Poor relapse recovery heralds progressive MS

By Eleanor McDermid, Senior medwireNews Reporter

Multiple sclerosis (MS) patients with poor recovery from relapses develop the progressive form faster than those with good recovery, research shows.

Half of patients with poor recovery developed progressive MS by 8.3 years after their initial diagnosis, whereas the time for 50% of the patients who made a complete or near complete recovery to develop the progressive form was more than threefold longer, at 30.2 years.

Orhun Kantarci (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and co-researchers suggest that “an early and aggressive recovery strategy such as plasma exchange could be adopted in patients with a fulminant relapse or a history of poor recovery from relapses”.

As reported in Neurology, 30 of 191 population-based MS patients had poor recovery, on average, from relapses over a 5-year period, with poor recovery defined as the failure to achieve either a Kurtzke Functional System Score of 0 or 1 or a “marked improvement” relative to peak deficit.

“Although multiple early relapses portend a worse prognosis than a single relapse, we found that even a single relapse associated with poor recovery may lead to rapid onset of progressive MS”, say the researchers.

This finding came from a separate clinic-based MS cohort of 415. Among the 97 with single-attack progressive MS, the time between initial diagnosis and onset of progressive MS was more than 5 years longer in patients with good relapse recovery, at 10.1 years, compared with just 4.2 years in those with poor recovery.

Patients also developed progressive MS faster if they had sudden and severe initial symptoms and if they had brainstem, cerebellar or spinal cord syndrome at onset. These findings were not notably affected by multivariate analysis, the researchers note.

They comment that patients with multiple annual relapses are currently moved rapidly to more intensive treatment and suggest that “a similar strategy can be considered in patients with poor recovery from relapses, especially those that involve brainstem, cerebellum, or spinal cord, without waiting to establish the high frequency of relapses”.

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