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Disability Outcomes of Early Cerebellar and Brainstem Symptoms in Multiple Sclerosis Publisher Pubmed



Le M1, 39 ; Malpas C1, 39 ; Sharmin S1, 39 ; Horakova D2 ; Havrdova E2 ; Trojano M3 ; Izquierdo G4 ; Eichau S4 ; Ozakbas S5 ; Lugaresi A6, 40 ; Prat A7 ; Girard M7 ; Duquette P7 ; Larochelle C7 Show All Authors
Authors
  1. Le M1, 39
  2. Malpas C1, 39
  3. Sharmin S1, 39
  4. Horakova D2
  5. Havrdova E2
  6. Trojano M3
  7. Izquierdo G4
  8. Eichau S4
  9. Ozakbas S5
  10. Lugaresi A6, 40
  11. Prat A7
  12. Girard M7
  13. Duquette P7
  14. Larochelle C7
  15. Alroughani R8
  16. Bergamaschi R9
  17. Sola P10
  18. Ferraro D10
  19. Grammond P11
  20. Grand Maison F12
  21. Terzi M13
  22. Boz C14
  23. Hupperts R15
  24. Butzkueven H16
  25. Pucci E17
  26. Granella F18
  27. Van Pesch V19
  28. Soysal A20
  29. Yamout BI21
  30. Lechnerscott J22
  31. Spitaleri DLA23
  32. Ampapa R24
  33. Turkoglu R25
  34. Iuliano G26
  35. Ramotello C27
  36. Sanchezmenoyo JL28
  37. Sidhom Y29
  38. Gouider R29
  39. Shaygannejad V30
  40. Prevost J31
  41. Altintas A32
  42. Fragoso YD33
  43. Mccombe PA34
  44. Petersen T35
  45. Slee M36
  46. Barnett MH37
  47. Vucic S38
  48. Van Der Walt A16
  49. Kalincik T1, 39

Source: Multiple Sclerosis Journal Published:2021


Abstract

Background: Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear. Objective: The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms. Methods: This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores. Results: The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = −0.06, p < 0.001). Neither presentation was associated with changes in relapse risk. Conclusion: Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach. © The Author(s), 2020.
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