Acute Multiple-Sclerosis relapses rarely result in permanent disability
 

This could be rather good "news" . . .

Acute Multiple-Sclerosis relapses rarely result in permanent disability

Acute relapses in patients with relapsing-remitting multiple sclerosis (MS) rarely lead to disability, according to a retrospective chart review presented here at the American Neurological Association (ANA) 133rd Annual Meeting.

Loren Rolak, MD, Marshfield Clinic, Marshfield, Wisconsin, explained that many patients with MS fear they "might wake up paralyzed" from an acute relapse.

To assess the likelihood of severe disability from an acute relapse, Dr. Rolak examined the clinical course of 1,078 patients with relapsing-remitting MS over the last 14 years from his own database of patients with MS treated at Marshfield Clinic.

The patients in the database had a total of 2,587 attacks (mean of 2.4 attacks per patient, range: 1-14 attacks over 1-34 years). Only 7 of 1,078 patients (0.6%) had an attack that resulted in severe disability, defined as an Expanded Disability Status Scale (EDSS) score of 6 or more sustained for longer than 6 months.

Two of the 7 patients who had an attack that resulted in severe disability presented with an acute severe attack at the time of their diagnosis with MS. Of the remaining 5 patients, 2 were taking interferon beta-1b, which did not prevent the severe disability. The other 3 were not taking interferon or glatiramer-acetate therapy.

Genetic analysis failed to reveal any association between major histocompatibility complex class II DR beta 1 (HLA-DRB1) or nitric oxide synthase (NOS2A) genotypes and severe disability from an acute relapse.

Dr. Rolak concluded, "These results allow me to reassure my patients that a relapse with severe disability is extremely unlikely -- whether or not they are treated with disease-modifying therapy. Consequently, the fear of irreversible disability should not influence their decision to take interferons or other treatment."

Source: Doctor's Guide Channels (25/09/08)

http://www.msrc.co.uk/index.cfm?fuse...how&pageid=723
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Wish I could see the data on how many of those 7 had severe Transverse Myelitis (spinal lesion attacks). I'm betting most, if not all.

I guess it would help to know what is actually causing the underlying damage, IF it is not related to relapses in any way. Then again, perhaps we "appear" fully to recover (on the surface), but the underlying (but not obvious) damage has still been done by the relapse. :confused:

Overall these results seem somewhat reassuring though. :)

Cherie

Dumb question from noobcakes me, but what's an 'acute' relapse exactly?

What's the 'other' type of relapse (other than acute)?

Good question, Laura.

I suspect any relapse that seems debilitating to us at the time would be considered "acute", but in this study I imagine they ran into everything from having only the "having difficulty walking + sudden relentless fatigue"-type, right through to the "paralyzed from the get go"-type.

Cherie

Makes sense. My first 'true' relapse (and I say 'true', because they found me and diagnosed me in a state where I had a bunch of stuff piled up from over time) felt like that, entirely. It was literally an 'attack' of symptoms all coming back at once and smacking me in the face.

Now those have abated. Thankfully!

ok I am confused, hush... acute same as pseudo's? and if its not disabilitating, then what I dont have RRms cause i have disabilities? im so confused

I have not heard the term acute used with MS before and from the article didnt find his definition of acute ms, did I miss it? thank you Cherie

Hurumph!!! Tell that one to my body..:rolleyes:

Well, I signed onto the AAN Conference that presented this abstract, and the abstract itself (T-91, "What Is the Risk of Permanent Disability from an MS Attack?") reads rather differently then this article does. I'm not sure if I am allowed to post the abstract though, cause there suddenly seems to be strict copyright laws in place . . . but for now if anyone is really interested, they can sign onto the American Academy of Neurology site, and search for "risk of permanent disability" to find the actual abstract.

I know that the NMSS is also following up on this angle, through the University Research Center here in Vancouver:

"Helen Tremlett, PhD (University of British Columbia) is asking, “Do relapses affect disease progression in MS?” by evaluating the long-term relationship between MS attacks and disability in a large group of individuals with MS.

The majority of people with MS experience disabling relapses that can last weeks to months before a full or partial recovery occurs. However, the progression to permanent disability is not necessarily associated with a relapse. The team is focusing on patients enrolled in a database that holds data on 6000 people with MS in British Columbia, examining relapse rates in over 2500 people who have not taken disease-modifying drugs and have been followed for up to 23 years. They are investigating the effect of MS relapses occurring at different stages of the disease on disability progression, using measures such as the EDSS, a scale that measures disease activity.

This study may provide much-needed information on the progression of MS, and on how to tailor treatments for individuals with this disease."

http://www.nationalmssociety.org/res...ors/index.aspx

I guess what it comes down to is that at present they don't feel at all confident that relapses have anything to do with permanent disability. In other words, they feel that people with RRMS will likely accumulate disability even without relapses, and vice-versa.

Cherie

This makes sense. Thanks for the additional information Cherie! :)

Thanks for all of it!