Fatigue, Leg Problems May Foreshadow MS Progression

In multiple sclerosis, limited leg function predicts decline.

Older multiple sclerosis patients who report fatigue and limited leg function are much more likely to transition to secondary progressive MS within 5 years, according to a new study.

The research could give physicians a new way to predict MS progression and plan treatment for patients.

The vast majority of MS patients (80-85%) are initially diagnosed with relapsing-remitting multiple sclerosis (RRMS), characterized by flare-ups followed by stints of remission. According to the National MS Society, without disease-modifying drugs about 50% of RRMS patients will transition to secondary progressive MS (SPMS) within a decade, and 90% will transition to the more severe form within 25 years.

A team of researchers from the University of Buffalo sought to find out which, if any, symptoms were predictive of near-term conversion from RRMS to SPMS.

In order to find out, the researchers looked at data from 155 MS patients ages 50 and older. All were part of the New York State Multiple Sclerosis Consortium, and all had been diagnosed with RRMS at least 15 years prior.

After 5 years, the patients were reevaluated. By that time, one in three had progressed to SPMS.

When researchers looked back at the data from the start of the study, two symptoms stood out-- fatigue and limited leg function.

“Study participants with those symptoms were more likely to progress from relapsing-remitting MS to secondary progressive MS within 5 years,” said Bianca Weinstock-Guttman, MD, (photo) one of the study’s authors. “Better understanding who is at high risk of getting worse may eventually allow us to tailor more specific treatments to these people.”

Patients who reported fatigue at the start of the study were four times more likely than those without fatigue to be diagnosed with SPMS over the next 5 years. Patients with limited leg function were three times more likely to transition to SPMS in the next 5 years.

The results held even when data was adjusted for age, disease duration, and disability status. The average patient had had MS for 22 years at the time of the 5-year follow-up.

Weinstock-Guttman, a professor at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences, noted that while new drugs have been successful as slowing progression in patients with RRMS, no drugs have yet succeeded at doing the same for patients with SPMS. She said the study should help point drug developers in the right direction.

“While more research needs to be done, this study brings us closer to understanding which older adults with MS may be at higher risk of getting worse,” said Weinstock-Guttman. “With the aging population, this information will be vital as people with MS, their families and policy makers make decisions about their care.”

The study results were released last week by the American Academy of Neurology. Full results will be presented at AAN’s annual conference in Boston next month.

The abstract of the study, titled “Self-reported Fatigue and Lower Limb Problems Predictive of Conversion to Secondary Progressive Multiple Sclerosis in an Aging Sample of Patients,” can be viewed online here.

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