Contributions
Abstract: P388
Type: Poster
Abstract Category: Clinical aspects of MS - 8 Clinical assessment tools
Background: Over their disease course, large portion of multiple sclerosis (MS) patients develop walking disabilities. Currently the Expanded Disability Status Scale (EDSS) is the gold standard among tests used in assessing MS-related disability. There is a pressing need to understand how clinical measures portray the underlying global and microstructural neuronal integrity. .
Objective: To assess the correlations between tests used to measure disability and MRI-derived global and microstructural damage.
Methods: The study consisted of 81 MS patients recruited in this prospective study. An experienced neurologist applied EDSS, expanded timed get-up and go (ETGUG) test, and timed 25-foot walk (T25FW) test as part of the clinical examination. Lesion volumes were calculated using a reproducible, semiautomatic thresholding and contouring technique. The SIENAX cross-sectional software tool was used to estimate gray matter volume (GMV), white matter volume (WMV), whole brain volume (WBV) and normalized cortical volume (NCV). To segment subcortical deep gray matter (DGM) structures, the FIRST tool was used. DTI processing was performed using FMRIB´s Diffusion Toolbox (FDT) and scalar maps of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were calculated. Spearman rank correlation analyses were performed.
Results: EDSS, T25FW test, and all ETGUG components were associated with all MRI-derived inflammatory measures (T2 lesion volume, p< 0.001; T1 lesion volume, p< 0.01), global (GMV and NCV, p< 0.001; WBV, p< 0.01; and WMV p< 0.05) and regional (DGM p< 0.001; thalamus < 0.001; and basal ganglia nuclei, p< 0.05) volumes. Specifically, the T2 lesion volume correlated with ETGUG (r=0.452, p< 0.001), EDSS (r=0.552, p< 0.001), and T25FW (r=0.393, p< 0.001). The highest volumetric correlations were noted for the EDSS and “turn around” segment of the ETGUG with GMV (r=-0.617, p< 0.001; r=-0.559, p< 0.001, respectively) and thalamic volumes (r=-0.553, p< 0.001; r=-0.580, p< 0.001, respectively). From the DTI measures, FA of the WM correlated with total ETGUG (r=-0.346, p=0.002), T25FW (r=-0.307, p=0.006) and EDSS (r=-0.363, p=0.002).
Conclusion: All three employed disability measures showed good association with MRI-derived global and microstructural pathology markers. This study also confirmed the association of global and subcortical gray matter pathology with respect to greater walking disability.
Disclosures of conflict of interest: None
Disclosure:
Dejan Jakimovski, Jesper Hagemeier, Caila Vaughn, Katelyn Kavak and Niels Bergsland have nothing to disclose.
Bianca Weinstock-Guttman received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Acorda. Dr Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis, Acorda.
Susan Bennett received honoraria as a speaker from Acorda Therapeutics.
Ralph Benedict has acted as a consultant or scientific advisory board member for Bayer, Biogen Idec, Actelion, and Novartis. He receives royalties from Psychological Assessment Resources, Inc. He has received financial support for research activities from Shire Pharmaceuticals, Accorda and Biogen Idec
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and
research grant support from Novartis.
Robert Zivadinov received personal compensation from Teva Pharmaceuticals, Biogen Idec, EMD Serono, Genzyme-Sanofi, Claret Medical, IMS Health and Novartis for speaking and consultant fees. He received financial support for research activities from Teva Pharmaceuticals, Genzyme-Sanofi, Novartis, Claret Medical, Intekrin-Coherus and IMS Health.
Abstract: P388
Type: Poster
Abstract Category: Clinical aspects of MS - 8 Clinical assessment tools
Background: Over their disease course, large portion of multiple sclerosis (MS) patients develop walking disabilities. Currently the Expanded Disability Status Scale (EDSS) is the gold standard among tests used in assessing MS-related disability. There is a pressing need to understand how clinical measures portray the underlying global and microstructural neuronal integrity. .
Objective: To assess the correlations between tests used to measure disability and MRI-derived global and microstructural damage.
Methods: The study consisted of 81 MS patients recruited in this prospective study. An experienced neurologist applied EDSS, expanded timed get-up and go (ETGUG) test, and timed 25-foot walk (T25FW) test as part of the clinical examination. Lesion volumes were calculated using a reproducible, semiautomatic thresholding and contouring technique. The SIENAX cross-sectional software tool was used to estimate gray matter volume (GMV), white matter volume (WMV), whole brain volume (WBV) and normalized cortical volume (NCV). To segment subcortical deep gray matter (DGM) structures, the FIRST tool was used. DTI processing was performed using FMRIB´s Diffusion Toolbox (FDT) and scalar maps of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were calculated. Spearman rank correlation analyses were performed.
Results: EDSS, T25FW test, and all ETGUG components were associated with all MRI-derived inflammatory measures (T2 lesion volume, p< 0.001; T1 lesion volume, p< 0.01), global (GMV and NCV, p< 0.001; WBV, p< 0.01; and WMV p< 0.05) and regional (DGM p< 0.001; thalamus < 0.001; and basal ganglia nuclei, p< 0.05) volumes. Specifically, the T2 lesion volume correlated with ETGUG (r=0.452, p< 0.001), EDSS (r=0.552, p< 0.001), and T25FW (r=0.393, p< 0.001). The highest volumetric correlations were noted for the EDSS and “turn around” segment of the ETGUG with GMV (r=-0.617, p< 0.001; r=-0.559, p< 0.001, respectively) and thalamic volumes (r=-0.553, p< 0.001; r=-0.580, p< 0.001, respectively). From the DTI measures, FA of the WM correlated with total ETGUG (r=-0.346, p=0.002), T25FW (r=-0.307, p=0.006) and EDSS (r=-0.363, p=0.002).
Conclusion: All three employed disability measures showed good association with MRI-derived global and microstructural pathology markers. This study also confirmed the association of global and subcortical gray matter pathology with respect to greater walking disability.
Disclosures of conflict of interest: None
Disclosure:
Dejan Jakimovski, Jesper Hagemeier, Caila Vaughn, Katelyn Kavak and Niels Bergsland have nothing to disclose.
Bianca Weinstock-Guttman received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Acorda. Dr Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis, Acorda.
Susan Bennett received honoraria as a speaker from Acorda Therapeutics.
Ralph Benedict has acted as a consultant or scientific advisory board member for Bayer, Biogen Idec, Actelion, and Novartis. He receives royalties from Psychological Assessment Resources, Inc. He has received financial support for research activities from Shire Pharmaceuticals, Accorda and Biogen Idec
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and
research grant support from Novartis.
Robert Zivadinov received personal compensation from Teva Pharmaceuticals, Biogen Idec, EMD Serono, Genzyme-Sanofi, Claret Medical, IMS Health and Novartis for speaking and consultant fees. He received financial support for research activities from Teva Pharmaceuticals, Genzyme-Sanofi, Novartis, Claret Medical, Intekrin-Coherus and IMS Health.