Contributions
Abstract: P841
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Objective: Cognitive changes during clinical relapses in MS were documented in recent observational and controlled prospective studies, but these findings are considered by some to be preliminary, and are yet to be replicated. In this paper, we describe cognitive processing speed data collected at baseline, during relapse, and three months post relapse. We hypothesized that cognitive testing would decline in relapses vs controls, and that cognitive function would correlate with MRI indicators of disease activity.
Methods: 70 relapsing-remitting multiple sclerosis (RRMS) patients and 25 stable RRMS controls were recruited from two independent cohort studies: [a] NMSS study focused on characterizing the degree of CPS decline in clinical vs MRI relapses, [b] Mallinkrodt study targeting recovery from cognitive relapses following treatment with HP Acthar® Gel repository corticotropin injection. For NMSS inclusion criteria were a clinical relapse or presence of gadolinium enhancing MRI lesion, and the ACTHAR protocol added a minimum 3 point decline on Symbol Digit Modalities Test (SDMT) from baseline. Gadolinium enhancing lesion volume was acquired in all cases for the NMSS study. Measures of neuropsychological performance and Expanded Disability Status Scale (EDSS) were documented at a baseline visit prior to relapse, during relapse, and at recovery phase three months following the relapse. Stable MS controls underwent the same evaluations and were matched to the relapsing group based on demographics. The relapse group scores on the SDMT were compared at each time point using mixed-factor ANOVA.
Results: There was a significant interaction between group and time (p = 0.001), with a greatest drop in SDMT occurring for the Acthar study, followed by the NMSS relapse group, and no decline in stable controls. Recovery from relapse was significant in both relapsing groups. GAD enhancing lesion volume at relapse significantly correlated with SDMT (p< 0.033) but did not correlate at recovery time point.
Conclusion: This study is the first replication of a SDMT measured cognitive relapse in MS since the work of Benedict et al (2014) and Pardini et al (2014). The cognitive decline is related to GAD lesion volume and normalizes after treatment.
Disclosure: Jeta Pol: nothing to disclose
Faizan Yasin: nothing to disclose
Curtis Wojcik: nothing to disclose
Allison Drake: nothing to disclose
Svetlana Eckert: nothing to disclose
Ralph H. B. Benedict has received research support from Accorda, Novartis, Genzyme, Biogen Idec, and Mallinkrodt, and is on the speakers' bureau for EMD Serono, and consults for Biogen Idec, Genentech, Roche, Sanofi/Genzyme, Takeda, NeuroCog Trials, and Novartis. Dr. Benedict also receives royalties for Psychological Assessment Resources.
Bianca Weinstock-Guttman has received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi, Novarties and Acorda. Dr. Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi , Novartis and Acorda.
Robert Zivadinov received personal compensation from EMD SeronoGenzyme-SanofiCelgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-SanofiNovartisClaret MedicalProtembo and IMS Health.
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals and the National Multiple Sclerosis Society. He has received personal compensation for consulting for Novartis Pharmaceuticals, Arena Pharmaceuticals, and Tanabe Laboratories.
Sarah A Morrow: In the past 3 years, Dr. Morrow has served on advisory boards for Biogen Idec, EMD Serono, Genzyme Canada, Novartis and Roche. She has received Investigator Initiated Grant Funds from Genzyme Canada and acted as site PI for multi-center trials funded by Novartis, Genzyme, Roche
David Hojnacki provides consultancies for Biogen Idec, Teva Neurosciences, EMD Serono, Novartis and Sanofi - Genzyme for speaking and consultant fees.
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grantsupport from Novartis.
Abstract: P841
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Neuropsychology
Objective: Cognitive changes during clinical relapses in MS were documented in recent observational and controlled prospective studies, but these findings are considered by some to be preliminary, and are yet to be replicated. In this paper, we describe cognitive processing speed data collected at baseline, during relapse, and three months post relapse. We hypothesized that cognitive testing would decline in relapses vs controls, and that cognitive function would correlate with MRI indicators of disease activity.
Methods: 70 relapsing-remitting multiple sclerosis (RRMS) patients and 25 stable RRMS controls were recruited from two independent cohort studies: [a] NMSS study focused on characterizing the degree of CPS decline in clinical vs MRI relapses, [b] Mallinkrodt study targeting recovery from cognitive relapses following treatment with HP Acthar® Gel repository corticotropin injection. For NMSS inclusion criteria were a clinical relapse or presence of gadolinium enhancing MRI lesion, and the ACTHAR protocol added a minimum 3 point decline on Symbol Digit Modalities Test (SDMT) from baseline. Gadolinium enhancing lesion volume was acquired in all cases for the NMSS study. Measures of neuropsychological performance and Expanded Disability Status Scale (EDSS) were documented at a baseline visit prior to relapse, during relapse, and at recovery phase three months following the relapse. Stable MS controls underwent the same evaluations and were matched to the relapsing group based on demographics. The relapse group scores on the SDMT were compared at each time point using mixed-factor ANOVA.
Results: There was a significant interaction between group and time (p = 0.001), with a greatest drop in SDMT occurring for the Acthar study, followed by the NMSS relapse group, and no decline in stable controls. Recovery from relapse was significant in both relapsing groups. GAD enhancing lesion volume at relapse significantly correlated with SDMT (p< 0.033) but did not correlate at recovery time point.
Conclusion: This study is the first replication of a SDMT measured cognitive relapse in MS since the work of Benedict et al (2014) and Pardini et al (2014). The cognitive decline is related to GAD lesion volume and normalizes after treatment.
Disclosure: Jeta Pol: nothing to disclose
Faizan Yasin: nothing to disclose
Curtis Wojcik: nothing to disclose
Allison Drake: nothing to disclose
Svetlana Eckert: nothing to disclose
Ralph H. B. Benedict has received research support from Accorda, Novartis, Genzyme, Biogen Idec, and Mallinkrodt, and is on the speakers' bureau for EMD Serono, and consults for Biogen Idec, Genentech, Roche, Sanofi/Genzyme, Takeda, NeuroCog Trials, and Novartis. Dr. Benedict also receives royalties for Psychological Assessment Resources.
Bianca Weinstock-Guttman has received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi, Novarties and Acorda. Dr. Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme & Sanofi , Novartis and Acorda.
Robert Zivadinov received personal compensation from EMD SeronoGenzyme-SanofiCelgene and Novartis for speaking and consultant fees. He received financial support for research activities from Genzyme-SanofiNovartisClaret MedicalProtembo and IMS Health.
Devon Conway has received research support paid to his institution by Novartis Pharmaceuticals and the National Multiple Sclerosis Society. He has received personal compensation for consulting for Novartis Pharmaceuticals, Arena Pharmaceuticals, and Tanabe Laboratories.
Sarah A Morrow: In the past 3 years, Dr. Morrow has served on advisory boards for Biogen Idec, EMD Serono, Genzyme Canada, Novartis and Roche. She has received Investigator Initiated Grant Funds from Genzyme Canada and acted as site PI for multi-center trials funded by Novartis, Genzyme, Roche
David Hojnacki provides consultancies for Biogen Idec, Teva Neurosciences, EMD Serono, Novartis and Sanofi - Genzyme for speaking and consultant fees.
Michael G. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grantsupport from Novartis.