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Neurology. 2015 Aug 25;85(8):722-9. doi: 10.1212/WNL.0000000000001856. Epub 2015 Jul 24.

Poor early relapse recovery affects onset of progressive disease course in multiple sclerosis.

Author information

1
From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey.
2
From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. kantarci.orhun@mayo.edu.

Abstract

OBJECTIVE:

To evaluate the relationship between early relapse recovery and onset of progressive multiple sclerosis (MS).

METHODS:

We studied a population-based cohort (105 patients with relapsing-remitting MS, 86 with bout-onset progressive MS) and a clinic-based cohort (415 patients with bout-onset progressive MS), excluding patients with primary progressive MS. Bout-onset progressive MS includes patients with single-attack progressive and secondary progressive MS. "Good recovery" (as opposed to "poor recovery") was assigned if the peak deficit of the relapse improved completely or almost completely (patient-reported and examination-confirmed outcome measured ≥6 months post relapse). Impact of initial relapse recovery and first 5-year average relapse recovery on cumulative incidence of progressive MS was studied accounting for patients yet to develop progressive MS in the population-based cohort (Kaplan-Meier analyses). Impact of initial relapse recovery on time to progressive MS onset was also studied in the clinic-based cohort with already-established progressive MS (t test).

RESULTS:

In the population-based cohort, 153 patients (80.1%) had on average good recovery from first 5-year relapses, whereas 30 patients (15.7%) had on average poor recovery. Half of the good recoverers developed progressive MS by 30.2 years after MS onset, whereas half of the poor recoverers developed progressive MS by 8.3 years after MS onset (p = 0.001). In the clinic-based cohort, good recovery from the first relapse alone was also associated with a delay in progressive disease onset (p < 0.001). A brainstem, cerebellar, or spinal cord syndrome (p = 0.001) or a fulminant relapse (p < 0.0001) was associated with a poor recovery from the initial relapse.

CONCLUSIONS:

Patients with MS with poor recovery from early relapses will develop progressive disease course earlier than those with good recovery.

PMID:
26208962
PMCID:
PMC4553030
DOI:
10.1212/WNL.0000000000001856
[Indexed for MEDLINE]
Free PMC Article

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