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Upper Extremity Composite Picks Up Early MS

Image Source: BLOGSPOT

Outperformed individual tests that may be less sensitive

A composite score for upper extremity function in multiple sclerosis was more sensitive than individual traditional tests in a small trial, and correlated well with neuroimaging markers of disability, researchers reported here.

Cross-sectional data from 105 patients with early MS showed that the Upper Extremity Score (UES), combining results from four tests of hand/arm function, was better at discerning those with disease from 33 healthy controls compared with its individual component tests alone, Asaff Harel, MD, of Mount Sinai Hospital in New York, and colleagues reported during an oral session at the joint ECTRIMS-ACTRIMS meeting here.

It also aided in the development of neuroimaging markers of upper extremity dysfunction, showing that thalamic volume was the best predictor of UES score, followed by cervical spine lesion count, Harel said.

"The topographic model of MS suggests there's disease under the threshold of clinical detection, and over time with loss of reserve, that disease becomes more apparent," Harel said. "We are increasing our ability to detect that disease under the surface."

He added that the UES may be useful to predict which patients will worsen or go on to develop progressive disease. "We hypothesize that deficits that emerge under high challenge testing may be harbingers of future deterioration," he said.

Harel said that patients may report a decline in upper extremity function even if their clinical exam is normal, describing available routine clinical measures as crude. In addition, a common measure of disability – the Expanded Disability Status Scale (EDSS) – is weighted towards lower limb function.

To determine whether a composite score is a better measure of patient-reported upper extremity function, Harel and colleagues looked at baseline data from 105 patients with early MS enrolled in the RESERVE trial. Most had relapsing-remitting MS (87) while 18 had clinically isolated syndrome (CIS); they were compared with 33 healthy controls. Mean age was 34, and MS patients were diagnosed within the last two years and had a relatively low EDSS score.

Harel said that while all four tests could differentiate between those with MS and healthy controls, the UES "allowed us to do that more easily." For instance, the 9-hole peg test z-score of 0.54 was significant at P=0.01, but the UES composite z-score of -0.49 was significant at P=0.001.

All patients had both T1 and T2 brain imaging, and the researchers found that the best predictor of UES composite z-score was thalamic volume, accounting for 18% of the variance with an effect size of 0.185 (P<0.001).

"It makes sense to be one of the best predictors because it's a relay center with a lot of sensory function and it connects to a host of different structures in the brain," Harel said.

The next best predictor was cervical spine lesion count, accounting for an additional 6% of the variance, with an effect size of 0.063 (P=0.005), followed by cerebellar volume and putaminal volume, both of which were also significant.

To assess whether the UES was able to reflect patient-reported outcomes, the researchers used three questions from the Multiple Sclerosis Impact Scale (MSIS) questionnaire that dealt with gripping tightly, carrying, and using the hands in everyday tasks. They separated the groups into those with no deficits, mild deficits, and moderate deficits, and found statistically significant differences in UES scores between those three groups.

Story Source: The above story is based on materials provided by MEDPAGETODAY
Note: Materials may be edited for content and length

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