Quantification of impairment in MS: discussion of the scales in use

Amato, Maria Pia; Ponziani, Giuseppina

doi:10.1177/135245859900500404

Cited by 55 publications

(37 citation statements)

References 15 publications

(12 reference statements)

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“…As reported in the literature, the lower scale values (0-4.0) are influenced by impairments detected by the neurological exam of eight functional systems, whereas the values above 4.0 are mainly based on walking ability and values above 6.0 mainly on patients' handicaps [21,[26][27][28]. Acquisition of EDSS steps 4 or above is considered a sufficient milestone because, once reached, MS inevitably progresses [29].…”

Section: Discussionmentioning

confidence: 95%

T helper 9 cells induced by plasmacytoid dendritic cells regulate interleukin-17 in multiple sclerosis

et al. 2015

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Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by persistent inflammation orchestrated by cluster of differentiation (CD) 4 T helper (Th) cells. In particular, Th1 and Th17 cells amplify, whereas T regulatory (Treg) cells moderate inflammation. The role of other Th subsets in MS is not clear. In the present study, we investigated the generation of different Th responses by human dendritic cells (DCs) in MS. We compared the production of several Th cytokines by naive CD4+ T-cells polarized with myeloid and plasmacytoid DCs (mDCs and pDCs) in healthy donors (HD) and relapsing-remitting (RR)-MS patients. We found that resiquimod-stimulated mDCs were able to activate Th17 differentiation, whereas pDCs induced interleukin (IL)-10-producing Th cells. Surprisingly, resiquimod-stimulated pDCs from MS patients also significantly induced the differentiation of Th9 cells, which produce IL-9 and are known to be involved in allergic diseases. We investigated the potential role of IL-9 in MS. We found that IL-9 activated signal transducer and activator of transcription (STAT) 1 and STAT5 phosphorylation and interfered with IL-17 and interferon (IFN) regulatory transcription factor (IRF)-4 expression in Th17-polarized cells. Moreover, in the cerebrospinal fluid (CSF) of 107 RR-MS patients, IL-9 inversely correlated with indexes of inflammatory activity, neurodegeneration and disability progression of MS. High levels of IL-9 were associated with the absence of IL-17 in the CSF of RR-MS patients. Our results demonstrate a Th9-inducing potential of pDCs in MS, suggesting an immunoregulatory role leading to attenuation of the exaggerated Th17 inflammatory response.

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Section: Discussionmentioning

confidence: 95%

T helper 9 cells induced by plasmacytoid dendritic cells regulate interleukin-17 in multiple sclerosis

et al. 2015

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“…EDSS Kurtzke scale remains by far the most widely used scoring system in MS despite some perceived problems 20,21 . The development of combined analysis of clinical rating systems, envolving some aspects of neurological function in more detail than the EDSS, with more reliable and consistent MRI techniques may improve the evaluation of progression of the disease [20][21][22] . Kira et al 23 observed that DR2-associated DRB1*1501 allele and DRB5*0101 allele were associated with Western-type MS, but not with Asiantype MS, in their Japanese MS patients.…”

Section: Discussionmentioning

confidence: 99%

Multiple sclerosis: report on 200 cases from Curitiba, Southern Brazil and comparison with other Brazilian series

Arruda

Scola

Teive

et al. 2001

Arq. Neuro-Psiquiatr.

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-We reviewed the clinical and laboratorial findings of 200 patients in Curitiba, Southern Brazil (25°25'40" S; 49°16'23" W-GR), with multiple sclerosis (MS)according to Poser's criteria. The patients were classified as: clinically definite (A1 and A2) -142 patients (71%); laboratory-supported definite -42 patients (21%); and clinically probable -16 patients (8%). Relapsing-remitting (RR) form was the most common clinical presentation, with 182 (91%), followed by primary progressive (PP)(16 cases, 8%), and only 2 cases with secondarily progressive form (SP). Nine women and 7 men totalized the 16 PP cases. The mean age of onset was 32.0±9.9 (median 32 years). The gender ratio was female 1.8:1 male. All patients, except 3 AfricanBrazilian, were white. Seven (3.5%) patients developed a clinical history of Devic´s syndrome. The initial clinical picture included brainstem/cerebellar syndrome in 126 (63%) cases, sensorial findings in 106 (53%)patients, motor (pyramidal) syndrome in 102 (49.5%), and optic neuritis in 79 (39.5%) cases. 122 (61%) patients had a final EDSS score < 3.5; 45 (22.5%) a score between 3.5 and 5.5, and 33 (16.5%) a score ≥ 6.0. There was no significant correlation between the number of relapses or duration of disease with EDSS scores (Spearman's test). Only 14 (7%) of the total number presented the benign form (EDSS< 3.5 after 10 years of disease). We observed a later age of onset and initial clinical findings with higher frequency of brainstem/ cerebellar syndrome and optic neuritis, when compared to other Brazilian and Western series KEY WORDS: multiple sclerosis, clinical forms, Brazilian series, EDSS.Esclerose múltipla: descrição de 200 casos de Curitiba, Paraná e comparação com outras séries brasileiras RESUMO -Os autores analisaram retrospectivamente 200 pacientes portadores de esclerose múltipla de acordo com os critérios de Poser (1983). Cento e quarenta e dois (71%) dos casos possuíam a forma clinicamente definida, 42 (21%) a forma definida laboratorialmente e 16 (8%) a forma clinicamente provável. A forma recorrente-remitente (RR) foi a mais comumente observada (182 casos, 91%), seguida pela forma progressiva primária (PP)(16 casos, 8%), e somente 2 pacientes com a forma secundariamente progressiva. A idade média de início da doença foi 32,0±9,9 anos (mediana 32 anos).A relação entre os gêneros foi mulheres 1,8:1 homens. Todos os pacientes eram da raça branca, com exceção de 3 pacientes afro-brasileiros. Síndrome de Devic ou neuromielite óptica foi observada em 7 (3,5%) pacientes. Síndrome de tronco cerebral/cerebelar foi a forma mais comum de apresentação inicial da doença, com 126 casos (63%), seguido por achados sensoriais (106 casos, 53%), síndrome motora/piramidal (102 casos, 49,5%), e neurite óptica (79 casos, 39,5%). Nesta série, 122 pacientes (61%) possuíam um EDSS final < 3,5; 45 (22,5%) escore entre 3,5 e 5,5 e 33 (16,5%) um escore ≥ 6.0. Não se observou uma correlação entre o número de surtos ou os anos de doença com o escore EDSS (teste de Spearman). Somente 14 paci...

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“…Disability evaluation among MS patients has given rise to the challenge of constructing instruments that are able to translate this clinical parameter of MS 13 .…”

Section: Reliability Testmentioning

confidence: 99%

Validation of the "Six Step Spot Test" for gait among patients with multiple sclerosis in Brazil

Pavan¹,

Tilbery²,

Lianza³

et al. 2010

Arq. Neuro-Psiquiatr.

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The clinical manifestations of multiple sclerosis (MS) are variable among patients, and the course of disease is not linear. Different symptoms are presented, with gradual accumulation of disability. These variations are difficult to quantify in clinical practice, and several studies have attempted to create instruments capable of measuring these disabilities. The Six Step Spot Test (SSST) was developed for quantitative evaluation of the lower limbs (LL) over time. Performance in this test reflects the complexity of sensory-motor function, including LL strength, spasticity, coordination and balance, going beyond vision and cognition. The aim of the present study was to validate the SSST in a population of MS patients in Brazil. This prospective study included 75 patients with MS, with EDSS 0 to 6.5 in the study group. Ninety-one healthy subjects were randomly selected for the control group. The results showed that the groups were similar, and that the SSST is a reliable and reproducible test. According to the statistical analysis on the data in this study, the SSST is a valid, reliable and reproducible tool for use in the Brazilian MS patient population. Key words: gait, multiple sclerosis, disability evaluation, validation studies, reproducibility of results.Validação do teste de marcha "six step spot test" em pacientes com esclerose múltipla no brasil resumo As manifestações clínicas da esclerose múltipla (EM) são variáveis e o curso da doença não é linear, caracterizado por sintomas, acúmulo progressivo de incapacidades. Estas variações são difíceis de quantificar na prática clínica, motivo pelo qual surgiram diversos estudos para criação de instrumentos capazes de mensurar essas incapacidades. O Six Step Spot Test (SSST) foi desenvolvido para avaliar função dos membros inferiores (MMII) de forma quantitativa, mensurado no domínio tempo, avaliando a complexa função sensório-motora, como força em MMII, espasticidade, coordenação e equilíbrio, além da visão e cognição. Este estudo teve como objetivo validar o SSST para pacientes com EM no Brasil. Estudo prospectivo do qual participaram 75 pacientes com EM e EDSS de 0 a 6,5 no grupo de estudo e 91 indivíduos saudáveis no controle que foram selecionados aleatoriamente. Segundo os dados estatísticos deste estudo, o SSST é válido, confiável e reprodutível para pacientes com EM no Brasil. Palavras-chave: marcha, esclerose múltipla, avaliação da deficiência, estudos de validação, reprodutibilidade dos testes.

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Quantification of impairment in MS: discussion of the scales in use

Cited by 55 publications

References 15 publications

T helper 9 cells induced by plasmacytoid dendritic cells regulate interleukin-17 in multiple sclerosis

T helper 9 cells induced by plasmacytoid dendritic cells regulate interleukin-17 in multiple sclerosis

Multiple sclerosis: report on 200 cases from Curitiba, Southern Brazil and comparison with other Brazilian series

Validation of the "Six Step Spot Test" for gait among patients with multiple sclerosis in Brazil

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