Автор:
Makshakova G., Nazarov V., Magonovd E., Lapin S., Trofimova T., Shumilina M., Totolyan N., Skoromets A., Evdoshenko E.
Год:
2017
Публикация: Journal of the Neurological Sciences 381:782-783. October 2017.
Аннотация
Background: Relapse rate and changes in MRI and the Expanded Disability Status Scale (EDSS) are universally used as indicators of therapeutic efficacy in disease modifying treatments in multiple sclerosis (MS). Though, the EDSS has limitations, namely, in the assessment of cognitive dysfunction.
Objective: To investigate the accuracy of clinical measures in the detection of disease activity.
Patients and Methods/Material and Methods: Patients with RRMS were evaluated using clinical and MRI measures in two different moments. Disease activity was defined as N1 relapses and/or changes in MRI (≥2 Gd-enhancing or new T2 lesions). It was considered a change (“clinically meaningful worsening”) if EDSSN1, Timed 25-foot walk (T25FW) N20%, 9-hole peg test (9HPT) N20%, and symbol digit modality test (SDMT) N10%. Classification accuracy statistics and Fisher’s exact were applied.
Results: Of the 127 patients included (age=42±11, education=14±7, disease duration=11.±7 years; first evaluation EDSS=2.6±3.4, and time between evaluations=12±5 months), 41 (32%) met the criteria for disease activity. Changes in EDSS and SDMT correctly classified (sensitivity) respectively 22/41 (54%) and 24/41 (59%) patients with disease activity. However, there was a modest association between changes in EDSS and SDMT (p=0.034; 30/127 patients had changes in
one measure but not on the other). When combined, the sensitivity of EDSS and SDMT reached 93%. Both clinical measures correctly classified all patients without disease activity (specificity). The sensitivity of changes in T25FW (15%) and 9HPT (7%) was low.
Conclusion: Changes in EDSS and SDMT have high accuracy in the detection of disease activity. Though, these clinical measures may be sensitive to different aspects of disease activity.
Процитировать:
Makshakov, Gleb & Nazarov, V. & Magonov, E. & Lapin, Sergey & Trofimova, T. & Shumilina, Maria & Totolyan, Natalia & Skoromets, A. & Evdoshenko, Evgeniy. (2017). Prevalence of leptomeningeal foci of gadolinium enhancement in multiple sclerosis and its relationship to the disease severity. Journal of the Neurological Sciences. 381. 782-783. 10.1016/j.jns.2017.08.2209.