Contributions
Abstract: P917
Type: Poster
Abstract Category: Clinical aspects of MS - 8 Clinical assessment tools
Background: People with early multiple sclerosis (MS) may have subclinical balance deficits not reflected by changes in the Expanded Disability Status Scale (EDSS). Topographical distribution of lesions has been shown to impact disability accumulation. We evaluated 2 simple, concise balance tasks for sensitivity to detect cerebellar lesions relative to the standard cerebellar functional system (FS) of the EDSS.
Methods: Patients with early MS (16 clinically isolated syndrome, 64 relapsing remitting, diagnosed within 5 years with median EDSS 1.0) underwent 3.0T MRI. Cerebellar lesions were identified and cerebellar lesion volume quantified using 3D T2-weighted sequences. Patients performed the NIH Toolbox Standing Balance Test, a 5-minute procedure requiring 5 different stances of increasing balancing difficulty. An iPod measured postural sway and calculated an age-adjusted balance score. Patients were dichotomized as failing (n=14) or not failing (n=66) any stance. A separate balance beam task evaluated patients' ability to complete tandem gait across a 3.0m long, 12cm wide, 1.3cm high board. Patients attempted the walk 3 times. The number of quarters (0.75m lengths) completed without falling off the beam across all trials (0-12) was recorded. Patients were dichotomized by perfect (12/12, n=53) or imperfect (< 12, n=27) beam scores.
Results: 32/80 patients had cerebellar lesions. Abnormal cerebellar FS score (n=12) was not reliably related to presence (X2=1.98, p=0.160, sensitivity=21.9%, specificity=89.6%) or volume (t[78]=0.472 cm3, p=0.639) of cerebellar lesions. In contrast, cerebellar lesions were more common among patients who failed any NIH balance task stance (X2=10.52, p=0.001, sensitivity=34.4%, specificity=93.8%). Worsened quantitative balance (sway) was linked to greater cerebellar lesion volume (rho=-.324, p=0.003). Patients with imperfect beam scores were more likely to have cerebellar lesions (X2=12.08, p=0.001; sensitivity=56.3%, specificity = 81.3%) and larger cerebellar lesion volume (t[78]=3.22 cm3, p=0.002). Finding either a failure on any NIH balance task stance or imperfect beam score had 62.5% sensitivity for detecting cerebellar lesions (79.2% specificity).
Conclusion: We identify simple balance tasks that are more sensitive for detecting topography of cerebellar lesions than the EDSS. A composite of these tasks may identify subtle changes in balance present during a relapse or longitudinal changes occurring during progression.
Disclosure:
Oluwasheyi Ayeni: nothing to disclose.
Rachel Brandstadter: nothing to disclose.
Asaff Harel: received consulting fees from Teva Pharmaceuticals.
Matilde Inglese has received research grants from NIH; NMSS; Novartis Pharmaceuticals Corp.; Teva Neuroscience; and is a member of the editorial board of MS Journal.
Stephen Krieger has received compensation for consulting and advisory board work with Acorda Therapeutics Inc.; Bayer; Biogen; EMD Serono (Merck & Co., Inc.); Genentech; Genzyme; Mallinckrodt; Novartis; and Teva Pharmaceutical Industries Ltd. and has given non-promotional lectures with Biogen.
Christina Lewis: nothing to disclose.
Fred Lublin has received research support from Biogen Idec; Novartis Pharmaceuticals Corp; Teva Neuroscience, Inc.; Genzyme; Sanofi; Celgene; Transparency Life Sciences; NIH; NMSS; compensation for consulting and advisory board work/DSMB from Bayer HealthCare Pharmaceuticals; Biogen Idec; EMD Serono, Inc.; Novartis; Teva Neuroscience; Actelion; Sanofi/Genzyme; Acorda; Questcor/Malinckrodt; Roche/Genentech; MedImmune; Osmotica; Xenoport, Receptos/Celgene; Forward Pharma; Akros; TG Therapeutics; Abbvie; Toyama; Amgen; Medday; Atara Biotherapeutics; Polypharma; compensation for speaking from Genentech (non-promotional); Genzyme (non-promotional); and is co-chief editor of Multiple Sclerosis and Related Disorders.
Aaron Miller has received research support from BiogenIdec; Genzyme/sanofi; Mallinckrodt (Questcor); Novartis; Roche /Genentech; MedDay; consulting fees from Accordant Health Services (Caremark); Acorda; Adamas; Alkermes; Biogen Idec; Celgene; EMD Serono ( Merck Serono); Genzyme/Sanofi; Mallinckrodt (Questcor); Mapi-Pharma; Novartis; Roche/Genentech; and compensation for speaking Biogen Idec (unbranded disease awareness programs only) and Genentech/Roche (unbranded programs only).
Gabrielle Pelle: nothing to disclose.
Alessio Pepe: nothing to disclose.
Maria Petracca: nothing to disclose.
James Sumowski: nothing to disclose.
Abstract: P917
Type: Poster
Abstract Category: Clinical aspects of MS - 8 Clinical assessment tools
Background: People with early multiple sclerosis (MS) may have subclinical balance deficits not reflected by changes in the Expanded Disability Status Scale (EDSS). Topographical distribution of lesions has been shown to impact disability accumulation. We evaluated 2 simple, concise balance tasks for sensitivity to detect cerebellar lesions relative to the standard cerebellar functional system (FS) of the EDSS.
Methods: Patients with early MS (16 clinically isolated syndrome, 64 relapsing remitting, diagnosed within 5 years with median EDSS 1.0) underwent 3.0T MRI. Cerebellar lesions were identified and cerebellar lesion volume quantified using 3D T2-weighted sequences. Patients performed the NIH Toolbox Standing Balance Test, a 5-minute procedure requiring 5 different stances of increasing balancing difficulty. An iPod measured postural sway and calculated an age-adjusted balance score. Patients were dichotomized as failing (n=14) or not failing (n=66) any stance. A separate balance beam task evaluated patients' ability to complete tandem gait across a 3.0m long, 12cm wide, 1.3cm high board. Patients attempted the walk 3 times. The number of quarters (0.75m lengths) completed without falling off the beam across all trials (0-12) was recorded. Patients were dichotomized by perfect (12/12, n=53) or imperfect (< 12, n=27) beam scores.
Results: 32/80 patients had cerebellar lesions. Abnormal cerebellar FS score (n=12) was not reliably related to presence (X2=1.98, p=0.160, sensitivity=21.9%, specificity=89.6%) or volume (t[78]=0.472 cm3, p=0.639) of cerebellar lesions. In contrast, cerebellar lesions were more common among patients who failed any NIH balance task stance (X2=10.52, p=0.001, sensitivity=34.4%, specificity=93.8%). Worsened quantitative balance (sway) was linked to greater cerebellar lesion volume (rho=-.324, p=0.003). Patients with imperfect beam scores were more likely to have cerebellar lesions (X2=12.08, p=0.001; sensitivity=56.3%, specificity = 81.3%) and larger cerebellar lesion volume (t[78]=3.22 cm3, p=0.002). Finding either a failure on any NIH balance task stance or imperfect beam score had 62.5% sensitivity for detecting cerebellar lesions (79.2% specificity).
Conclusion: We identify simple balance tasks that are more sensitive for detecting topography of cerebellar lesions than the EDSS. A composite of these tasks may identify subtle changes in balance present during a relapse or longitudinal changes occurring during progression.
Disclosure:
Oluwasheyi Ayeni: nothing to disclose.
Rachel Brandstadter: nothing to disclose.
Asaff Harel: received consulting fees from Teva Pharmaceuticals.
Matilde Inglese has received research grants from NIH; NMSS; Novartis Pharmaceuticals Corp.; Teva Neuroscience; and is a member of the editorial board of MS Journal.
Stephen Krieger has received compensation for consulting and advisory board work with Acorda Therapeutics Inc.; Bayer; Biogen; EMD Serono (Merck & Co., Inc.); Genentech; Genzyme; Mallinckrodt; Novartis; and Teva Pharmaceutical Industries Ltd. and has given non-promotional lectures with Biogen.
Christina Lewis: nothing to disclose.
Fred Lublin has received research support from Biogen Idec; Novartis Pharmaceuticals Corp; Teva Neuroscience, Inc.; Genzyme; Sanofi; Celgene; Transparency Life Sciences; NIH; NMSS; compensation for consulting and advisory board work/DSMB from Bayer HealthCare Pharmaceuticals; Biogen Idec; EMD Serono, Inc.; Novartis; Teva Neuroscience; Actelion; Sanofi/Genzyme; Acorda; Questcor/Malinckrodt; Roche/Genentech; MedImmune; Osmotica; Xenoport, Receptos/Celgene; Forward Pharma; Akros; TG Therapeutics; Abbvie; Toyama; Amgen; Medday; Atara Biotherapeutics; Polypharma; compensation for speaking from Genentech (non-promotional); Genzyme (non-promotional); and is co-chief editor of Multiple Sclerosis and Related Disorders.
Aaron Miller has received research support from BiogenIdec; Genzyme/sanofi; Mallinckrodt (Questcor); Novartis; Roche /Genentech; MedDay; consulting fees from Accordant Health Services (Caremark); Acorda; Adamas; Alkermes; Biogen Idec; Celgene; EMD Serono ( Merck Serono); Genzyme/Sanofi; Mallinckrodt (Questcor); Mapi-Pharma; Novartis; Roche/Genentech; and compensation for speaking Biogen Idec (unbranded disease awareness programs only) and Genentech/Roche (unbranded programs only).
Gabrielle Pelle: nothing to disclose.
Alessio Pepe: nothing to disclose.
Maria Petracca: nothing to disclose.
James Sumowski: nothing to disclose.