Contributions
Abstract: EP1337
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Background: Ambulatory impairment is common in multiple sclerosis (MS) and may lead to early disability. When ambulation deteriorates, preservation of upper extremity function (UEF) becomes increasingly relevant to maintain the ability to perform activities of daily living (ADL). Currently, the exact relation between UEF deterioration and ambulatory impairment is unknown.
Objective: To examine the prevalence of UEF deficits in MS for different levels of ambulatory impairment, and to assess the relationship between UEF and ambulation impairment.
Methods: Patients were derived from a cohort of MS patients that participated in the Assess MS study, a project to improve clinical disability assessment through automated quantification of motor function. The Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25WT) were used to stratify patients into clinically different ambulation subgroups: fully ambulatory (EDSS 0-3.5; T25WT < 6 s), mild (EDSS 4.0-5.5; T25WT 6-7.99 s) and severe ambulatory impairment (EDSS 6.0-7.0; T25WT ≥8 s). UEF was assessed with the nine-hole peg test (9HPT), the Arm Function in MS Questionnaire (AMSQ) and three clinical tests from Assess MS, including an ADL task 'drinking from a cup' (CUP), and compared between subgroups. Associations between UEF measures and ambulation were examined with logistic regression models.
Results: A total of 255 patients were included. Preliminary results revealed differences between the EDSS ambulation subgroups (all p-values < 0.001) with worse UEF measures in the mildly (n=68) and severely impaired groups (n=58). Larger group differences were found between the mild and severely affected patients (9HPT 6.3 seconds, AMSQ 30 points), than between the fully ambulatory (n=121) and mildly impaired patients (9HPT 4.4 seconds; AMSQ 17 points). Regression analysis revealed that worse ambulation was associated with worse UEF scores (p< 0.001 for all associations), with the largest magnitude effect for CUP [lowest vs highest: OR 0.008(95% CI 0.001-0.061)]. Further analyses of T25WT subgroups are pending.
Conclusion: MS patients with severe ambulatory impairment showed UEF deficits in all domains with larger differences between the clinically worse ambulatory impaired groups. These findings suggest that to some extent UEF and ambulation develop independently, which implicates possible different treatment windows. Furthermore, ambulatory impairment was most prominently associated with UEF related ADL-tasks.
Disclosure: C.E.P. van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme and Teva Pharmaceuticals; and honoraria for lecturing and consulting from Novartis Pharma AG, Biogen-Idec and Merck Serono; and compensation for serving in a scientific advisory board from Merck Serono and Sanofi Genzyme.
J. Burggraaff has received travel support from Novartis Pharma AG.
S. Steinheimer has no conflict of interest.
C.P. Kamm has received honoraria for lectures as well as research support from Biogen-Idec, Novartis Pharma AG, Almirall, Bayer Schweiz AG, Teva Pharmaceuticals, Merck Serono, Sanofi Genzyme and the Swiss MS Society.
M. D'Souza has received travel support from Bayer AG, Teva and Genzyme and research support from the University Hospital Basel.
J. Boisvert is an employee of Novartis Pharma AG.
M. Diederich has no conflict of interest.
K. Kravalis has no conflict of interest.
J. Dorn is an employee of Novartis Pharma AG.
L. Walsh is an employee of Novartis Pharma AG.
L. Balk has nothing to disclose
F. Dahlke is an employee of Novartis Pharma AG.
L. Kappos Institution (University Hospital Basel) received in the last 3 years and used exclusively for research support at the Department of Neurology steering committee, advisory board and consultancy fees from Actelion, Alkermes, Almirall, Bayer, Biogen, df-mp, Excemed, GeNeuro SA, Genzyme, Merck, Minoryx, Mitsubishi Pharma, Novartis, Receptos, Roche, sanofi-aventis, Santhera, Teva, Vianex and royalties from Neurostatus products. For educational activities of the Department, the institution received honoraria from Allergan, Almirall, Bayer, Biogen, Excemed, Genzyme, Merck, Novartis, Pfizer, Sanofi-Aventis, Teva and UCB.
B.M.J. Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva.
Abstract: EP1337
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Background: Ambulatory impairment is common in multiple sclerosis (MS) and may lead to early disability. When ambulation deteriorates, preservation of upper extremity function (UEF) becomes increasingly relevant to maintain the ability to perform activities of daily living (ADL). Currently, the exact relation between UEF deterioration and ambulatory impairment is unknown.
Objective: To examine the prevalence of UEF deficits in MS for different levels of ambulatory impairment, and to assess the relationship between UEF and ambulation impairment.
Methods: Patients were derived from a cohort of MS patients that participated in the Assess MS study, a project to improve clinical disability assessment through automated quantification of motor function. The Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25WT) were used to stratify patients into clinically different ambulation subgroups: fully ambulatory (EDSS 0-3.5; T25WT < 6 s), mild (EDSS 4.0-5.5; T25WT 6-7.99 s) and severe ambulatory impairment (EDSS 6.0-7.0; T25WT ≥8 s). UEF was assessed with the nine-hole peg test (9HPT), the Arm Function in MS Questionnaire (AMSQ) and three clinical tests from Assess MS, including an ADL task 'drinking from a cup' (CUP), and compared between subgroups. Associations between UEF measures and ambulation were examined with logistic regression models.
Results: A total of 255 patients were included. Preliminary results revealed differences between the EDSS ambulation subgroups (all p-values < 0.001) with worse UEF measures in the mildly (n=68) and severely impaired groups (n=58). Larger group differences were found between the mild and severely affected patients (9HPT 6.3 seconds, AMSQ 30 points), than between the fully ambulatory (n=121) and mildly impaired patients (9HPT 4.4 seconds; AMSQ 17 points). Regression analysis revealed that worse ambulation was associated with worse UEF scores (p< 0.001 for all associations), with the largest magnitude effect for CUP [lowest vs highest: OR 0.008(95% CI 0.001-0.061)]. Further analyses of T25WT subgroups are pending.
Conclusion: MS patients with severe ambulatory impairment showed UEF deficits in all domains with larger differences between the clinically worse ambulatory impaired groups. These findings suggest that to some extent UEF and ambulation develop independently, which implicates possible different treatment windows. Furthermore, ambulatory impairment was most prominently associated with UEF related ADL-tasks.
Disclosure: C.E.P. van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme and Teva Pharmaceuticals; and honoraria for lecturing and consulting from Novartis Pharma AG, Biogen-Idec and Merck Serono; and compensation for serving in a scientific advisory board from Merck Serono and Sanofi Genzyme.
J. Burggraaff has received travel support from Novartis Pharma AG.
S. Steinheimer has no conflict of interest.
C.P. Kamm has received honoraria for lectures as well as research support from Biogen-Idec, Novartis Pharma AG, Almirall, Bayer Schweiz AG, Teva Pharmaceuticals, Merck Serono, Sanofi Genzyme and the Swiss MS Society.
M. D'Souza has received travel support from Bayer AG, Teva and Genzyme and research support from the University Hospital Basel.
J. Boisvert is an employee of Novartis Pharma AG.
M. Diederich has no conflict of interest.
K. Kravalis has no conflict of interest.
J. Dorn is an employee of Novartis Pharma AG.
L. Walsh is an employee of Novartis Pharma AG.
L. Balk has nothing to disclose
F. Dahlke is an employee of Novartis Pharma AG.
L. Kappos Institution (University Hospital Basel) received in the last 3 years and used exclusively for research support at the Department of Neurology steering committee, advisory board and consultancy fees from Actelion, Alkermes, Almirall, Bayer, Biogen, df-mp, Excemed, GeNeuro SA, Genzyme, Merck, Minoryx, Mitsubishi Pharma, Novartis, Receptos, Roche, sanofi-aventis, Santhera, Teva, Vianex and royalties from Neurostatus products. For educational activities of the Department, the institution received honoraria from Allergan, Almirall, Bayer, Biogen, Excemed, Genzyme, Merck, Novartis, Pfizer, Sanofi-Aventis, Teva and UCB.
B.M.J. Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva.