Relapse recovery

Kantarci, Orhun H.; Zeydan, Burcu; Atkinson, Elizabeth J.; Conway, Brittani L.; Castrillo‐Viguera, Carmen; Rodriguez, Moses

doi:10.1212/nxi.0000000000000653

Cited by 15 publications

(17 citation statements)

References 29 publications

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“…In this cohort, 44.6% of early relapses left a residual deficit after at least 6 months. It has been established that, even in early stages, relapses often leave residual deficits, with the percentage of early relapses with incomplete recovery reported in different cohorts as 34%, 9 42%, 5 49.9%, 7 53.3%, 8 54.5%, 19 and 58.6%. 10 …”

Section: Discussionmentioning

confidence: 99%

“…23 More importantly, a follow-up analysis of an interferon beta-1a trial underlined the importance of immediate treatment initiation in patients with incomplete first episode recovery, in order to prevent 10-year disability. 8 Older studies pooling treated patients failed to show an effect. 11 , 19 Whereas previous studies have shown declining recovery with subsequent relapses, 7 , 24 we found improved recovery for later relapses within the three years.…”

Section: Discussionmentioning

confidence: 99%

“…These findings should also inform the design of clinical trials, which should include relapse recovery as an endpoint and account for it as a possible confounder. 8 Moreover, basic and translational research on the pathophysiology underlying recovery could lead to the discovery of recovery biomarkers and the development of therapies improving recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Although its contribution to disability has been shown in a small number of studies, 5 – 7 it has not been included as a treatment endpoint in clinical trials. 8 …”

Section: Introductionmentioning

confidence: 99%

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Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability

Sotiropoulos

Lokhande

Healy

et al. 2021

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Although recovery from relapses in MS appears to contribute to disability, it has largely been ignored as a treatment endpoint and disability predictor. Objective To identify demographic and clinical predictors of relapse recovery in the first 3 years and examine its contribution to 10-year disability and MRI outcomes. Methods Relapse recovery was retrospectively assessed in 360 patients with MS using the return of the Expanded Disability Status Scale (EDSS), Functional System Scale and neurologic signs to baseline at least 6 months after onset. Univariate and multivariable models were used to associate recovery with demographic and clinical factors and predict 10-year outcomes. Results Recovery from relapses in the first 3 years was better in patients who were younger, on disease-modifying treatment, with a longer disease duration and without bowel or bladder symptoms. For every incomplete recovery, 10-year EDSS increased by 0.6 and 10-year timed 25-foot walk increased by 0.5 s. These outcomes were also higher with older age and higher baseline BMI. Ten-year MRI brain atrophy was associated only with older age, and MRI lesion volume was only associated with smoking. Conclusions Early initiation of disease-modifying treatment in MS was associated with improved relapse recovery, which in turn prevented long-term disability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Although its contribution to disability has been shown in a small number of studies, 5 – 7 it has not been included as a treatment endpoint in clinical trials. 8 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability

Sotiropoulos

Lokhande

Healy

et al. 2021

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“…The two main MS phenotypes are the relapsing and the progressive disease phenotypes [ 2 ]. Both could occur throughout the disease course in MS [ 3 ]. The relapsing disease course is characterized by the occurrence of clearly defined relapses/attacks which are defined as acute or subacute neurological deficits of at least 24-h duration and occurring at least 30 days apart from a previous attack and not attributed to worsening in the context of concomitant infection or fever.…”

Section: Introductionmentioning

confidence: 99%

Predictors of severity and outcome of multiple sclerosis relapses

et al. 2023

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Background Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). The most common type of MS is the relapsing–remitting MS (RRMS) where relapses are the main component of the disease course. However, the relationship between the characteristics of the relapses on one hand and their severity and outcome on the other hand has not been fully characterized. Objectives To explore the characteristics of relapses among a cohort of Egyptian MS patients and their relation to the severity and outcome of the disease. Subjects and methods We analyzed 300 attacks from 223 patients in a retrospective study to identify demographic, clinical and paraclinical (laboratory and radiological) factors affecting: 1- Severity of relapses (the difference between the EDSS at the day of maximum worsening and the EDSS before the onset of the attack). 2- Outcome of relapses (the difference between the EDSS at the day of maximum improvement and the EDSS before the onset of the relapse). Results Severe attacks were most likely to occur in patients who are males, single, presenting with poly-symptomatic presentation, slower tempo of evolution of attack symptoms, longer duration of the attack, absence of DMTs at the time of the attack. The risk of having a severe relapse is more than 3 times when the patient is single. Regarding attack outcome, poorly recovered attacks were more common in patients with older age at disease onset and at attack onset, male sex, higher number of relapses, longer duration of illness prior to the attack, severe relapses, polysymptomatic presentation, associated cognitive symptoms, slower tempo of symptom evolution, longer duration of the attack, patients on OCPs, smoking, and presence of black holes in brain MRI. The risk of having relapses with partial or no recovery is more than five times when the patient has black holes in brain MRI and more than 4 times when the patient is a smoker. Conclusion Bearing in mind the demographic characteristics as well as the clinical and paraclinical characteristics of each attack and their relation to attack severity and outcome are a key to understanding the individual disease course of every patient and hence tailoring the best therapeutic plan suitable for his individual needs. In other words, prompt, rapid intervention in male patients, polysymptomatic attacks, slower tempo of evolution of attack symptoms and longer duration of the attack should be adopted since these factors are predictive of severe relapses as well as poor relapse outcome.

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Clinical and transcriptional recovery profiles in pediatric and adult multiple sclerosis patients

Menascu

Khavkin

Zilkha‐Falb

et al. 2020

Ann Clin Transl Neurol

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Objective To determine whether pediatric‐onset multiple sclerosis (POMS) and adults‐onset multiple sclerosis (AOMS) patients are different in initial disease severity and recovery and to investigate the associations with peripheral blood mononuclear cells (PBMCs) transcriptional profiles. Methods Clinical and radiological severity of first and second relapses and 6‐month recovery were analyzed in 2153 multiple sclerosis (MS) patients and compared between POMS (onset at 8–18years old) and AOMS (onset at 19–40 years old) patients. PBMCs transcriptomes of 15 POMS and 15 gender‐matched AOMS patients were analyzed 6 months after the first relapse and compared to 55 age‐matched healthy controls. Differentially Expressed Genes (DEGs) with a false discovery rate ≤ 10% were evaluated using the Partek software. Results POMS had increased Expanded Disability Status Scale (EDSS) score at first and second relapses, higher brain gadolinium‐enhancing T1‐lesions volume at first relapse, and more complete recovery after both relapses compared to AOMS. POMS patients, who recovered completely from the first relapse, were characterized by 19 DEGs that were mainly related to suppression of antigen presentation. Six upstream regulators of these genes were differentially expressed between pediatric and adult healthy controls. POMS patients, who showed no recovery from the first relapse, were characterized by 28 DEGs that were mainly associated with B‐cell activation. Five upstream regulators of these genes were differentially expressed between pediatric and adult healthy controls. Interpretation POMS patients may have more severe first and second relapses than AOMS. However, most often, POMS have better recovery that may be attributed to PBMCs age‐related transcriptional profiles associated with antigen presentation and B‐cell activation.

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Relapse recovery

Cited by 15 publications

References 29 publications

Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability

Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability

Predictors of severity and outcome of multiple sclerosis relapses

Clinical and transcriptional recovery profiles in pediatric and adult multiple sclerosis patients

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