 4273 patients studied had an onset of MS after the age of 50 years (LOMS), and 1.33% experienced an onset after age 60. Progressive onset was more common in LOMS relative to AOMS. The proportion of women with progressive-onset disease was similar in AOMS and LOMS. Time to EDSS 6 was delayed in AOMS females compared with males; however, it was similar between males and females in the LOMS group.

    Conclusions: Women with LOMS have a different trajectory in terms of disease progression than women with AOMS. The effect of menopause combined with race/ethnicity on the MS disease course requires further investigation.

    Source: Multiple Sclerosis Journal Copyright © 2012 by SAGE Publications (27/09/12)

    New international research collaborative begins work on progressive MS

    MS MRIPeople with the progressive forms of MS – where the effects of the disease progressively worsen over time – have only a few treatment options, and answers are urgently needed. MSIF together with the MS Societies of Canada, Italy, the Netherlands, the United Kingdom and the United States, have convened an International Progressive MS Collaborative dedicated to finding solutions, now.

    MS is a chronic, unpredictable, often disabling disease of the central nervous system that interrupts the flow of information within the brain, and between the brain and the body. Symptoms range from numbness and tingling to blindness and paralysis. MS affects an estimated 2.1 million people worldwide.

    The global MS community is committed to finding solutions to address the complexity of progressive MS. The newly formed International Progressive MS Collaborative is dedicated to working together, to identify and maximise worldwide resources to propel this effort forward.

    Research priorities have been identified, and each will be tackled with a multi-disciplinary approach to drive new therapies for people with progressive MS.

    As the collaborative continues to gain momentum, additional information and progress will be broadly communicated, and specific opportunities to support this work will be made available worldwide.

    Find out more about the International Progressive MS Collaborative

    Source: Multiple Sclerosis International Federation (28/08/12)

    'Clinically definite benign MS', an unwarranted conceptual hodgepodge

    MS DiagnosisSummary: This new French study assesses two definitions of 'clinically definite benign multiple sclerosis' (CDBMS) using long-term follow-up data, and to look for prognostic factors of CDBMS. The authors find that by either of two definitions of CDBMS, between 40-60% of patients would deteriorate on subsequent follow up and accrue disability leading the authors to conclude that CDBMS, as currently defined, is an “unwarranted conceptual hodgepodge”, and that more reliable biomarkers should be developed to identify patients with benign MS.

    Abstract

    BACKGROUND:
    Benign multiple sclerosis (BMS) is a controversial concept which is still debated. However identification of this kind of patients is crucial to prevent them from unnecessary exposure to aggressive and/or long term medical treatments.

    OBJECTIVES:
    To assess two definitions of 'clinically definite benign multiple sclerosis' (CDBMS) using long-term follow-up data, and to look for prognostic factors of CDBMS.

    METHODS:
    In 874 patients with definite relapsing-remitting MS, followed up for at least 10 years, disability was assessed using the Disability Status Scale (DSS). CDBMS was defined by either DSS score≤2 (CDBMS1 group) or DSS score≤ 3 (CDBMS2 group) at 10 years. We estimated the proportion of patients who were still benign at 20 and 30 years after clinical onset.

    RESULTS:
    CDBMS frequency estimates were 57.7% and 73.9% when using CDBMS1 and CDBMS2 definitions, respectively. In the CDBMS1 group, only 41.7% (105/252) of cases were still benign 10 years later, and 41.1% (23/56) after an additional decade, while there were 53.8% (162/301) and 59.5% (44/74) respectively in the CDBMS2 group.

    CONCLUSIONS:
    This 30-year observational study, which is one of the largest published series, indicates that favourable 10-year disability scores of DSS 2 or 3 fail to ensure a long-term benign course of multiple sclerosis. After every decade almost half of the CDBMS were no longer benign. CDBMS, as currently defined, is an unwarranted conceptual hodgepodge. Other criteria using new biomarkers (genetic, biologic or MRI) should be found to detect benign cases of MS.

    Leray E, Coustans M, Le Page E, Yaouanq J, Oger J, Edan G.

    Epidemiology Department, EHESP School of Public Health, Rennes, France.

    Source: Mult Scler. 2012 Aug 2 & Pubmed PMID: 22859724 (08/08/12)

    Will the real multiple sclerosis please stand up?

    MS QuestionsSummary: MS has typically been viewed as a disease with an autoimmune basis, which is thought to account for its association with other autoimmune diseases. The authors of this article challenge this conventional view of MS and propose that it is in fact a neurodegenerative disorder with relapses occurring as a consequence of immune reaction to the breakdown products from the degenerative process.

    The authors term the conventional model of MS as an ‘outside-in’ model and they hypothesise that in fact we should examine this disease as an ‘inside-out’ model. Firstly the inconsistencies in current clinical observations are outlined, including a review of pathology and therapeutics in MS. Secondly the different phenotypes of MS are compared and it is argued that primary progressive MS represents the true disease, while the relapsing-remitting form is a secondary immune response to the underlying process. Comparisons are drawn with other neurological disorders and lastly a proposed mechanism is explored for this novel approach to this incurable disease.

    This review article makes a compelling case for re-evaluating current thinking on the proposed mechanisms involved in the pathogenesis of MS.

    Abstract
    Multiple sclerosis (MS) is considered to be an autoimmune, inflammatory disease of the CNS. In most patients, the disease follows a relapsing-remitting course and is characterized by dynamic inflammatory demyelinating lesions in the CNS. Although on the surface MS may appear consistent with a primary autoimmune disease, questions have been raised as to whether inflammation and/or autoimmunity are really at the root of the disease, and it has been proposed that MS might in fact be a degenerative disorder. We argue that MS may be an 'immunological convolution' between an underlying primary degenerative disorder and the host's aberrant immune response. To better understand this disease, we might need to consider non-inflammatory primary progressive MS as the 'real' MS, with inflammatory forms reflecting secondary, albeit very important, reactions.

    Full article

    Stys PK, Zamponi GW, van Minnen J, Geurts JJ.

    Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada.

    Source: Pubmed PMID: 22714021 & Nat Rev Neurosci. 2012 Jun 20;13(7):507-14. doi: 10.1038/nrn3275.(04/07/12)

    Slow MS progress most likely if diagnosed young

    MS Diagnosis Being a woman and being young at diagnosis of multiple sclerosis were key hallmarks that allowed for "benign" disease over two decades or more, researchers said here.

    Among MS patients who achieved benign status after 10 years, female sex (OR=1.68, P=0.032) was associated with a higher probability of remaining benign, with not more than moderate disability, at 20 years, said Antonio Scalfari, MD, from Imperial College in London, and colleagues at the American Academy of Neurology meeting.

    This higher chance for maintaining a benign status was also seen for younger age at disease onset (ages 21 to 30 versus >30, OR=1.77, P=0.02; age ≤20 versus >30, OR=3.36, P<0.001), the authors reported.

    Males and those older at disease onset had higher risk to become "no longer benign," Scalfari's group concluded.

    "There are patients -- if we can identify them at an early age -- who may not require treatment," Scalfari told MedPage Today at his poster presentation. All of the benign patients in this study are untreated, he said.

    He and colleagues reviewed data on 722 patients in the London Ontario Database. They noted that 270 of these patients converted to secondary progressive MS within 10 years of diagnosis, leaving 452 patients, classified by the researchers as experiencing "benign" MS. Of that group, 113 were lost to follow-up, leaving 339 patients for evaluation at 20 years.

    Scalfari said that in the 10- to 20-year period, 166 of the subjects converted to secondary progressive disease, leaving 173 of these patients free from progression. However, he did note that lack of progression did not mean the patients were free of MS episodes; only that their condition did no deteriorate beyond an Expanded Disability Status Scale score of 3.

    The majority of patients were female (71%) with a mean age of 26.8 at disease onset. Most of patients had monosymptomatic onset characterized by sensory disturbances (52.2%).

    "This is a very controversial issue," he said. He noted that many clinicians believe that if MS is identified, patients should undergo early treatment because "there is a narrow opportunity for possibly modifying the disease and preventing progression." However, he added that treatments tend to attack the inflammatory component of the disease, so it remains unclear whether that treatment strategy actually changes the course of disability associated with the disease.

    He pointed out that the number of MS episodes did not appear to influence whether a person lost their benign status. For example, the odds ratio of remaining in benign status was 30% greater if the patients had one attack in the first 2 years after diagnosis versus patients who had 3 or more attacks, but the difference was not statistically significant (P=0.50).

    There was a 7% increased chance of remaining in benign status if a person had two attack in the first 2 years versus patients who had 3 or more attacks, but that result also did not reach statistical significant (P=0.87).

    Abdullatif Al Khedr, MD, from the University Hospital Amiens in France, told MedPage Today, that he did not designate MS patients as "benign" in his practice. "These patients are mostly going to progress, but we think we can slow that progression if we take these patients and begin them on disease modifying treatments as early as possible."

    Scalfari and Al Khedr had no disclosures.

    Primary source: American Academy of Neurology
    Source reference:
    Scalfari A, et al "Long-term evolution of 'benign' multiple sclerosis patients in the London Ontario Database" AAN 2012; P01.138.

    Source: Medpage Today © 2012 Everyday Health, Inc. (27/04/12)

    Different mechanisms might be involved in relapsing and progressive onset MS

    MS DiagnosisPatients with relapsing onset Multiple Sclerosis (MS) who consumed alcohol, wine, coffee and fish on a regular basis took four to seven years longer to reach the point where they needed a walking aid than people who never consumed them. However the study, published in the April issue of the European Journal of Neurology, did not observe the same patterns in patients with progressive onset MS.

    The authors say that the findings suggest that different mechanisms might be involved in how disability progresses in relapsing and progressive onset MS.

    Researchers asked patients registered with the Flemish MS Society to take part in a survey, which included questions on themselves, their MS and their current consumption of alcohol, wine, coffee, tea, fish and cigarettes.

    The 1,372 patients who agreed to take part were also asked to indicate whether they had reached stage six on the zero to ten stage Expanded Disability Status Scale (EDSS) and, if so, when this had happened.

    "MS is a chronic, often disabling disease that attacks the central nervous system" explains lead author Dr Marie D'hooghe from the National MS Center at Melsbroek, Belgium. "The clinical symptoms, progression of disability and severity of MS are unpredictable and vary from one person to another.

    "Two major MS onset types can be distinguished. Progressive onset MS is characterised by a gradual worsening of neurological function from the beginning, whereas patients with relapsing onset MS patients experience clearly defined attacks of worsening neurologic function with partial or full remission.

    "EDSS 6 is an important milestone in the development of MS as it is the point at which patients need support to walk a reasonable distance."

    The patients who took part were aged between 17 and 89 years-of-age:

    - 65% (893) had relapsing onset MS. 76% were female, with an average age of 50 years. Age at MS onset averaged 31.5 years and disease duration averaged 19 years.

    - 35% (479) had progressive onset MS. 62% were female, with an average age of 59 years. Age at MS onset averaged 37 years and disease duration averaged 21 years.

    The researchers analysed how long it had taken people to reach EDSS 6 and compared those who reported moderate consumption of fish, alcoholic and non-alcoholic drinks and cigarettes with those who reported occasional or no consumption. This showed that:

    Just over half (51%) had reached EDSS 6 after an average disease duration of 20 years. The percentage was much higher for people with progressive onset MS (80%) than relapsing onset (36%).
    Patients with relapsing onset MS who consumed moderate amounts of alcohol (one drink a week or more) reached EDSS 6 seven years later than people who did not drink at all and wine drinkers reached it four years later than those who did not drink wine. The time differences were insignificant in people with progressive onset MS.
    Daily coffee consumption delayed reaching EDSS 6 by five years in people with relapsing onset MS, but there were no significant differences in people with progressive onset MS. Drinking tea daily produced insignificant results in both groups.

    People with relapsing onset MS who ate fish two or more times a week reached EDSS 6 seven years later than those who ate it less than once a month. It made no difference whether the fish was lean or fatty.

    The time differences quoted above did not take into account gender, age at onset and treatment, which are known to affect disability progression in MS. But even after adjusting for these factors, the hazard risk analysis for time to sustained EDSS 6 (where 1.0 was the reference number for zero consumption) showed that:

    The hazard risks for relapsing onset MS were significantly lower for a number of factors: moderate alcohol (0.61), moderate wine (0.67), daily coffee (0.60), occasional coffee (0.60), fish at least twice a week (0.60) and fish at least once a month (0.63).

    - Daily cigarette smoking raised the risk to 1.35 in relapsing onset MS.

    - The only hazard risk of any statistical significance for progressive onset MS was 1.56 for patients who preferred fatty fish, compared with those who preferred lean fish.

    The paper contains full details of the suggested mechanisms that may be involved in the links between consumption and disease progression.

    "Although our findings show a number of associations between consumption and disease progression, it is important that patients recognise that this does not imply that certain food and drinks provide a protective effect as other factors may be involved" stresses Dr D'hooghe.

    "Our study does, however, provide valuable pointers for future research as it reinforces the theory that different mechanisms may be involved in the progression of disability in relapsing and progressive onset MS."

    Full Article

    Source: News-Medical.Net (19/03/12)

    © Multiple Sclerosis Resource Centre (MSRC)

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