Predicting Worsening RRMS When MRI Doesn't Support It

“Multiple sclerosis usually begins with a relapsing-remitting (RRMS) phase characterized by clinical relapses and inflammatory demyelination evident on magnetic resonance imaging (MRI),” an Ohio based team began at the 32^nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2016) in London, England.

Researchers believe that RRMS leads to disability when a patient doesn’t recovery completely from relapses. Most of the time, patients end up developing a secondary-progressive course — defined by gradual disability increase secondary to neurodegeneration. But if a patient with RRMS has inflammatory stability, can they still experience gradual worsening disease?

A total of 128 patients with RRMS met the criteria out of a cohort of 5,735 from The Knowledge Program. All participants had stable magnetic resonance imaging (MRI), were at least 50 years old, had an average disease duration of at least 10 years, and did not have new or enlarging T2 lesions or gadolinium enhancing lesions from the first to last MRI. There was a 4.2-year average between first and last MRI and the average amount of MRIs was 4.1

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During a time of disease stability, patients performed the Timed 25 Foot Walk (T25FW), 9 Hole Peg Test (9HPT), Performance Scales (PS), Patient Health Questionnaire-9 (PHQ9), and European Quality of Life 5-Dimension (EQ5D). Data was gathered from January 2008 to December 2014.

The results showed a significant increase for the T25FW of 0.26 seconds per year. For the 9HPT, there was a nonsignificant increase on the right of 0.20 seconds per year and 0.45 seconds per year on the left. PS increased 0.07 points per year and PHQ9 improved by 0.20 points per year, however, neither of these were significant. EQ5D scores worsened by 0.0021 points per year.

“A subtle but significant increase was seen in the T25FW over time, but the other outcomes did not significantly change,” the authors confirmed.

The findings support the belief that worsening RRMS stems from inflammatory pathology. In addition, the team showed that patients in early stages of multiple sclerosis can experience gradual worsening.

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