Details

Autor(en) / Beteiligte

• Shalaby, Nevin M
• Rushdi, Rufaida
• Soliman, Nourhan M.
• Abdelbaky, Hadeel Ahmed
• Elmerghany, Nahla
• Mounir, Nesma
• Hassan, Amr
• Fahmi, Rasha M.
• Elsaid, Ahmed F.
• Mekkawy, Doaa

Titel

Clinical Predictors of Transation to Secondary Progressive Multiple Sclerosis

Ist Teil von

• Multiple sclerosis and related disorders, 2023-03, Vol.71, p.104368, Article 104368

Ort / Verlag

Elsevier B.V

Erscheinungsjahr

2023

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• The demarcation of transition of multiple sclerosis (MS) from the relapsing remitting (RR) to the secondary progressive (SP) phase is still illusive with no defined clinical, radiological or biological biomarkers. The need for detection of the transition phase has become an urgent need to avoid the insidious transformation to the SP stage especially in the context of new emerging approved therapies. The clinical signs are usually under looked. We aimed at detecting clinical biomarkers that can define the potential transition from RRMS to SPMS. This is a prospective observational study including patients with RRMS, according to McDonalds 2005 and 2010 criteria, who are followed up to 10 years. Patients with cerebellar functional system score of ³3 were excluded. The primary end point was the conversion to SPMS, defined as gradual worsening independent of relapse activity reaching an Expanded disability status scale (EDSS) of 6. The patients were regularly followed every 6-12 months for 10 years. All participants underwent thorough history taking concerning any significant change in gait pattern or decrease in walking distance, the focus was pyramidal affection. Detailed neurological examination was performed besides EDSS. Eighty seven patients progressed to SPMS were significantly older in age (P<0.001); had higher age of disease onset (P=0.003); higher initial EDSS (P<0.001); higher number of relapses (P<0.001); and disease duration (P<0.001). The clinical symptoms and signs that were predated the definite transformation to SP stage included impaired motor performance (91.6%) [in the form of decreased endurance (91.7%), decreased walking distance (91.8%), genuine lower limb (LL) motor weakness (91.6%) of those the weakness was mainly proximal in 66%]; sphincteric problem (59.4%); fatigue (51.7%);deep sensory affection (36.1%); progressive upper limb weakness (31.4%);symptoms fluctuations (27.3%);dragging of one LL during walking (20%); and subjective increase in motor weakness without change in EDSS (15.7%). The progression emerged from relapse-associated worsening (RAW) with gradual deterioration from that point in 61.2%, where 38.8% progressed independent of RAW. In the absence of radiological or laboratory biomarkers predicting RRMS transformation to SPMS in daily practice, certain clinical symptoms and signs can predate the definite transitioning from RRMS to SPMS, and their early detection can help with early intervention to abort the potential transition.