The Kurtzke EDSS rank stability increases 4 years after the onset of multiple sclerosis: results from the MSBase Registry

BackgroundThe Expanded Disability Status Scale (EDSS) is widely used to rate multiple sclerosis (MS) disability, but lack of disease duration information limits utility in assessing severity. EDSS ranking at specific disease durations was used to devise the MS Severity Score, which is gaining popula...

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Published in:	Journal of neurology, neurosurgery and psychiatry Vol. 83; no. 3; pp. 305 - 310
Main Authors:	Hughes, Stella, Spelman, Timothy, Trojano, Maria, Lugaresi, Alessandra, Izquierdo, Guillermo, Grand'Maison, Francois, Duquette, Pierre, Girard, Marc, Grammond, Pierre, Oreja-Guevara, Celia, Hupperts, Raymond, Boz, Cavit, Bergamaschi, Roberto, Giuliani, Giorgio, Rio, Maria Edite, Lechner-Scott, Jeannette, van Pesch, Vincent, Iuliano, Gerardo, Fiol, Marcela, Verheul, Freek, Barnett, Michael, Slee, Mark, Herbert, Joseph, Kister, Ilya, Vella, Norbert, Moore, Fraser, Petkovska-Boskova, Tatjana, Shaygannejad, Vahid, Jokubaitis, Vilija, McDonnell, Gavin, Hawkins, Stanley, Kee, Frank, Gray, Orla, Butzkueven, Helmut
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd 01-03-2012 BMJ Publishing Group BMJ Publishing Group LTD
Subjects:	Biological and medical sciences blood–brain barrier clinical neurology CSF Disability Evaluation Disease Progression EDSS ranking EMG Expanded Disability Status Scale (EDSS) functional imaging Guillain–Barre syndrome Humans image analysis interferon Medical sciences Multiple sclerosis Multiple Sclerosis - pathology Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Multiple Sclerosis Severity Score (MSSS) myelopathy neurochemistry neuroepidemiology neurogenetics neuroimmunology Neurology neurourology neurovirology parkinson's disease Patients pet polymyositis predicting MS severity Registries Reproducibility of Results Severity of Illness Index Software Time Factors Australia Nervous system diseases Multiple sclerosis Stability Central nervous system disease Inflammatory disease
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Summary:	BackgroundThe Expanded Disability Status Scale (EDSS) is widely used to rate multiple sclerosis (MS) disability, but lack of disease duration information limits utility in assessing severity. EDSS ranking at specific disease durations was used to devise the MS Severity Score, which is gaining popularity for predicting outcomes. As this requires validation in longitudinal cohorts, we aimed to assess the utility of EDSS ranking as a predictor of 5-year outcome in the MSBase Registry.MethodsRank stability of EDSS over time was examined in the MSBase Registry, a large multicentre MS cohort. Scores were ranked for 5-year intervals, and correlation of rank across intervals was assessed using Spearman's rank correlation. EDSS progression outcomes at 10 years were disaggregated by 5-year EDSS scores.ResultsCorrelation coefficients for EDSS rank over 5-year intervals increased with MS duration: years 1–6=0.55, years 4–9=0.74, years 7–12=0.80 and years 10–15=0.83. EDSS progression risk at 10 years after onset was highly dependent on EDSS at 5 years; one-point progression risk was greater for EDSS score of >2 than ≤2. Two-point progression was uncommon for EDSS score of <2 and more common at EDSS score of 4.ConclusionsEDSS rank stability increases with disease duration, probably due to reduced relapses and less random variation in later disease. After 4 years duration, EDSS rank was highly predictive of EDSS rank 5 years later. Risk of progression by 10 years was highly dependent on EDSS score at 5 years duration. We confirm the utility of EDSS ranking to predict 5-year outcome in individuals 4 years after disease onset.
Bibliography:	ark:/67375/NVC-065X2G3D-2 PMID:22205675 href:jnnp-83-305.pdf ArticleID:jnnp-2011-301051 To see the members of the MSBase Study group see end of article. local:jnnp;83/3/305 istex:24DCFE804293C96403FD6170ACFB9A49F93C0C4E ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0022-3050 1468-330X
DOI:	10.1136/jnnp-2011-301051