Guy's Neurological Disability Scale Research Articles

The use of multi-domain patient reported outcome measures for detecting clinical disease progression in multiple sclerosis

ObjectivePatient reported outcome measures (PROMs) are especially relevant in times of increased interest in telehealth but little is known about their relation to functional disability measures. MethodsWe assessed 248 people with MS at baseline and at > = 5-years follow-up. We investigated cross-sectional and longitudinal correlations between changes in the Guy's Neurological disability scale (GNDS), and the physical part of the Multiple Sclerosis Impact Scale (MSIS-29) and the Expanded Disability Status Scale (EDSS), 9-hole peg test (9-HPT) and timed 25-foot walk (T25FW). ResultsThe strongest cross-sectional correlations were found between the GNDS and EDSS in the complete cohort (r = 0.66, p <.001, n = 248) as well as in progressive patients (r = 0.72, p <.001, n = 35), and the GNDS and T25FW in progressive MS (r = 0.64, p <.001, n = 34). Longitudinal correlations were poor except for changes on the leg domain of the GNDS in relation to T25FW changes in progressive MS (r = 0.68, p <.001, n = 26). In the majority of cases a clinically significant deterioration on the EDSS also resulted in a clinically significant worsening of the GDNS and MSIS. ConclusionBoth PROMs correlate well with physical disability outcomes, and seem suitable for detecting changes in lower limb function in progressive MS. The GNDS has a higher agreement with EDSS progression than the MSIS-physical.

Trunk and foot acceleration variability during walking relates to fall history and clinical disability in persons with multiple sclerosis

BackgroundPersons with multiple sclerosis are often at higher risk for falling, but clinical disability scales and fall risk questionnaires are subjective and don't provide specific feedback about why an individual is unstable. The purpose of this study was to determine how relationships between trunk and foot acceleration variability relate to physiological impairments, clinical disability scales, and mobility questionnaires in persons with multiple sclerosis. Methods15 fallers and 25 non-fallers with multiple sclerosis walked on a treadmill at normal walking speed while trunk and foot accelerations were recorded with wireless accelerometers and variability measures were extracted and used to calculate the gait stability index metrics as a ratio of trunk acceleration variability divided foot acceleration variability. Subjects' sensorimotor delays and lower extremity vibration sensitivity were tested. Subjects also completed clinical disability scales (Guy's Neurological Disability Scale and Patient Reported Expanded Disability Status Scale) and mobility questionnaires (Falls Efficacy Scale, Activities Balance Confidence Scale, 12 Item Multiple Sclerosis Walk Scale). FindingsMultiple gait stability index metrics were significantly correlated with clinical measures of disability and mobility in multiple sclerosis subjects (r = 0.354–0.528), but no correlations were found for sensorimotor delays or lower extremity sensation. Multiple gait stability indices performed at least as well as clinical questionnaires for separating fallers from non-fallers. InterpretationThe gait stability indices can potentially be used outside of a laboratory setting to measure walking characteristics related to fall history and disability level in people with multiple sclerosis.

Safety and efficacy of intrathecal interferon-α therapy in subacute sclerosing panencephalitis - An interim analysis

Definitive therapy for subacute sclerosing panencephalitis (SSPE) does not exist. In view of sparse availability of isoprinosine, and issues related with intraventricular instillation of intraventricular interferon-α2b (IFN), we planned to evaluate the safety and efficacy of intrathecal IFN (IT-IFN) in patients with SSPE. Patients diagnosed with SSPE, as per Dyken’s criteria, and enrolled between September 2015 and February 2017 at King George’s Medical University, Lucknow, India were analyzed. IT-IFN, 6 million units, was given weekly for 6 weeks and then monthly for 6 months; those with stage IV as per Jabbour’s classification were excluded. Clinical, electroencephalography, cerebrospinal fluid and imaging parameters were recorded at baseline and at the completion of study period (7½ months). Modified Ranking Scale (mRS), Barthel Index (BI) and Guy’s Neurological Disability Scale (GNDS) were used to assess disability. Those who refused IT-IFN, constituted the control group. Out of a total of 47 patients, 24 patients who received IT-IFN, 6 (25%) patients showed improvement in their Jabbour’s stage while only 1 (4.3%) patient in the control group showed improvement. Three (12.5%) patients in the IT-IFN group and 12 (52.2%) in the control group progressed to next higher stage (p=0.007). A non-significant improvement in mRS and a significant improvement in BI and GNDS scores was observed in those receiving IT-IFN. Besides transient flu-like symptoms no other adverse events were observed. IT-IFN regime appears to be well-tolerated and effective in SSPE. Further comparison with isoprinosine should be done to compare their combined efficacy.

Validation of the Guy's Neurological Disability Scale as a screening tool for cognitive impairment in multiple sclerosis

Cognitive impairment is a common symptom affecting daily activities of the patients with multiple sclerosis (MS). Various cognitive evaluation tests are available, yet most of them are complex and time-consuming to perform in outpatient clinics. In this study, we aimed to validate a Japanese version of the Guy's Neurological Disability Scale (GNDS) as a user-friendly tool to evaluate comprehensive disabilities in MS including cognitive function. Questions of the GNDS were translated into Japanese and named GNDS-J. Forty-four patients were examined by the Expanded Disability Status Scale (EDSS), the Paced Auditory Serial Addition Test (PASAT), the Symbol Digit Modalities Test (SDMT), the vitality scale, and the GNDS-J in the same time at remission state. The GNDS-J scores correlated with the EDSS scores(r = 0.61), and inversely correlated with the PASAT2/1(r=-0.56/-0.49) scores and the SDMT scores (r=-0.68), whereas the GNDS-J did not show any correlation with the vitality scale. Furthermore, eleven patients were evaluated over 5 years for changes in these scores. Eight out of 11 patients had exacerbated GNDS, and all of these patients experienced clinical relapse during this period. The GNDS-J is a valid tool to perform in outpatient clinics, which could provide a comprehensive scale for evaluating symptoms of MS, thus the disease activity by repeated measure.

Clinical and Sociodemographic Variables and the Level of Social Support in People with Multiple Sclerosis

Introduction. Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system which leads to permanent disability. Social support is a resource that is particularly important in the situation of chronic illness.Aim. The aim of the study was to determine the relationship between clinical and sociodemographic variables and the level of social support in people with multiple sclerosis.Material and Methods. 137 people diagnosed with MS participated in the study. Extended Disability Status Scale (EDSS), Guy’s Neurological Disability Scale (GNDS) and Berlin Social Support Scales were used in the study.Results. Perceived social support is not related to clinical variables such as disability or disease symptoms. However, the relationship between the need for support and disability and some symptoms (i.a. cognitive impairment, mood disorders and intestinal problems) was demonstrated. Women, people married, having children and in better financial condition felt greater social support. Women also need more support and more often seek it.Conclusions. Perceived social support in people with multiple sclerosis is less associated with clinical variables, but more to variables such as gender, marital status or having children. Of the studied types of support, the need for support was most related to the features of the disease. People living with a disability or more severe symptoms need help in daily functioning as well as emotional support. This is also associated with the need for professional support from doctors, psychologists and nurses. (JNNN 2019;8(4):148–156)

Disability as a determinant of fatigue in MS patients.

Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis (MS). Central, psychological, and peripheral factors may contribute to the occurrence of fatigue. The current study aimed to evaluate potential fatigue determinants in patients with relapsing-remitting MS with a low functional impairment. We compared inflammatory markers, respiratory pressures, disability, and quality of life in 39 relapsing-remitting MS patients with and without fatigue. Patients with relapsing-remitting MS with fatigue had higher Expanded Disability Status Scale scores (p = 0.002). We observed a significant association between the results of the Guy Neurological Disability Scale, the Functional Assessment of MS Quality of Life Rating Scale and the presence of fatigue (p < 0.05). The degree of functional impairment is a determinant for the presence of fatigue in MS patients, but respiratory function and inflammatory markers are not.

Biomedical Variables and Adaptation to Disease and Health-Related Quality of Life in Polish Patients with MS.

The aim of this research was to assess the level of adaptation to multiple sclerosis (Sclerosis multiplex; MS) and health-related quality of life (HRQoL) of the study population as well as to determine the relationship between biomedical factors related to the course of multiple sclerosis, adaptation to the disease, and HRQoL. Analysis of medical records, clinical and psychological interviews, the Extended Disability Status Scale (EDSS), Guy’s Neurological Disability Scale (GNDS), the Acceptance of Illness Scale (AIS), and the Multiple Sclerosis Impact Scale 29 (MSIS-29) were collected from 137 patients with MS. It was found that there was a relation between motor impairment, neurological disability, adaptation to illness, and HRQoL; it was also found that there were negative correlations between adaptation to illness and the severity of lower-limb disability, fatigue, mood disorders, other problems related to MS, and upper-limb disability. Of all the symptoms, lower-limb disability, fatigue, and mood disorders had the strongest relation with adaptation. All of the analysed symptoms were found to correlate with HRQoL. Of all the symptoms, HRQoL was most affected by lower- and upper-limb disability, fatigue, other MS problems, and mood disorders.

Natural History of Vanishing White Matter.

ObjectiveTo comprehensively describe the natural history of vanishing white matter (VWM), aiming at improving counseling of patients/families and providing natural history data for future therapeutic trials.MethodsWe performed a longitudinal multicenter study among 296 genetically confirmed VWM patients. Clinical information was obtained via disease‐specific clinical questionnaire, Health Utilities Index and Guy's Neurological Disability Scale assessments, and chart review.ResultsFirst disease signs occurred at a median age of 3 years (mode = 2 years, range = before birth to 54 years); 60% of patients were symptomatic before the age of 4 years. The nature of the first signs varied for different ages of onset. Overall, motor problems were the most common presenting sign, especially in children. Adolescent and adult onset patients were more likely to exhibit cognitive problems early after disease onset. One hundred two patients were deceased. Multivariate Cox regression analysis revealed a positive relation between age at onset and both preservation of ambulation and survival. Absence of stress‐provoked episodes and absence of seizures predicted more favorable outcome. In patients with onset before 4 years, earlier onset was associated with more severe disability and higher mortality. For onset from 4 years on, disease course was generally milder, with a wide variation in severity. There were no significant differences for sex or for the 5 eIF2B gene groups. The results confirm the presence of a genotype–phenotype correlation.InterpretationThe VWM disease spectrum consists of a continuum with extremely wide variability. Age at onset is a strong predictor for disease course. Ann Neurol 2018;84:274–288

Immunomodulatory treatment other than corticosteroids, immunoglobulin and plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy.

Immunomodulatory treatment other than corticosteroids, immunoglobulin and plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy.

Augmenting home exercise programmes in multiple sclerosis with ‘exercise buddies’: A pilot study

Background: Non-ambulatory people with multiple sclerosis comprise 25% of the multiple sclerosis population. Literature reviews show insufficient evidence exists regarding physiotherapy for this population. A qualitative study suggested benefits from ‘exercise buddies’, who were paid carers delivering a physiotherapy home exercise programme. Aims: To explore the feasibility and effects of ‘exercise buddies’ for non-ambulatory people with multiple sclerosis. Methods: Twenty-nine non-ambulatory people with multiple sclerosis (age range: 43–72) were randomised to 10 weeks of ‘usual care’ or the ‘exercise buddy’ intervention. People with multiple sclerosis were assessed with the Multiple Sclerosis Impact Scale 29 and the Guys Neurological Disability Scale pre- and post-intervention. Their informal caregivers (12 male, 16 female, aged 21–68) completed the Adult Carer Quality of Life questionnaire. Findings: Using analysis of covariance to adjust for pre-intervention scores, there was no significant differences between groups after treatment on the Multiple Sclerosis Impact Scale 29 physical (P=0.395), Multiple Sclerosis Impact Scale 29 psychological (P=0.176) or Guys Neurological Disability Scale (P=0.177). The Adult Carer Quality of Life was also not significantly different between groups post-treatment (P=0.432). Using paired t-tests, the exercise buddy group improved significantly from baseline on the two components of the Multiple Sclerosis Impact Scale 29 (physical: P=0.024; psychological: P=0.009), which was not seen in the usual care group. Conclusions: This pilot study found no significant between group differences post-treatment. However, good feasibility and significant positive changes from baseline for the exercise buddy group warrant further exploratory work, in addition to a cost analysis.

The Associations Between Fatigue, Disability, and Mobility and the Quality of Life in Patients with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic disease which is caused by demyelination in the central nervous system (CNS) in young adults. This disease affects independence and the ability to participate in family and community activities, thus affecting the quality of life. Objectives: This cross-sectional study was designed to investigate the associations between fatigue, disability, and mobility and the quality of life in patients with MS in the city of Semnan, Iran. Patients and Methods: Sixty-six MS patients completed the Rivermead mobility index (RMI), Guy’s neurological disability scale (GNDS), modified fatigue impact scale (MFIS), and Multiple sclerosis quality of life-54 (MSQL-54) questionnaires, which assessed the physical and mental health of the participants in 12 dimensions. Results: The results of this study showed significant correlations between fatigue (P = 0.002), disability (P 0.05). Conclusions: Our findings indicate that fatigue and disability may affect a patient’s quality of life. Although mobility may affect the overall quality of life in patients with multiple sclerosis, it may also affect the physical health of MS patients. Therefore, the identification of factors affecting the quality of life in MS patients may help in predicting the quality of life, and designing a rehabilitation protocol.

Uphill and Downhill Walking in Multiple Sclerosis: A Randomized Controlled Trial.

Various exercise protocols have been recommended for patients with multiple sclerosis (MS). We investigated the effects of uphill and downhill walking exercise on mobility, functional activities, and muscle strength in MS patients. Thirty-four MS patients were randomly allocated to either the downhill or uphill treadmill walking group for 12 sessions (3 times/wk) of 30 minutes' walking on a 10% negative slope (n = 17) or a 10% positive slope (n = 17), respectively. Measurements were taken before and after the intervention and after 4-week follow-up and included fatigue by Modified Fatigue Impact Scale; mobility by Modified Rivermead Mobility Index; disability by Guy's Neurological Disability Scale; functional activities by 2-Minute Walk Test, Timed 25-Foot Walk test, and Timed Up and Go test; balance indices by Biodex Balance System; and quadriceps and hamstring isometric muscles by torque of left and right knee joints. Analysis of variance with repeated measures was used to investigate the intervention effects on the measurements. After the intervention, significant improvement was found in the downhill group versus the uphill group in terms of fatigue, mobility, and disability indices; functional activities; balance indices; and quadriceps isometric torque (P < .05). The results were stable at 4-week follow-up. Downhill walking on a treadmill may improve muscle performance, functional activity, and balance control in MS patients. These findings support the idea of using eccentric exercise training in MS rehabilitation protocols.

Assessment of fatigue in multiple sclerosis: methodological quality of adapted original versions available in Brazil of self-report instruments

Assessment of fatigue in multiple sclerosis is a difficult task and its instruments have no uniformity regarding the methodological evaluation parameters to ensure validity and reliability of its inferences. The objective of this study was to analyze the methodological quality of development, cross-cultural adaptation to Portuguese language (Brazil), and psychometric properties of self-report instruments that assess fatigue in multiple sclerosis and are available in Brazil. A search was conducted in the electronic databases LILACS, MEDLINE, Embase, PsycINFO, CINAHL, SciELO and SPORTDiscus with analysis of the selected instruments by consensus-based standards for the selection of health measurement instruments. It was included 10 articles and presented the instruments Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), Cognitive and Physical Fatigue in Multiple Sclerosis Scale (CPF-MS), Guy's Neurological Disability Scale (GNDS), Functional Assessment of Multiple Sclerosis (FAMS), and their adapted versions in Brazil. Most instruments present a multidimensional structure with documented cross-cultural adaptation in Brazil and emphasize the physical domain and adequate reliability. There is difficulty in identifying a self-report instrument to adequately assess fatigue in multiple sclerosis and that is an example of methodological and psychometric standards in their design and management.

Musculoskeletal Pain and Arthritis in MS and Other Types of Chronic Pain: Case Control Study

Objective: To investigate the relationship between sense of autonomy and attitudes toward exercise and behavior in persons with MS. Design: Prospective cohort study. Setting: Academic medical center. Participants: 46 subjects (35 female) were solicited from clinical practices. Interventions: Not applicable. Main Outcome Measure(s): Two physical measures: grip strength dynamometry and the 2 minute walk test (2MWT);the Guys Neurological Disability Scale (GNDS), the Impact on Participation and Autonomy Questionnaire (IPA) and the Multidimensional Outcome Expectations for Exercise Scale (MOEES) previously validated in the ambulatory MS population. A medical history relevant to MS was elicited, and in the second part of the study, the subjects completed an exercise diary for 2 weeks. Results: 46 subjects (35 female) were recruited and enrolled. Mean GNDS score was 10.7 (7.1) for males and 12.1(9.4) for females, which were not significantly different. Bivariate correlation analyses showed significant relationship between GNDS and 2MWT (rZ -0.425, p <.003); GNDS and presence of pain or spasticity (r Z 0.452, p < .002; r Z 0.541, p < .001). The IPA subscales showed significant correlations with average daily pain rating: Autonomy Indoors (AI Scale) rZ 0.450; Family Role Scale (FR) rZ 0.463 and Autonomy Outdoors (AO Scale) r Z 0.453, all with p values less than .01. Social Role (SR) scale and pain rating showed rZ 0.365, pZ .013. The MOEES scale data evaluated by principal components analysis showedexcellent agreementwith published 3-subscale factormodel.TheSelfEvaluative (SELF) subscale showed significant correlation with average daily pain rating (Kendall’s tau-b, 0.247, pZ .036; Somer’s dZ 0.247, pZ .012). Grip dynamometrywas left hand: 30.9 kg (11.1) andR hand: 32.1 kg (12.1). Mean of exercise minutes per week (diary) was 219.5 (260.3). Log transformed data showed it to be normally distributed. Bivariate correlation analyses showed no significant correlation between reported exercise per week and the following measures: age, GNDS, IPA subscales, MOEES subscales, RH or LH Grip, 2 MWT. Conclusions: GNDS correlates well with walking distance, and presence of pain or spasticity. MOEES questionnaire 3 subscales appear valid, and Self-Evaluative scale correlates with pain score as well as physical measure (grip). Our hypothesized relationship between exercise performance (diary self-report) did not correlate with age, GNDS, MOEES, IPA or physical measures. Other factors must influence exercise behavior beyond those measured in this study.

Detecting clinically-relevant changes in progressive multiple sclerosis

Objective: To investigate which changes in different clinical outcome measures contribute most to increased disease impact, as reported by the patient, in progressive multiple sclerosis (MS). Methods: From a cohort of prospectively-followed MS patients, we selected progressive patients with two visits, 4–6 years apart. We assessed long-term changes on the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT) and Guy’s Neurological Disability Scale (GNDS). We defined the presence or absence of clinically meaningful change by using the Multiple Sclerosis Impact Scale (MSIS-29) as an anchor measure. We also studied change on recently identified sub-scales of GNDS. Results: Change on GNDS (especially the spinal-plus subscale) contributed most to increased disease impact. Also change on the T25FW contributed largely. Specific profiles of change in T25FW and MSIS seemed to exist (generally, a lower increase in disease impact in patients with longer disease duration and higher baseline impact/disability). In some patients a dissociation existed between increased impact, according to the MSIS-29, and objective physical worsening of the T25FW. Conclusion: These results support using GNDS (particularly the spinal-plus domain) and T25FW in outcome measurement in progressive MS. We suggest there is a relation between baseline clinical characteristics and an increased impact at follow-up. This may have implications for patient selection in trials for progressive MS.

INCAT disability score: a critical analysis of its measurement properties.

The INCAT (Inflammatory Neuropathy Cause and Treatment) disability score is a measure of activity limitation. It is used frequently as a primary endpoint in inflammatory polyneuropathy clinical trials. A comprehensive critical analysis of its measurement properties has not been performed. Critical analysis of measurement properties. The INCAT disability score was derived based on items from Guy's Neurological Disability Scale (GNDS), a disability measure intended for application in multiple sclerosis. Strengths of the INCAT score include evaluation of upper and lower limb dysfunction, ease of administration (feasibility), high face validity, and high reliability. Weaknesses of the scale include concerns about methodological quality of validation studies; failure to properly capture activity limitations due to proximal arm weakness, or fatigue; heavy individual item weighting; and poor sensitivity for detection of clinically important change. Although the INCAT scale has been an effective tool in inflammatory polyneuropathy studies, its limitations may warrant development of new scales.

Level of Mobility Limitations and Falls Status in Persons With Multiple Sclerosis

ObjectiveTo investigate whether fall rates are constant across levels of mobility limitations. DesignSecondary analysis of baseline assessments from a stratified randomized controlled trial. SettingCommunity. ParticipantsPersons with multiple sclerosis (N=365) were divided into 5 groups based on the mobility section of the Guy's Neurological Disability Scale (GNDS): no walking impairment (n=82); impaired walking, no aid (n=87); unilateral support (n=76); bilateral support to walk (n=78); or occasional wheelchair user (n=42). InterventionsNot applicable. Main Outcome MeasuresSelf-reported fall history (ie, retrospective) in the preceding 3 months. ResultsOne hundred twenty-four persons in the overall sample reported falling in the last 3 months (fall prevalence, 33.97%). Of the total sample, 17.8% reported 2 or more falls in the last 3 months. Chi-square analysis revealed a significant difference in the proportion of fallers across GNDS categories (χ2=42.64, P<.001). Post hoc analysis revealed that the group who walked with bilateral support had the greatest proportion of fallers (52.6%), while the group without walking impairment had the lowest proportion (15.9%). An examination of recurrent fallers as a function of group found that there were more recurrent fallers (70%) in the group that had a walking impairment but used no aid, relative to the other groups. ConclusionsThe current findings highlight that fall rates including recurrent fall prevalence are not uniform across mobility aid categories in persons with MS. Those using bilateral assistance for gait have the highest prevalence of fallers, and those with walking limitations and not yet using an aid had the greatest prevalence of multiple falls.

Analyzing differences between patient and proxy on Patient Reported Outcomes in multiple sclerosis

BackgroundProxy respondents, partners of multiple sclerosis (MS) patients, can provide valuable information on the MS patients' disease. In an earlier publication we found relatively good agreement on patient reported outcomes (PROs) measuring physical impact and functioning, but we found large differences on (neuro)psychological scales. ObjectiveWe aim to identify patient and proxy related variables explaining differences between patients' and proxies' ratings on five PROs. MethodsWe report on data from 175 MS patients and proxy respondents. Regression analyses were performed, using as dependent variable the mean differences on five scales: Physical and Psychological scale of the Multiple Sclerosis Impact Scale (MSIS-29), the Multiple Sclerosis Walking Scale (MSWS), Guy's Neurological Disability Scale (GNDS) and the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). The independent variables were patient, proxy and disease related variables. ResultsCaregiver strain was significantly related to differences between patient and proxy scores for all five PROs. A higher level of patient anxiety on the HADS was linked to larger differences on all PROs except the GNDS. In addition, cognitive functioning, proxy depression, walking ability, proxy gender and MS related disability were contributing to the discrepancies. ConclusionWe found several patient and proxy factors that may contribute to discrepancies between patient and proxy scores on MS PROs. The most important factor is caregiver burden.

Cognitive impairment and “invisible symptoms” are not associated with CCSVI in MS

BackgroundWe investigated the association between chronic cerebrospinal venous insufficiency (CCSVI) and cognitive impairment (CI) in multiple sclerosis (MS). Moreover, we evaluated the association between CCSVI and other frequent self-reported MS symptoms.MethodsWe looked at the presence of CI in incident MS patients with CCVSI in a population-based cohort of Catania, Italy. All subjects were group-matched by age, sex, disease duration and EDSS score with MS patients without CCSVI, serving as controls. CI was assessed with the Brief Repeatable Battery (BRB) and the Stroop Test (ST) and it was defined by the presence of at least three impaired tests. Fatigue and depressive symptoms were assessed with Fatigue Severity Scale (FSS) and Hamilton Depressive Rating Scale (HDRS), respectively. Bladder and sexual symptoms were assessed with the respective items of the Italian version of Guy's Neurological Disability Scale (GNDS). Quality of life was evaluated with Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54).ResultsOut of 61 MS patients enrolled in the study, 27 were CCSVI positive and 34 were CCSVI negative. Of them, 43 were women (70.5%); the mean age was 43.9 ± 11.8 years; the mean disease duration was 159.7 ± 113.7 months; mean EDSS was 3.0 ± 2.6. Of them, 36 (59.0%) were classified relapsing-remitting (RR), 12 (19.7%) secondary progressive (SP), seven (11.5%) primary progressive (PP) and six (9.3%) Clinically Isolated Syndrome (CIS). Overall, CI was detected in 29/61 (47.5%) MS patients; particularly 13/27 (48.1%) in the CCSVI positive group and 16/34 (47.0%) in the CCSVI negative group. Presence of CCSVI was not significantly associated with the presence of CI (OR 1.04; 95% CI 0.37-2.87; p-value = 0.9). Not significant differences were found between the two groups regarding the other MS symptoms investigated.ConclusionsOur findings suggest a lack of association between CCSVI and CI in MS patients. Fatigue, depressive, bladder/sexual symptoms and self-reported quality of life are not associated with CCSVI.

Cognitive impairment is correlated with reduced quality of life in patients with clinically isolated syndrome

To evaluate the quality of life (QoL) and potential QoL determinants in patients with clinically isolated syndrome (CIS). Eighteen CIS patients and eighteen controls were submitted to QoL evaluation with Functional Assessment of Multiple Sclerosis QoL instrument (FAMS). Cognition was evaluated with specific battery tests; Anxiety and depression with Beck Anxiety (BAI) and Depression (BDI) Inventories and Neurological disability with Guy's Neurological Disability Scale (GNDS). There was a significant difference in QoL between CIS patients and controls. CIS patients had worse performance in Paced Auditory Serial Addition 2 seconds (p=0.009) and fluency tests (p=0.0038). There was a significant difference in BAI (p=0.003), but no significant difference in BDI between patients and controls. There were significant correlations between QoL measure and verbal fluency and Stroop's test. Cognition, but not anxiety, depression and disability, was associated with reduced quality of life.