Multi Scle Progression

8/3/2019 Multi Scle Progression

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Clinical Question: Patients with multiple sclerosis present to inpatient rehab at variety of

functional levels. As therapists, we address both current functional status and anticipated level of

function given the progression of the disease. What is the rate of progression of disability inmultiple sclerosis (is it affected by subtypes such as relapsing-remitting, primary progression,

secondary progression?)

Relapses and Progression of Disability inMultiple Sclerosis:

Intro: MS affects 1:1000 in Western Counties

-Most patients disease begins at 30 years with

acute episodes of of partial or completeremission with clinical stability between

relapses. Except in patient with relapsing-

remitting MS, this phase is followed by

progressive disability with or withoutremissions. In a minority of patients, the

disease is progressive from the beginningwith/without relapses ( primary progressive).

Methods: Patient’s were identified throughcomputerized survellience in Lyon’s France.

1844 patients who had MS. Examined the time

of clinical onset of disese, initial course(relapsing-remitting vs progressive) time of

relapses, time to onset of irreversible disability,and the time course of progressive irreversibledisability. Disability was defined as reversible

when a patient had a given score for at lease 6

months.-Researchers looked at 3 scores on the Kurtzke

Disability Status Scale (designed to classify

patient’s with MS 0-10 with 10 being most

severe) to indicate severity and progression.-4: limited walking ability but able to

go > 500 m without AD

-6: able to walk with unilateral support< than 100 m

-7: walk < 10 m by furniture walking, I transfrs, manual w/c user Results: Patients with relapsing-remitting onset went the longest from onset of disease todisability than patients with onset of progressive. 11.4 yrs to score of 4, 23.1 yrs on 6, 33.1 to 7.

Patients with progressive onset were 0.0 years to 4, 7.1 years to 6, and 13.4 to 7.

- In contrast, the times from the assignment of score of4 to a score 6 were similar I the two

groups 5.7 and 5.4 years. The time course of irreversible disease among pateiens with primary

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progressive type was not affected by presence or absence of disease.



Discussion:

-Irreversible disability occurred sooner in patients in whom disease was progressive from onset

than those that were relapsing-remissing onset.

-In contrast, once irreversible disability occurs, times course of progressive disability was similar

in the two groups.-Relapses do not significantly indluence the progression of irreversible disability.

Given that patients typically go from being nearly community ambulators with an AD ( EDSS







Score 6) to being w/c level and requiring assistance for transfers ( EDSS 8) in 8 years, what can

we do to best prepare them?

What sort of resources can we provide them?



What services can we set them up with or provide them the information for?

How can we keep them connected to the services they will eventually need?

Multi Scle Progression

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