Different Subtypes Of Multiple Sclerosis Research Articles

Inner and outer retina findings determined by optical coherence tomography in different subtypes of multiple sclerosis.

Integrity of outer retinal bands among multiple sclerosis (MS) subtypes remains unclear, however alterations of thickness in retinal layers is well described. The objective of the study was to determine the alterations in the thickness of the inner and outer layers of the retina and the findings in both layers detected by optical coherence tomography (OCT) among patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). A total of 132 eyes from 66 patients with multiple sclerosis (MS) (70 eyes from 35 patients with RRMS and 62 eyes from 31 patients with SPMS) and 72 eyes from 36 healthy controls were included in the study. The external structures of the retina, including the outer limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ), were examined using OCT in RRMS, SPMS, and healthy control groups. The correlation of neurological disability expressed by the Expanded Disability Study Scale (EDSS) score, best-corrected visual acuity, and duration of disease among OCT parameters was also analyzed. In eyes, with no history of previous optic neuritis (ON), the macular nerve fiber layer, the internal plexiform layer of ganglion cells (GCIPL), and the total thickness of the retinal layer were thinner in the SPMS group than in the RRMS group (P < 0.05, in each comparison). EZ was more vulnerable among the three hyperreflective external retinal zones in the retina of patients with SPMS than in patients with RRMS (P = 0.016). Alterations in retinal thickness in MS are not limited to the inner layers of the retina and also occur in the outer structures of the retina.

The levels of the serine protease HTRA1 in cerebrospinal fluid correlate with progression and disability in multiple sclerosis.

High Temperature Requirement Serine Protease A1 (HTRA1) degrades extracellular matrix molecules (ECMs) and growth factors. It interacts with several proteins implicated in multiple sclerosis (MS), but has not previously been linked to the disease. Investigate the levels of HTRA1 in cerebrospinal fluid (CSF) in different subtypes of MS and brain tissue. Using ELISA, HTRA1 levels were compared in CSF from untreated patients with relapsing-remitting MS (RRMS, n = 23), secondary progressive MS (SPMS, n = 26) and healthy controls (HCs, n = 26). The effect of disease modifying therapies (DMTs) were examined in both patient groups. Cellular distribution in human brain was studied using immunochemistry and the oligointernode database, based on a single-nuclei RNA expression map. HTRA1 increased in RRMS and SPMS compared to HCs. DMT decreased HTRA1 levels in both types of MS. Using ROC analysis, HTRA1 cut-offs could discriminate HCs from RRMS patients with 100% specificity and 82.6% sensitivity. In the brain, HTRA1 was expressed in glia and neurons. HTRA1 is a promising CSF biomarker for MS correlating with disease- and disability progression. Most cell species of the normal and diseased CNS express HTRA1 and the expression pattern could reflect pathological processes involved in MS pathogenesis.

A Descriptive Cross-Sectional Study of Manipulative Dexterity on Different Subtypes of Multiple Sclerosis.

Background Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes. Purpose Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study. Methods 30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test. Results All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values (dr = 0.72) and very high values (dr = 1.46) were obtained. Conclusions Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions.

Efficacy and safety of siponimod for multiple sclerosis: Protocol for a systematic review and meta-analysis.

Multiple sclerosis is the most common demyelinating disease of the central nervous system with serious social and economic burden. Siponimod is a sphingosine-1-phosphate receptor agonist, and clinical trials in the past decade have shown good prospects for the treatment of multiple sclerosis. But there is a lack of comprehensive understanding of the dose-effect relationship and safety in different subtypes of multiple sclerosis at present. We will perform a systematic review and meta-analysis of clinical randomized controlled trials to evaluate the efficacy and safety of siponimod in multiple sclerosis. We will search PubMed, EMBASE, Cochrane Library, Clinical Trials, Cochrane Central Register of Controlled Trials (CENTRAL) using a comprehensive strategy. The reference lists of the articles we select for inclusion will be checked to identify additional studies for potential inclusion. Two reviewers will review all literature independently. Upon inclusion of articles, another 2 reviewers will extract available data using a standardized form and assess the potential bias. Review Manager will be used to conduct data synthesis. There is no requirement of ethical approval and informed consent. This is the first systematic assessment of siponimod for the treatment of multiple sclerosis. We predict it will provide high-quality synthesis of existing evidence for the efficacy and safety of siponimod for multiple sclerosis and a relatively comprehensive reference for clinical practice and clinical trials about siponimod to be conducted. The results of the systematic review and meta-analysis will provide updated evidence for the use of siponimod for multiple sclerosis. The systematic review and meta-analysis is registered in the PROSPERO international prospective register of systematic review (PROSPERO#CRD42018112721).

CSF-Progranulin and Neurofilament Light Chain Levels in Patients With Radiologically Isolated Syndrome-Sign of Inflammation.

Background: Cerebrospinal fluid (CSF) markers of disease in patients with radiologically isolated syndrome (RIS) are the subject of intense investigation, because they have the potential to enhance our understanding of the natural disease course and provide insights into similarities and differences between RIS and other multiple sclerosis (MS) disease identities.Methods: Here we compared neurofilament light chain (NFL) and progranulin (PGRN) levels in the CSF in RIS patients with levels in patients with different subtypes of MS and healthy controls (HC) using Kruskal–Wallis one-way analysis of variance.Results: Median CSF NFL concentrations in RIS patients did not differ to those in HC and clinically isolated syndrome (CIS) patients, but were significantly lower than in relapsing remitting (RRMS) and primary progressive (PPMS) MS patients. In contrast, RIS patients exhibited higher median CSF PGRN levels than HC and showed no significant differences compared with CIS, RRMS, and PPMS cases.Conclusion: We postulate that elevated PGRN values in the CSF of RIS patients might indicate inflammatory and repair activity prior to axonal disintegration.

Adipsin Is Associated with Multiple Sclerosis: A Follow-Up Study of Adipokines.

Background and Objective. The role of adipokines in regulation of immune responses has been recognized, but very little is known about their impact on multiple sclerosis (MS). In this study, we analysed whether the major adipokines are differentially expressed in plasma of patients with different MS subtypes and clinically isolated syndrome (CIS) and explored their association with major disease characteristics. Methods. The levels of adiponectin, adipsin, leptin, and resistin in the plasma of 80 patients with different subtypes of MS and CIS were followed up annually over the two years. The data obtained were correlated with disease activity, EDSS and volumes of T1-weighted lesions (T1-LV), and fluid attenuation inversion recovery lesions (FLAIR-LV) on MRI. Results. In MS group, a correlation was found between the level of adipsin and EDSS score at baseline (r = 0.506, p < 0.001). In RRMS, the levels of adipsin correlated with EDSS scores (r = 0.542, p = 0.002), T1-LV (r = 0.410, p = 0.034), and FLAIR-LV (r = 0.601, p = 0.0001) at baseline and an increase in the T1-LV over the follow-up (r = 0.582, p = 0.003). Associations with other adipokines were not detected. Conclusion. Our exploratory study provides novel insights on the impact of adipokines in MS and suggests that adipsin exerts predictive potential as a biomarker of neurodegeneration.

Leptin hormone level in serum of opticospinal, neuromyelitisoptica and multiple sclerosis patients

AbstractObjectivesA growing body of evidence shows that leptin acts as a pro‐inflammatory cytokine in autoimmune disorders and is related to multiple sclerosis (MS) pathogenesis. The present study was an analysis of serum leptin levels among healthy volunteers and patients with different subtypes of MS, opticospinal MS (OSMS) and neuromyelitis optica (NMO).MethodsLeptin concentrations in the sera of 121 healthy volunteers and 201 patients with different subtypes of MS, as well as in 27 NMO and 27 OSMS, were measured.ResultsSignificant differences in leptin serum levels were observed between healthy volunteers, and MS, OSMS and NMO patients (P &lt; 0.001). Furthermore, leptin serum concentration was in correlation with expanded disability status scale (EDSS) in primary progressive MS and secondary progressive MS groups. Interestingly, while the female‐to‐male ratio of leptin was approximately 2 in each group, the NMO female patients showed sevenfold higher levels of leptin than males.ConclusionThe present results show that leptin concentration is important in the pathogenesis of different neuroinflammatory diseases of the central nervous system, in particular NMO.

Premature Thymic Involution and Multiple Sclerosis

It is uncertain as to whether similar or different mechanisms contribute to different subtypes of multiple sclerosis (MS). A unifying concept proposes that patients with both relapsing-remitting MS (RRMS) and primary progressive MS (PPMS) have premature thymic involution, which alters peripheral T-cell homeostasis and leads to T-cell alterations that contribute to the pathogenesis of both MS subtypes.

Evaluation of reactive Epstein–Barr Virus (EBV) in Iranian patient with different subtypes of multiple sclerosis (MS)

ObjectivesEpstein-Barr virus has been recently associated with the onset of multiple sclerosis, yet understanding how it elicits autoimmunity remains elusive. We investigated the relation between Epstein-Barr virus reactivation and disease development in different subtypes of multiple sclerosis. MethodsIn the present research, we have determined the Epstein-Barr virus-DNA load by quantitative real-time polymerase chain reaction and Epstein-Barr virus antibody levels by EIA technique in both multiple sclerosis patients (n=78) and healthy controls (n=123). ResultsOur results demonstrated increased titer of both anti-Epstein-Barr virus-IgG and IgM antibodies in patients (91.02% vs 82.11% in controls, p<0.001 and 14.1% vs 4.06% in controls, p<0.001, respectively). Overall, Epstein-Barr virus reactivation was found in 68.75% of subtypes of multiple sclerosis, 4.54% of multiple sclerosis primary subtype, and in only 3.25% of healthy control subjects. Moreover, in samples of patients with disease relapse (exacerbation) cell free viral DNA was elevated in contrast to other patients (p<0.001). ConclusionsThese findings provide further support for the detrimental effects of Epstein-Barr virus in the reactivation of multiple sclerosis attacks.

Monitoring of Active Human Herpes Virus 6 Infection in Iranian Patients with Different Subtypes of Multiple Sclerosis

Background. Recently, it has been suggested that human herpes virus 6 (HHV6) may play a role in the pathogenesis of multiple sclerosis (MS). Our purpose is to determine the incidence of reactivated HHV6 in MS patients. Methods. Viral sequence analyzed by qPCR in the peripheral blood mononuclear cells (PBMCs), serum, and saliva samples of different subtypes of MS patients (n = 78) and healthy controls (n = 123). HHV6 IgG and IgM antibody levels measured by ELISA technique in the plasma samples of both groups. Likewise, cerebrospinal fluid (CSF) samples of some MS patients (n = 38) were analyzed for viral sequence. Results. Results demonstrate increased levels of anti-HHV6-IgG (78.2% versus 76.4% in controls; P = NS), and IgM (34.6% versus 6.5% in controls; P < 0.05) in MS patients. Furthermore, RRMS and SPMS patients showed relatively higher anti-HHV6 IgG and IgM compared to PPMS (P < 0.001). Moreover, load of cell-free viral DNA was higher in RRMS and SPMS patients and detected in 60.2% (47/78) of MS patients, compared with 14.6% (18/123) of healthy controls (P < 0.001). Moreover, load of cell-free viral DNA was higher in RRMS and SPMS patients and detected in 60.2% (47/78) of MS patients, compared with 14.6% (18/123) of healthy controls (P < 0.001). Conclusions. The results extend the observation of an increased frequency of systemic reactivated HHV6 infection in MS patients with developed stages of disease.

Axonal loss in multiple sclerosis: a morphological and functional analysis of retinal nerve fibbers

AbstractPurpose The main purpose of this work was to study the retinal nerve fibber layer (RNFL) atrophy by optic coherence tomography in different subtypes of multiple sclerosis (MS) patients and to compare these results with electrophysiological examinations.Methods Fifty eight patients were included, 43 suffered from a relapsing‐remitting MS and 15 suffered from a progressive MS. We studied all eyes according 2 groups, MS eyes with a history of acute optic neuritis (MS‐ON eyes, n=39) and MS eyes without history of optic neuritis (MS‐non ON eyes, n=76). Electrophysiological exams were performed in all MS patients: (1) visual letter acuity (Snellen Charts), (2) visual evoked potentials, (3) pattern electroretinogram and (4) perimetry (Metrovision France). Retinal nerve fibber thickness were measured by Optical coherence tomography (OCT; fast RNFL thickness protocol).Results The rate of MS‐ON eyes and MS non‐ON eyes were not different between the 2 subtypes of MS (p&gt;0.05, Fisher test). Progressive MS demonstrated a mean value decrease of RNFL thickness particularly in inferior quadrant compared to relapsing‐remitting MS (respectively, 92.9 um and 98.7 um for mean value, p= 0,04; 117.7 um and 127.4 um for inferior RNFL thickness, p=0,05). An increased P100 latency and decreased P50 and N95 amplitude were noted in MS‐non ON eyes compared to MS‐ON eyes (respectively p=0,013; p=0,026 and p=0,003).Conclusion This study seemed to illustrate a potential axonal loss in MS patients through these structural and functional differences between progressive MS and relapsing‐remitting MS optic nerves. The N95 amplitude of non‐affected eyes measurement appeared to be a new index to diagnose early progressive MS.

Olfactory Dysfunction in Different Subtypes of Multiple Sclerosis and in Neuromyelitis Optica (P07.065)

Objective: The olfactory function of patients with primary progressive MS (PPMS), relapsing remitting MS (RRMS), optic neuritis (ON) and patients with neuromyelitis optica (NMO) was investigated. Background Some studies reported about olfactory dysfunction in MS patients. Recently our study group could find out an inverse correlation between the olfactory bulb and olfactory brain volumes of MS patients compared with their lesion load. To this date no data are available on olfactory function of different types of the disease. Design/Methods: 54 patients (31 women, 23 men) and 30 control persons were examined. 10 patients had PPMS, 25 patients RRMS, 12 patients acute ON in the beginning state of disease and 7 patients had NMO. Exclusion criteria were olfactory disorders with a different genesis (sinunasal, post-viral, post-traumatic, toxic). Olfactory testing was performed using the tripartide TDI-test measuring olfactory threshold, the discrimination and the identification of different odours. Results: 9 of 10 PPMS patients (90%), 9 of 25 RRMS patients (36%), 7 of 12 ON patients (58%), 3 of 7 NMO patients (43%) and 1 of 30 control persons (3%) displayed hyposmia. The rest of the patients were normosmic, none was anosmic. There was a difference between the TDI-scores of patients with PPMS (p Conclusions: All different types of MS showed hyposmia. Olfactory dysfunction could be detected in early inflammatory phases as well as in chronic phases. Hyposmia seems to appear most frequently and most pronounced in PPMS patients. ON patients had a better perception of their olfactory capacity. Disclosure: Dr. Schmidt has nothing to disclose. Dr. Goektas has nothing to disclose. Dr. Harms has received personal compensation for activities with Biomarin, Biogen, Bayer Health Care, Talecris, Merck-Serono as scientific advisory board member and/or speaker.

Leptin serum levels in different subtypes of Multiple sclerosis: does leptin play a role in progress of Multiple sclerosis? (44.9)

Abstract Background: Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS resulting in accumulating neurological disability. Recent evidences have strongly indicated that leptin has influence on the immune system and maybe involved in the pathogenesis of autoimmune diseases such as MS. Objectives: To compare serum leptin levels among healthy volunteers and patients with different subtypes of MS and to investigate its association with disease progression. Material and Methods: Leptin concentrations in sera of 114 healthy volunteers and 136 patients with different types of MS, including 93 relapsing remitting (RR), 18 primary progressive (PP), 13 secondary progressive (SP), and 12 progressive relapsing (PR) after matching for sex, age and BMI were measured using ELISA technique. Results: Statistically significant difference was observed between healthy volunteers and MS patients (18.55±23.55 vs 38.86±39.59 ng/ml, p&amp;lt;0.001), SP and PP (25.80±22.05 vs 70.64±53.01, p&amp;lt;0.01), and also between RR and PP (42.10±42.35 vs 70.64±53.01, p&amp;lt;0.05). There was a tight correlation between Progression Index and leptin serum concentrations (F=21.7, P&amp;lt;0.001). Conclusion: Leptin serum level is significantly higher in the sera of MS patients compared to healthy sex, age and BMI matched group. Patients with progressive forms have elevated leptin levels that seem to be associated with their disease progression. Our data suggests a pro-inflammatory role for leptin in MS.

Disease-associated inflammatory biomarker profiles in blood in different subtypes of multiple sclerosis: Prospective clinical and MRI follow-up study

To identify biomarkers of disease activity and progression in multiple sclerosis (MS), we analyzed the serum profiles of cytokines, chemokines and apoptotic molecules in different subtypes of MS including clinically isolated syndrome (CIS) and correlated their levels with clinical and volumetric MRI findings obtained over a one-year follow up. Upregulated levels of apoptotic sFas molecule were found in MS patients with a worsening EDSS score and an accumulation of hypointense lesions in MRI. In such patients, the levels of MIF appeared to be higher than in non-progressing patients. In addition, increased levels of serum TNF-α and CCL2 were found especially in primary progressive MS (PPMS). These observations suggest that serum Fas and MIF are candidate biomarkers of neurological worsening related to progressive neurodegeneration, while serum TNF-α and CCL2 reflect the presence of inflammatory responses in PPMS.

Multiple Sclerosis: A Disorder of Altered T-Cell Homeostasis

Uncertainty exists as to whether similar or different mechanisms contribute to the pathogenesis of different subtypes of multiple sclerosis (MS). Detailed analysis of naive T cell homeostasis shows that patients with relapsing-remitting MS (RRMS) and with primary progressive MS (PPMS) have early-onset thymic involution that causes reduced thymic output. The reduced thymic output leads to secondary peripheral homeostatic alterations in naïve CD4 T-cells, which closely mimic T-cell alterations observed in an experimental animal model of diabetes mellitus. Homeostatic T-cell receptor (TCR) signalling and proliferation of naïve T cells are induced by self-peptides. Consequently, the findings of increased TCR signalling of naïve CD4 T-cells, without increased proliferation, in PPMS, and the increased homeostatic proliferation of naïve CD4 T-cells in RRMS favour the development of autoimmunity. Thus, it seems highly likely that peripheral T-cell alterations secondary to a thymic abnormality contribute to the pathogenesis of both MS subtypes.

Pattern of neuropsychological impairment in the early phase of relapsing-remitting multiple sclerosis

To investigate the neuropsychological profile in the first few years post-onset of relapsing-remitting multiple sclerosis (MS) we carried out a comprehensive neuropsychological evaluation of 33 patients characterized by very short evolution of this disease, minimal levels of neurological disability and preserved general cognition. Thirty-three individually pair-matched controls were also evaluated. Patients performed as well as controls on many of the cognitive exploration measures. Nevertheless, the group of patients evinced a general slowness that affected motor execution and cognitive processing. Memory functions were characterized by preservation of working memory, retrieval or storage of information and a deficit at the acquisition phase in (verbal and visual) supraspan tasks. In addition, significant correlations were observed between some measures of information processing speed and memory. These results highlight the importance of studying cognitive deficits not only in the different subtypes of MS but also in different phases of the disease.

Neurofilament and glial fibrillary acidic protein in multiple sclerosis

To evaluate levels of neurofilament light (NFL) and glial fibrillary acidic protein (GFAP) in CSF from patients with multiple sclerosis (MS) in relation to clinical progress of the disease. CSF levels of NFL and GFAP were determined by sensitive ELISAs in 99 patients with different subtypes of MS, classified in terms of "ongoing relapse" or "clinically stable disease," and 25 control subjects. Levels were compared with paraclinical data such as immunoglobulin G index and inflammatory cell count in the CSF, and the levels were related to Expanded Disability Status Scale score and progression index at clinical follow-up evaluations later in the disease course. NFL and GFAP levels were elevated in MS patients as compared with control subjects (p < 0.001). The NFL levels were higher at relapses, whereas GFAP levels were unaffected. High NFL levels correlated with progression in patients with an active relapse (r = 0.49; p < 0.01) and in clinically stable patients (r = 0.29; p < 0.05). GFAP correlated to progression in the total patient cohort (r = 0.24; p < 0.05). Moreover, a strong correlation between NFL levels and inflammatory cell counts was evident in the group of patients with an ongoing relapse (r = 0.52; p = 0.001). CSF levels of neurofilament light and glial fibrillary acidic protein may have prognostic value in multiple sclerosis.

Expression of adhesion molecules on peripheral lymphocytes predicts future lesion development in MS

The expression of adhesion molecules (alpha4beta1-integrin, LFA-1, ICAM-1) on T cells, measured by flow cytometry, was compared in different subtypes of multiple sclerosis (MS) and related to future lesion development as seen as delta T1 and T2 lesion load per year on magnetic resonance imaging (MRI). LFA-1 and alpha4beta1-integrin showed higher expression on CD4 and CD8 T lymphocytes in the secondary progressive compared to the relapsing–remitting (CD4: p<0.01, p=ns, p<0.05; CD8: p<0.001, p<0.001, p<0.001, respectively) and primary progressive MS phase (CD4: p<0.001, p<0.01, p<0.05; CD8: p<0.01, p<0.01, p<0.001, respectively). The adhesion molecule expression of alpha4- ( r=0.31; p<0.05) and beta1-integrin ( r=0.38; p<0.01) on CD4+ cells and of LFA-1beta on both CD4+ and CD8+ ( r=0.28, p<0.05) and r=0.29; p<0.05, respectively) cells was significantly related to increase in T2 lesion load. Our study provides further evidence for the involvement of integrins in lesion development, shown as T2 lesions on MRI in MS.

Longitudinal brain volume measurement in multiple sclerosis: rate of brain atrophy is independent of the disease subtype.

In multiple sclerosis (MS), brain atrophy depicted by magnetic resonance imaging reflects overall tissue loss, including axonal loss. To determine the course of atrophy by studying the rate of development of brain atrophy in patients who have different subtypes of MS. Eighty-three patients with MS (42 with relapsing-remitting, 21 with secondary progressive, and 20 with primary progressive) were studied longitudinally, with an interval of 2 to 4 years. Magnetic resonance imaging included T1- and T2-weighted images to obtain 2 brain volume measurements: (1) the parenchymal fraction as a marker of global brain atrophy and (2) the ventricular fraction as a marker of central atrophy. The annualized rate of global and central brain atrophy was compared between those with different subtypes of MS and related to clinical characteristics, including sex, age, disease duration, and disability. There was a significant decrease of the parenchymal fraction (-0.7% per year; SEM, 0.11% per year) and a significant increase of ventricular fraction (3.7% per year; SEM, 0.54% per year) in the total group. Significant tissue loss was also seen in all 3 subtypes of MS; the decrease in parenchymal fraction was not different between subtypes, whereas the increase in ventricular fraction tended to be larger in patients with secondary progressive MS compared with patients with primary progressive MS. Marginal associations were found between clinical determinants and the rate of brain atrophy. Annualized increase in the ventricular fraction was correlated with age (r = -0.26) and duration of symptoms (r = -0.22): younger patients (mainly patients with relapsing-remitting MS who have a limited disability) displayed a larger increase in ventricular fraction compared with older patients. The rate of development of brain atrophy is largely independent of the course of the disease and other clinical characteristics. The relentless loss of tissue occurring in MS is not restricted to later (progressive) phases of the disease, thereby stressing the need for early neuroprotective treatment in MS.

Event-related potentials in different subtypes of multiple sclerosis—a cross-sectional study

Impairment of cognitive skills is found in up to 65% of patients suffering from multiple sclerosis (MS). Little is known concerning the natural history or characteristics of progression of these cognitive dysfunctions. Furthermore, it has not been investigated to date whether there are differences in the course of cognitive impairment with respect to different diagnostic subgroups of MS. Event-related potentials (ERP) are an objective tool to evaluate cognitive processing. We performed a cross-sectional study on 179 consecutive patients suffering from MS (107 relapsing–remitting MS; 17 primary progressive MS; 50 secondary progressive MS; 5 undetermined). ERP were measured by a visual oddball paradigm, latencies of P3 components were correlated with demographic and clinical data. We found pathologically increased P3 latencies in 56% of all patients. Patients with secondary progressive MS showed significantly increased P3 latencies as compared to the other subgroups. There was a significant correlation between expanded disability status scale (EDSS) score and P3 latency ( r=0.48; p<0.001). We conclude that ERP are an appropriate method to follow up cognitive dysfunction in MS and that cognitive dysfunction as measured by ERP is progressively impaired in the course of MS, in particular in the secondary progressive subtype.