Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis

Abstract

<b><i>Introduction:</i></b> We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. <b><i>Methods:</i></b> Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. <b><i>Results:</i></b> EDSS values correlated with patient’s age (<i>r</i> = 0.543, <i>p</i> = 0.001), SC volume (<i>r</i> = −0.301, <i>p</i> = 0.034), and ganglion cell layer (GCL, <i>r</i> = −0.354, <i>p</i> = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke <i>R</i><sup>2</sup> = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. <b><i>Conclusions:</i></b> MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.

Association of Higher Mediterranean Diet Adherence With Lower Prevalence of Disability and Symptom Severity, Depression, Anxiety, Stress, Sleep Quality, Cognitive Impairment, and Physical Inactivity in Older Adults With Multiple Sclerosis

“…Our results are in accordance with certain previous studies that a higher compliance to MD may be associated with an improvement in disease disability and symptom severity, exerting also positive effects in several aspects of the mental health of older adults with MS such as depression, anxiety, and stress, reinforcing also daily quality of life, sleep quality and physical activity. [40][41][42][43][44][45][46][47][48][49] In this context, recent high-quality evidence has strongly supported that MD can exert anti-inflammatory and antioxidants effects against human diseases, including MS. [50][51][52] Notably, an update of the Cochrane Review 'Dietary interventions for MS has suggested that there is insufficient evidence to determine whether supplementation with antioxidants or other dietary interventions have any impact on MS-related outcomes, while some of the currently available studies suffers from high risk of bias at present. 60 Beyond MD, a recently published study found that a paleo diet, may be useful in MS treatment by reducing perceived fatigue, improving mental and physical quality of life, increasing exercise capacity, and improving arm and leg function.…”

“…The Expanded Disability Status Scale (EDSS) is a validated and well-recognized method of quantifying disability in MS and monitoring changes in the level of disability over time. 52 EDSS steps 1.0 to 4.5 refer to patients who are fully ambulatory, while EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation and usual equivalents and impairment to walking. 52 Depression status was assessed using the Geriatric Depression Scale (GDS) questionnaire which includes 30 items.…”

“…52 EDSS steps 1.0 to 4.5 refer to patients who are fully ambulatory, while EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation and usual equivalents and impairment to walking. 52 Depression status was assessed using the Geriatric Depression Scale (GDS) questionnaire which includes 30 items. 53 In each question accounted 2 possible answers, "yes" or "no" marked as 0 or 1, respectively.…”

“…52 EDSS steps 1.0 to 4.5 refer to patients who are fully ambulatory, while EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation and usual equivalents and impairment to walking. 52…”

Assessment of Motor Evoked Potentials in Multiple Sclerosis

“…Various quantitative measures (i.e., the number and volume of contrast-enhancing, the volumes of T2-hyperintense and T1-hypointense lesions, and brain volume changes), derived from conventional and advanced MRI methods, have been proposed as prognostic biomarkers for MS. However, correlations between different MRI indicators and EDSS are not satisfactory, and no specific MRI measure is used as a comprehensive prognostic imaging biomarker for MS [ 8 , 9 , 10 ].…”