Higher Expanded Disability Status Scale Scores Research Articles

Effects of physical comorbidities on disability progression in multiple sclerosis.

To examine the association between physical comorbidities and disability progression in multiple sclerosis (MS). We conducted a retrospective cohort study using linked health administrative and clinical databases in 2 Canadian provinces. Participants included adults with incident MS between 1990 and 2010 who entered the cohort at their MS symptom onset date. Comorbidity status was identified with validated algorithms for health administrative data and was measured during the 1 year before study entry and throughout the study period. The outcome was the Expanded Disability Status Scale (EDSS) score as recorded at each clinic visit. We used generalized estimating equations to examine the association between physical comorbidities and EDSS scores over time, adjusting for sex, age, cohort entry year, use of disease-modifying drugs, disease course, and socioeconomic status. Meta-analyses were used to estimate overall effects across the 2 provinces. We identified 3,166 individuals with incident MS. Physical comorbidity was associated with disability; with each additional comorbidity, there was a mean increase in the EDSS score of 0.18 (95% confidence interval [CI] 0.09-0.28). Among specific comorbidities, the presence of ischemic heart disease (IHD) or epilepsy was associated with higher EDSS scores (IHD 0.31, 95% CI 0.01-0.61; epilepsy 0.68, 95% CI 0.11-1.26). Physical comorbidities are associated with an apparent increase in MS disability progression. Appropriate management of comorbidities needs to be determined to optimize outcomes.

Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire

BackgroundMultiple sclerosis is a chronic neurological disease that may cause swallowing disorders. Dysphagia is a common problem, which patients with different levels of disability may encounter, but it is usually underestimated; therefore, effective assessments need to be performed before any serious complications. The aim of this study was to identify the frequency and characteristics of dysphagia in multiple sclerosis patients of Khuzestan MS society, using a Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire. Method105 consecutive MS patients (84 F and 21 M, mean age 33.8 ± 8.5 years, mean disease duration 3.5 ± 3.1 years, mean Expanded Disability Status Scale (EDSS) 1.8 ± 1.3) participated in the study and the DYMUS questionnaire was administered by a trained speech therapist. ResultsThe results have shown that 55 MS patients (52.4%) had dysphagia and the dysphagia was significantly associated with the disease course of MS (p = 0.02). However, significant associations between DYMUS values and EDSS, disease duration, age, and gender were not observed. (Respectively, p = 0.4, p = 0.09, p = 0.1, p = 1.0). In the dysphagia group, based on dysphagia severity, 17.1% and 35.2% of patients had mild and alarming dysphagia, respectively. Although, the patients with alarming dysphagia had longer disease duration, higher EDSS score and more with SP, PP and PR disease course than the patients with mild dysphagia, these differences were not significant. ConclusionThe oropharyngeal dysphagia in MS patients is very common even in early stages of the disease; therefore, it is important to assess these patients carefully and to initiate a treatment program if needed.

Leptomeningeal Contrast Enhancement Is Associated with Disability Progression and Grey Matter Atrophy in Multiple Sclerosis.

Leptomeningeal contrast enhancement (LMCE) on magnetic resonance imaging (MRI) is a newly recognized possible biomarker in multiple sclerosis (MS), associated with MS progression and cortical atrophy. In this study, we aimed to assess the prevalence of LMCE foci and their impact on neurodegeneration and disability. Materials. 54 patients with MS were included in the study. LMCE were detected with a 3 Tesla scanner on postcontrast fluid-attenuated inversion-recovery (FLAIR) sequence. Expanded Disability Status Scale (EDSS) score, number of relapses during 5 years from MS onset, and number of contrast-enhancing lesions on T1 weighted MRI were counted. Results. LMCE was detected in 41% (22/54) of patients. LMCE-positive patients had longer disease duration (p = 0,0098) and higher EDSS score (p = 0,039), but not a higher relapse rate (p = 0,091). No association of LMCE with higher frequency of contrast-enhancing lesions on T1-weighted images was detected (p = 0,3842). Analysis of covariates, adjusted for age, sex, and disease duration, revealed a significant effect of LMCE on the cortex volume (p = 0.043, F = 2.529), the total grey matter volume (p = 0.043, F = 2.54), and total ventricular volume (p = 0.039, F = 2.605). Conclusions. LMCE was shown to be an independent and significant biomarker of grey matter atrophy and disability in MS.

Yoga Training Has Positive Effects on Postural Balance and Its Influence on Activities of Daily Living in People with Multiple Sclerosis: A Pilot Study

There is a little evidence about the influence of yoga as a complementary therapy for postural balance and its influence on activities of daily living in multiple sclerosis (MS) patients. To evaluate the influence of a six-month yoga program on postural balance and subjective impact of postural balance impairment on activities of daily living in people with MS. Randomized controlled pilot study. Protocol developed at the Adaptive Physical Activity Study Department, College of Physical Education, State University of Campinas, Brazil. A total of 12 (11 women) yoga naive people with MS randomly divided into two groups as follows: Control (C-waiting list, n = 6) and Yoga (Y-Yoga training, n = 6). Yoga group practiced postures, breathing exercises, meditation, and relaxation on weekly 60-min classes for a six-month period. The following evaluations were performed at study entry (baseline), and after six months (six months): Berg Balance Scale (BBS), Expanded Disability Status Scale (EDSS), and self-reported postural balance quality and influence of postural balance on activities of daily living. There was a significant improvement in BBS score from baseline to six months only in the Yoga group, especially in subjects with higher EDSS score, with increased quality of self-reported postural balance, and decreased influence of postural balance impairment on activities of daily living. In conclusion, a six-month yoga training is beneficial for people with MS, since it improves postural balance and decreases the influence of postural balance impairment on activities of daily living. A greater sample size is necessary to increase generalization, but it seems that yoga could be included as a feasible complementary therapy for people with MS.

Myelopathy in systemic lupus erythematosus: clinical, laboratory, radiological and progression findings in a cohort of 1,193 patients

ObjectiveTo describe clinical, laboratory, radiological and progression characteristics of myelopathy in systemic lupus erythematosus (SLE). Patients and methodsA retrospective analysis was performed on a cohort of 1193 patients with SLE (ACR criteria) in order to identify patients with myelopathy (neuropsychiatric ACR). Disease activity was assessed by the SLE activity index (SLEDAI) on the date of the event and functional capacity was assessed by the Expanded Disability Status Scale (EDSS) at the last visit. ResultsWe identified 14 (1.2%) patients with myelopathy. All were women with a mean age of 30±11.5 years. Myelopathy occurred at the diagnosis of SLE in four (28%) patients; and nine (64%) patients had another type of neuropsychiatric manifestation associated. Neurological recurrence was observed in one (7%) patient. Disease activity was observed in 2 (14%) patients. Cerebrospinal fluid presented pleocytosis on 7 (53%) patients; antiphospholipid antibodies were positive in 5 (45%). Magnetic resonance imaging (MRI) showed T2 hyperintensity with a predominance of longitudinal involvement in 6 (86%) patients. Most were treated with intravenous corticosteroids and cyclophosphamide. No patient had full recovery and four (36%) had high EDSS scores. Three (21%) patients died from sepsis early in the course of their myelopathy, during or after immunosuppressive therapy. ConclusionsMyelopathy occurred in 14 (1.2%) of the patients in our cohort and this may be the first manifestation of the disease occurring independently of systemic disease activity. Although rare, myelopathy shows great morbidity and mortality, can be recurrent and MRI is critical for diagnosis.

Mielopatia no lúpus eritematoso sistêmico: achados clínicos, laboratoriais, radiológicos e evolutivos em uma coorte de 1.193 pacientes

ObjectiveTo describe clinical, laboratory, radiological and progression characteristics of myelopathy in systemic lupus erythematosus (SLE). Patients and methodsA retrospective analysis was performed on a cohort of 1193 patients with SLE (ACR criteria) in order to identify patients with myelopathy (neuropsychiatric ACR). Disease activity was assessed by the SLE activity index (Sledai) on the date of the event and functional capacity was assessed by the Expanded Disability Status Scale (EDSS) at the last visit. ResultsWe identified 14 (1.2%) patients with myelopathy. All were women with a mean age of 30±11.5 years. Myelopathy occurred at the diagnosis of SLE in four (28%) patients; and nine (64%) patients had another type of neuropsychiatric manifestation associated. Neurological recurrence was observed in one (7%) patient. Disease activity was observed in 2 (14%) patients. Cerebrospinal fluid presented pleocytosis on 7 (53%) patients; antiphospholipid antibodies were positive in 5 (45%). Magnetic resonance imaging (MRI) showed T2 hyperintensity with a predominance of longitudinal involvement in 6 (86%) patients. Most were treated with intravenous corticosteroids and cyclophosphamide. No patient had full recovery and four (36%) had high EDSS scores. Three (21%) patients died from sepsis early in the course of their myelopathy, during or after immunosuppressive therapy. ConclusionsMyelopathy occurred in 14 (1.2%) of the patients in our cohort and this may be the first manifestation of the disease occurring independently of systemic disease activity. Although rare, myelopathy shows great morbidity and mortality, can be recurrent and MRI is critical for diagnosis.

The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey.

Examination of prevalence, intensity and associations of pain in persons with multiple sclerosis (MS). Multicenter, international cross-sectional survey. Patients were recruited from seven MS centers: in Serbia (Clinic of Neurology, Clinical Center of Serbia, Belgrade; Clinic of Neurology, Military Medical Academy, Belgrade; Clinic of Neurology, Clinical Center Kragujevac; Clinic of Neurology, Clinical Center Nis; Department of Neurology, General Hospital-Uzice), in Republic of Srpska-Bosnia and Herzegovina (Clinic of Neurology, Clinical Center Banja Luka) and in Croatia (University Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb). Six hundred and fifty consecutive MS patients diagnosed according to the Revised McDonald criteria (2005), from the aforementioned centers, over the period of 6 months. A semistructured questionnaire was administered during a face-to-face interview with neurologists who also performed Expanded Disability Status Scale (EDSS), the Hamilton Rating Scale for Depression (HDRS) and Hamilton Rating Scale for Anxiety (HARS). To recognize predictive factors for the presence of pain, the linear regression analysis was used. Lifetime prevalence of pain was 66.5% (point prevalence = 44.3%). The prevalence of the comorbidity of pain and depression was 29.1%. Older age (P < 0.001), primary-progressive MS (P = 0.034), higher EDSS score (P = 0.008), higher scores of HDRS (P < 0.001), and HARS (P < 0.001) were significantly associated with pain. Finally, in our multivariate linear regression analysis, anxiety (P < 0.001) was the independent predictor of pain. We confirmed high prevalence of pain, affecting approximately more than half of patients during the course of MS. Pain in MS is associated with disability, depression and, especially with anxiety, which has significant implications for treatment.

Baseline clinical status as a predictor of methylprednisolone response in multiple sclerosis relapses

Background: To date, there are no available factors to predict the outcome after multiple sclerosis relapse. Aim: To investigate factors that may be useful for predicting response to methylprednisolone treatment, following a relapse of multiple sclerosis (MS). Methods: The study included 48 MS patients enrolled in a double-blind multicenter trial to receive intravenous versus oral high-dose methylprednisolone treatment. Associations were sought between the disability status prior to relapse and the relapse severity, determined by changes in the Expanded Disability Status Scale (EDSS) score, as well as the improvements after treatment. We also analyzed the relationships between the number of magnetic resonance imaging (MRI) gadolinium-enhancing lesions (Gd+) and improvement. Results: A higher EDSS score before relapse was associated with more severe relapses (p = 0.04) and less marked improvement (odds ratio (OR) 1.8; 95% CI (1.2–2.2); p = 0.05) after methylprednisolone treatment. Relapse severity (p = 0.29) and the number of Gd+ lesions at relapse (p = 0.41) were not related with improvement. Conclusions: Clinical baseline status prior to MS relapse is a predictor of response to methylprednisolone treatment.

Disease-related determinants of quality of life 10 years after clinically isolated syndrome.

The main clinical determinants of quality of life (QOL) 5 years after clinically isolated syndrome (CIS) are Expanded Disability Status Scale (EDSS) score and conversion to clinically definite multiple sclerosis (CDMS). The aim of this study was to determine the demographic, clinical, and magnetic resonance imaging (MRI) factors associated with QOL 10 years after CIS. Controlled High Risk Avonex® Multiple Sclerosis Prevention Study in Ongoing Neurologic Surveillance (CHAMPIONS) 10-year patients were assessed for CDMS, EDSS score, MRI T2 activity, brain parenchymal fraction, and patient-reported QOL. Associations were evaluated using analysis of variance models. A second clinical event consistent with CDMS and higher EDSS scores at years 5 and 10 were associated with lower 36-item Short Form Health Status Survey (SF-36) Physical Component Summary scores at year 10 (P < .01). Patients with earlier onset of CDMS had worse patient-reported Physical Component Summary, SF-36 Mental Component Summary, fatigue, and pain scores at year 10 than patients with later or no onset of CDMS. Neither initial randomization group nor any MRI metrics assessed at baseline or during follow-up were associated with QOL at 10 years. These results support the development of therapies for patients with CIS that significantly reduce the risk of conversion to CDMS and the progression of physical disability to milestones as low as EDSS scores of 2.0.

Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression

Hand grip strength in both the dominant and non-dominant hands is often used to assess upper limb impairment. Excessive hand grip fatigability is another important measure, as fatigability may also influence activities of daily living. To investigate to what extent hand grip fatigability in multiple sclerosis is dependent on hand dominance, muscle strength and disease progression. Thirty persons with multiple sclerosis and 16 healthy controls performed 15 repeated maximal hand grip contractions and a 30 s sustained contraction in order to determine dynamic and static fatigue indices. Fatigability was compared between the dominant and non-dominant hands and between the more and less affected hands in a subgroup of persons with multiple sclerosis with asymmetrical hand grip strength impairment. Furthermore, fatigability was compared between controls and subgroups of persons with multiple sclerosis with different disease progression. There was no difference in fatigability between dominant and non-dominant hands in healthy controls or in persons with multiple sclerosis. Similarly, there was no difference between the more and less affected hands in the subgroup of persons with multiple sclerosis with asymmetrical hand grip impairment. The dynamic fatigue index did not discriminate persons with multiple sclerosis from controls. While the static fatigue index was not different between healthy controls and persons with multiple sclerosis with low to moderate (< 6) Expanded Disability Status Scale (EDSS), it was significantly higher in persons with multiple sclerosis with high (≥ 6) EDSS scores. The static fatigue index was related to the EDSS score, but not to maximal grip strength. Fatigability of hand grip strength in persons with multiple sclerosis is not influenced by hand dominance or muscle strength, but there is a correlation with disease progression. Differences in fatigability between healthy controls and, in particular, persons with multiple sclerosis with high EDSS, were found during sustained, but not during dynamic, contractions.

Follow-up of pediatric patients treated by IVIG for Langerhans cell histiocytosis (LCH)-related neurodegenerative CNS disease.

The follow-up of eight Japanese children with Langerhans cell histiocytosis (LCH)-related neurodegenerative central nervous system (ND-CNS) disease who were treated with intravenous immunoglobulin (IVIG) for >3 years is described. The patients developed ND-CNS disease at a median age of 5.2 (range 3.5-10.0) years and received IVIG treatment for a median duration of 6.5 + (range 3.7 to 10+) years. After a median follow-up period of 11.6 + (8.3+ to 13.9+) years after ND-CNS disease diagnosis, the median Expanded Disability Status Scale (EDSS) score of the eight patients was 4.0 (range 2.0-9.5). At the last follow-up as of March 2014, three patients have low EDSS scores (<3.0) and can walk without any assistance. Another three patients have EDSS scores of 3.5-4.5 and can walk by themselves, albeit occasionally with supports. However, the remaining two patients are wheelchair bound or bed ridden. The school performance of seven of the eight patients was below average. IVIG appeared to be most beneficial when it was administered soon after ND-CNS disease diagnosis when the EDSS scores were low (1.0-2.5). The patients who began receiving IVIG when their high EDSS scores were higher (4.5-7.0) appeared to obtain less benefit. To prevent progression of ND-CNS disease in patients with LCH, it is recommended to introduce IVIG early and to continue this therapy for >3 years.

Clinical correlations of motor and somatosensory evoked potentials in neuromyelitis optica.

BackgroundMotor and somatosensory evoked potentials (MEPs and SSEPs) are sensitive tools for detecting subclinical lesions, assessing disease severity, and determining the prognosis for outcomes of patients with inflammatory neurological diseases such as multiple sclerosis. However, their roles in neuromyelitis optica (NMO), a severe inflammatory neurological disease that predominantly involves optic nerves and spinal cord, have not yet been clarified.Methods and FindingsClinical symptoms and examination findings at relapses of 30 NMO patients were retrospectively reviewed. Abnormal MEPs were observed in 69.2% of patients. Patients with abnormal motor central conduction time (CCT) of the lower limbs had higher Kurtzke Expanded Disability Status Scale (EDSS) scores than those with normal responses (P = 0.027). Abnormal SSEPs were found in 69.0% of patients. Patients with abnormal lower limb sensory CCT had higher EDSS scores than those with normal responses (P = 0.019). In 28 patients followed up more than 6 months, only one of 11 patients (9.1%) with normal SSEPs of the lower limbs had new relapses within 6 months, whereas 8 of 17 patients (47.1%, P = 0.049) with abnormal SSEPs of the lower limbs had new relapses.ConclusionsThese results indicate MEPs and SSEPs of the lower limbs are good indicators for the disability status at relapses of NMO. Lower limb SSEPs may be a good tool for reflecting the frequency of relapses of NMO.

Retinal Nerve Fiber Layer Thickness, Brain Atrophy, and Disability in Multiple Sclerosis Patients

To study the relationship between retinal nerve fiber layer (RNFL) thickness and brain atrophy using magnetic resonance imaging (MRI) with bicaudate ratio (BCR) in patients with multiple sclerosis (MS) with different levels of disease severity. We also assessed whether RNFL thickness correlated with Expanded Disability Status Scale (EDSS) score. The participants consisted of 88 patients with MS and 59 age- and sex-matched healthy control subjects. Eleven patients had clinically isolated syndrome (CIS), 68 patients had relapsing-remitting MS (RR-MS), and 9 patients had secondary progressive MS. Patients and controls were evaluated using optical coherence tomography (OCT, Cirrus) and scanning laser polarimetry with variable corneal compensation (GDx VCC). Patients underwent the same brain MRI scanning protocol. Disability was evaluated according to the EDSS. The BCR was calculated by dividing the minimum intercaudate distance by brain width along the same level. The BCR was higher in patients with MS (0.12 ± 0.03) than in controls (0.08 ± 0.009) (P < 0.001). OCT average RNFL thickness in patients with MS was significantly lower (84.51 ± 14.27 μm) than in control subjects (98.44 ± 6.83 μm). BCR was correlated with OCT average RNFL thickness (r = -0.48, P = 0.002) in patients with MS without optic neuritis. Significant correlations were found between average RNFL thickness and EDSS (r = -0.43, P = 0.003). Additionally, there were correlations between BCR with GDx parameters in patients with MS without optic neuritis. This study shows that RNFL thickness correlates with BCR and with MS subtypes. Additionally, our study indicates that OCT is better suited for MS assessment than GDx. We conclude that the damage of retinal axons appears related to brain damage in patients with MS.

Formes cavitaires de sclérose en plaques : étude multicentrique sur vingt patients

IntroductionCavitary white matter changes are mainly described in leukodystrophies and especially in vanishing white matter disease. Large cavitary lesions are not typical for multiple sclerosis (MS). MethodsWe studied MS patients with large cavitary brain lesions. Patient characteristics, disease onset/duration/subtype, expanded disability status scale (EDSS), mini mental state (MMS), vanishing white matter disease genetic analysis, and MRI characteristics of the cavitary lesions were analyzed. ResultsTwenty patients were analyzed (6 men and 14 women). Mean age at disease onset was 37.6 (range 17–58). Mean disease duration was 10 years (range 2–20). Five patients had initial relapsing-remitting MS and nine patients had primary-progressive MS. Mean EDSS was 5.5 (range 2–8). Mean MMS was 20/30. Vanishing white matter disease genetic analysis was performed and negative in seven patients. Inferior corpus callosum lesions were seen in all patients with available sagittal FLAIR sequences. Cavitary lesions were strictly supratentorial, and located inside the diffuse leukoencephalopathy, with often a posterior predominance. ConclusionMS patients with large cavitary lesions seem to represent a MS subgroup, predominantly women, with relatively late disease onset, predominantly primary-progressive type, relatively high EDSS scores, and severe cognitive dysfunction.

Disability improvement in the first case treated by Natalizumab in Libya

Disability improvement in the first case treated by Natalizumab in Libya

Retrograde diagnosis of tumifactive multiple sclerosis

Retrograde diagnosis of tumifactive multiple sclerosis

1303 – Depression, anxiety and multiple sclerosis-serbian experience

It is well known that patients with multiple sclerosis (MS) have frequently affective and anxiety spectrum disorders.The aim of our study was to assesss the links between anxious and depressive symptoms on one hand and the quality of life (QOL) and daily activities and abilities on the other, in patients diagnosed with MS. We measured the intensity of depression using HAMD-17 item., and the intensity of anxiety using HAM-A scale. We also measured the expanded disability status scale (EDSS) score for each patient. Our batch was composed of 98 patients diagnosed with different forms of multiple sclerosis. The patients with relapsing remitting MS were free of acute neurological deficits during the examination. For every patient we performed neurological examination (EDSS) and the assessment of depression, of anxiety, of daily activities (activities of daily living-ADL and instrumental activities of daily living-IADL) and of the quality of life-score and grade (QOL score and QOL grade). First we found strong correlations between neurological deficit (measured by EDSS) and HAM-A, HAM-D, ADL, IADL,QOL score and QOL grade (using Pearson method: p= 0.0001 for each. For different levels of EDSS score we tried to correlate HAM-A and HAm-D with ADL, IADL, QOL (score and grade). The correlations were all valid with a stronger connection in the groups with a higher EDSS score. Anxiety and depression levels grow together with the EDSS score. Anxiety and depression spectrums are interrelated by increasing each other;s level regardless of MS severity.

Clinical and Radiological Characteristics in Multiple Sclerosis Patients with Large Cavitary Lesions

Background: Large cavitary lesions are not typical for multiple sclerosis (MS). Cavitary white matter changes may be seen in megalencephalic leukoencephalopathy with subcortical cysts, Alexander disease, mitochondrial leukoencephalopathies, vanishing white matter disease, leukoencephalopathy with calcifications and cysts, cytomegalovirus infection, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Objective: To analyze clinical and radiological characteristics in MS patients with large cavitary lesions. Methods: We studied MS patients with large cavitary brain lesions. Patient characteristics, disease onset/duration/subtype, expanded disability status scale (EDSS), Mini Mental State (MMS), corpus callosum lesions, history of segmental myelitis, CSF oligoclonal bands (OCB), visual evoked potentials (VEP), vanishing white matter disease genetic analysis, and characteristics of the cavitary lesions were analyzed. Results: Nine patients were analyzed, 1 man and 8 women. Mean age of disease onset was 38.5 years. Mean disease duration was 9 years. Three patients had initial relapsing-remitting MS and 6 patients had primary-progressive MS. Mean EDSS was 4.5. Mean MMS was 20/30. Segmental myelitis was present in 6 cases. OCB were found in 6 patients. VEP was performed in 6 patients, and pathological in all but one. Vanishing white matter disease genetic analysis was performed and negative in 5 patients. Inferior corpus callosum lesions were seen in all patients with available sagittal FLAIR sequences. Cavitary lesions were strictly supratentorial, and located inside the diffuse leukoencephalopathy, with often a posterior predominance. Conclusion: MS patients with large cavitary lesions seem to represent an MS subgroup, predominantly women, with relatively late disease onset, predominantly primary-progressive type, relatively high EDSS scores, and severe cognitive dysfunction.

Multiple Sclerosis and Socioeconomic Status: What Happens in South America? (P01.142)

Objective: The aim of our study is to analyze the socioeconomic status (SES) of a population of Multiple Sclerosis (MS) patients in Argentina, compared with controls and correlated with clinical variables such as Expanded Disability Status Scale (EDSS), annualized relapse rate (ARR) and Multiple Sclerosis Severity Scale (MSSS). Background SES is the relative position of an individual on a hierarchical social structure, based on their access to wealth, prestige and power. SES variables most used include educational level, annual income, health insurance status, marital status and region of residence. A clear relationship between SES and health exists. In countries with high prevalence of MS was shown correlation between MS in people who achieve superior levels of education. Also there is an association between MS moderate-severe disability (higher EDSS scores) and divorce-separation and lower rates of employment. In South America, a region of low/medium prevalence, there is no data published about it. Design/Methods: A 36 questions survey that includes the main aspects of SES was completed by 47 MS outpatient clinic and 42 controls matched for sex and age. Both groups were compared using Student9s t test and Chi-square test. In MS, group variables were analyzed independently related to disease duration, ARR and MSSS; using contingency tables, Mann Whitney test, nonparametric correlations and ANOVA. Results: MS patients have less self-sustaining capacity(p0,013), less trips abroad(p0,007) and less retirement contributions(p0,007) than controls. No statistically significant associations were observed between SES and clinical variables. A multiple logistic regression model neither showed significant association. 14 variables were put together to build a score of SES. This score correlated with higher MSSS(AuC 0,73;p0,008). Conclusions: MS patients and controls have similar global SES. Those with more disease progression have worst SES. Patients have greater economic dependence on their families. They have an informal employment more frequently. Finally, we observed a tendency to relegate unnecessary expenses. Disclosure: Dr. Pontello has nothing to disclose. Dr. Racosta has nothing to disclose. Dr. Gonzalez Toledo has nothing to disclose. Dr. Gleichgerrcht has nothing to disclose. Dr. Manes has nothing to disclose. Dr. Sinay has received personal compensation for activities with Bayer, Biogen Idec, Teva Tuteur, Novartis, and Merck Serono. Dr. Sinay has received research support from Merck Serono and Teva Tuteur.

Limb Apraxia in Multiple Sclerosis: Prevalence and Impact on Manual Dexterity and Activities of Daily Living

Kamm CP, Heldner MR, Vanbellingen T, Mattle HP, Müri R, Bohlhalter S. Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living. ObjectiveTo evaluate the prevalence and impact of limb apraxia on manual dexterity and activities of daily living (ADLs) in patients with multiple sclerosis (MS). DesignSurvey. SettingUniversity hospital. ParticipantsConsecutive patients (N=76) with clinically isolated syndrome, relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) or primary progressive multiple sclerosis (PPMS), Expanded Disability Status Scale (EDSS) score from 0 to 6.5, and aged from 18 to 70 years were included. InterventionsNot applicable. Main Outcome MeasuresApraxia was assessed by the apraxia screen of TULIA (AST). The relationship of apraxia with ADLs and manual dexterity was evaluated using a dexterity questionnaire and the coin rotation task, respectively. ResultsOverall, limb apraxia was found in 26.3% of patients (mean AST score ± SD, 7.3±1.3; cutoff <9). Apraxia was significantly correlated with higher EDSS scores, longer disease duration, and higher age with the EDSS being predictive. Furthermore, patients with SPMS and PPMS were more apraxic than patients with RRMS. Finally, limb apraxia was significantly associated with impaired ADLs and manual dexterity. ConclusionsLimb apraxia is a frequent and clinically significant symptom contributing to disability in MS. It should therefore be evaluated and possibly treated, particularly in patients with MS reporting manual difficulties in everyday life.