Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

Amaç: Bu çalışma, hastalık prognozunu tahmin etmek için Multipl Skleroz (MS) hastalarının uzun vadeli klinik ve demografik özelliklerini araştırmaktadır. Gereç ve Yöntem: Poser veya McDonald kriterleri kullanılarak teşhis konulan 275 MS hastası retrospektif olarak incelendi. Genişletilmiş Engellilik Durumu Ölçeği (EDSS) puanlarına göre 4'ün altı (grup 1) ile 4 ve 4'ün üzerinde (grup 2) olarak sınıflandırıldı. Bulgular: Hastaların ortalama yaşı 55.459.63, hastalık süresi 26.766.08 yıldı. İlk EDSS puanları 20 yıl sonra 2.56 ± 2.36'dan 4.23 ± 1.8'e yükselmiştir. %69,1'inin 20 yıl sonra EDSS puanı 4 veya daha yüksekti. Özellikle, supratentoryal ve omurilik tutulumu başlangıçlı hastalar daha yüksek EDSS skorları gösterdi. Lojistik regresyon analizi, daha yüksek bir ilk EDSS puanının, ilk ataktan sonra tam iyileşme olmamasının ve ataklar arasında daha uzun bir sürenin, 4 veya daha yüksek bir EDSS puanı riski ile ilişkili olduğunu ortaya koydu. Sonuç: Çalışmamız, başlangıçtaki EDSS'deki artışın MS'te uzun süreli sakatlığın öngörücüsü olduğunu desteklemektedir. MS'te uzun dönemli gerçek yaşam verileri hakkında bilgi sahibi olmak, hastalığın seyrini anlamak, takibi ve tedavi seçimi açısından oldukça değerlidir.

Anahtar Kelimeler:

Multipl skleroz, yeti yitimi, prognoz

Long-term disability in multiple sclerosis: a longitudinal study over 20 years

Purpose: This study investigated the long-term clinical and demographic characteristics of multiple sclerosis (MS) patients to predict disease prognosis. Materials and Methods: Two hundred and seventy-five MS patients diagnosed using the Poser or McDonald criteria were retrospectively analyzed. They were categorized based on their Expanded Disability Status Scale (EDSS) scores: below 4 (group 1) and 4 or above (group 2). Results: The average patient age was 55.45 ± 9.63 years, with a disease duration of 26.76 ± 6.08 years. The initial EDSS scores increased from 2.56 ± 2.36 to 4.23 ± 1.8 after 20 years. Of the patients, 69.1% had EDSS scores of 4 or higher after 20 years. Notably, patients with supratentorial and spinal cord involvement at onset had higher EDSS scores. Logistic regression analysis revealed that a higher initial EDSS score, no full recovery after the first attack, and a longer duration between attacks were associated with a higher risk of an EDSS score of 4 or above. Conclusion: Thisr study shows that an increase in the initial EDSS score is predictive of long-term disability in patients with MS. Having information on long-term, real-life data in MS is highly valuable in terms of understanding the course of the disease, its monitoring, and treatment selection.

Keywords:

multiple sclerosis, disability, long term,

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Cree BA, Oksenberg JR, Hauser SL. Multiple sclerosis: two decades of progress. The Lancet Neurology. 2022;21:211-4.
Cortesi PA, Fornari C, Capra R, Cozzolino P, Patti F, Mantovani LG. Multiple sclerosis progressive courses: a clinical cohort long-term disability progression study. Value Health. 2022;25:1489-98.
Thrower Ben W. Clinically isolated syndromes: predicting and delaying multiple sclerosis. Neurology. 2007;68:12-5.
Chan, Jane W. Optic neuritis in multiple sclerosis. Ocul Immunol Inflamm. 2002;10:161-86.
Phadke JG. Clinical aspects of multiple sclerosis in north-east scotland with particular reference to its course and prognosis. Brain. 1990;113:1597-628.
Cinar BP, Özakbaş S. Prediction of conversion from clinically isolated syndrome to multiple sclerosis according to baseline characteristics: a prospective study. Noro Psikiyatr Ars. 2018;55:15-21.
Kavaliunas A, Karrenbauer VD, Binzer S, Hillert J. Systematic review of the socioeconomic consequences in patients with multiple sclerosis with different levels of disability and cognitive function. Front Neurol. 2022;12:737211.
Højsgaard Chow H, Schreiber K, Magyari M, Ammitzbøll C, Börnsen L, Christensen JR et al. Progressive multiple sclerosis, cognitive function, and quality of life. Brain Behav. 2018;8:e00875.
Young CA, Mills R, Rog D, Sharrack B, Majeed T, Constantinescu CS et al. Quality of life in multiple sclerosis is dominated by fatigue, disability and self-efficacy. J Neurol Sci. 2021;426:117437.
Chabas D, Green AJ, Waubant E. Pediatric multiple sclerosis. NeuroRx. 2006;3:264–75.
Kurtzke JF. Rating neurologic impairment in multipl sclerosis: an expanded disability status scale. Neurology. 1983;33:1444-52.
Dzau W, Sharmin S, Patti F, Izquierdo G, Eichau S, Prat A et al. Risk of secondary progressive multiple sclerosis after early worsening of disability. J Neurol Neurosurg Psychiatry. 2023;doi:10.1136/jnnp-2023-331748
Voigt I, Inojosa H, Wenk J, Akgün K, Ziemssen T. Building a monitoring matrix for the management of multiple sclerosis. Autoimmun Rev. 2023;22:103358.
Portaccio E, Bellinvia A, Fonderico M, Pastò L, Razzolini L, Totaro R et al. Progression is independent of relapse activity in early multiple sclerosis: a real-life cohort study. Brain. 2022;145:2796-805.
Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391:1622-36.
Filippi M, Preziosa P, Meani A, Costa GD, Mesaros S, Druloviç J et al. Performance of the 2017 and 2010 revised mcdonald criteria in predicting ms diagnosis after a clinically isolated syndrome: a magnims study. Neurology. 2022;98:e1-14.
Malik MT, Healy BC, Benson LA, Kivisakk P, Musallam A, Weiner HL et al. Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis. Neurology. 2014;82:2173-9.
Sellner J, Luthi N, Buhler R, Gebhardt A, Findling O, Greeve I et al. Acute partial transverse myelitis: risk factors for conversion to multiple sclerosis. Eur J Neurol. 2008;15:398–405.
Kearney H, Schneider T, Yiannakas MC, Altmann DR, Wheeler-Kingshott CAM, Ciccarelli O et al. Spinal cord grey matter abnormalities are associated with secondary progression and physical disability in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2015;86:608-14.
Casserly C, Seyman EE, Alcaide‐Leon P, Guenette M, Lyons C, Sankar S et al. Spinal cord atrophy in multiple sclerosis: a systematic review and meta‐analysis. J Neuroimaging. 2018;28:556-86.
Naldi P. Predictors of attack severity and duration in multiple sclerosis: a prospective study. Open Neurol J. 2011;5:75–82.
Baghizadeh S, Sahraian MA, Beladimoghadam N. Clinical and demographic factors affecting disease severity in patients with multiple sclerosis. Iran J Neurol. 2013;12:1-8.
Hosny HS, Shehata HS, Ahmed S, Ramadan I, Abdo SS, Fouad AM. Predictors of severity and outcome of multiple sclerosis relapses. BMC Neurol. 2023;13:23-67.
West T, Wyatt M, High A, Bostrom A, Waubant E. Are initial demyelinating event recovery and time to second event under differential control? Neurology. 2006;67:809–13.
Leone M, Bonissoni S, Collimedaglia L, Tesser F, Calzoni S, Stecco A et al. Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study. Mult Scler J. 2008;14:485–93.
Confavreux, Christian, Sandra Vukusic, and Patrice Adeleine. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain. 2003;126:770-82.
Scalfari A, Neuhaus A, Degenhardt A, Rice GP, Muraro PA, Daumer M et al. The natural history of multiple sclerosis, a geographically based study 10: relapses and long-term disability. Brain. 2010;133:1914-29.
McCombe, Pamela A. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother. 2022;22:377-92.
Van Wijmeersch B, Hartung HP, Vermersch P, Pugliatti M, Pozzilli C, Grigoriadis N et al.Using personalized prognosis in the treatment of relapsing multiple sclerosis: a practical guide. Front Immunol. 2022;13:991291.
Luetic GG, Menichini ML, Vrech C, Pappolla A, Patrucco L, Cristiano E et al. Clinical and demographic characteristics of male ms patients included in the national registry-relevarem. Does sex or phenotype make the difference in the association with poor prognosis? Mult Scler Relat Disord. 2022;58:103401.
Lublin FD, Häring DA, Ganjgahi H, Ocampo A, Hatami F, Čuklina J et al. How patients with multiple sclerosis acquire disability. Brain. 2022;145:3147-61.
Weinstock-Guttman B, Sormani MP, Repovic P. Predicting long-term disability in multiple sclerosis: a narrative review of current evidence and future directions. Int J MS Care. 2022;24:184-8.
Novotna M, Paz Soldán MM, Abou Zeid N, Kale N, Tutuncu M, Crusan DJ et al. Poor early relapse recovery affects onset of progressive disease course in multiple sclerosis. Neurology. 2015;85:722-9.