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. 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

Martina Novotna  1 , M Mateo Paz Soldán  1 , Nuhad Abou Zeid  1 , Nilufer Kale  1 , Melih Tutuncu  1 , Daniel J Crusan  1 , Elizabeth J Atkinson  1 , Aksel Siva  1 , B Mark Keegan  1 , Istvan Pirko  1 , Sean J Pittock  1 , Claudia F Lucchinetti  1 , John H Noseworthy  1 , Brian G Weinshenker  1 , Moses Rodriguez  1 , Orhun H Kantarci  2
Affiliations

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

Martina Novotna et al. Neurology. .

Erratum in

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.

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Figures

Figure 1
Figure 1. Study design and patient populations
MS = multiple sclerosis; PPMS = primary progressive MS; RRMS = relapsing-remitting MS; SAPMS = single-attack progressive MS; SPMS = secondary progressive MS.
Figure 2
Figure 2. Application of the relapse-impact model on Functional System Scores from the Kurtzke scale
Patients with minimal baseline deficit (Functional System Score [FSS] 1) or marked improvement in FSS compared to peak deficit were classified as good recoverers. Others were classified as poor recoverers.
Figure 3
Figure 3. Kaplan-Meier analyses of time from MS onset to progressive MS onset
Patients with good recovery from early relapses reached progressive multiple sclerosis (MS) >20 years later than poor recoverers (A). Time to maximum recovery from early relapses did not have an impact on time from MS onset to progressive MS onset (C). (B, D) Results of recovery from the first relapse alone.
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