scholarly journals Plasma Exchange in Secondary Progressive Multiple Sclerosis: Twenty-Five Year Follow-Up Study

2013 ◽  
Vol 01 (01) ◽  
Author(s):  
Bhupendra O Khatri ◽  
Sergey Tarima
Keyword(s):  
Multiple Sclerosis ◽  
Plasma Exchange ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Follow Up Study

Plasma exchange therapy for steroid-refractory superimposed relapses in secondary progressive multiple sclerosis

2007 ◽  
Vol 254 (9) ◽  
pp. 1288-1289 ◽  
Author(s):  
Ralf A. Linker ◽  
Andrew Chan ◽  
Martin Sommer ◽  
Michael Koziolek ◽  
Gerhard-Anton Müller ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Plasma Exchange ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Plasma Exchange Therapy ◽  
Steroid Refractory

Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis

2014 ◽  
Vol 20 (12) ◽  
pp. 1654-1657 ◽  
Author(s):  
Ilana Katz Sand ◽  
Stephen Krieger ◽  
Colleen Farrell ◽  
Aaron E Miller
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Transition Period ◽  
Clinical Phenotype ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Diagnostic Uncertainty ◽  
Secondary Progressive ◽  
Relapsing Remitting

Secondary progressive multiple sclerosis (MS) is typically defined as deterioration independent of relapses for ≥ 6 months following an initial relapsing–remitting course; however, this definition is not always easily applied in clinical practice and the declaration of the change in clinical phenotype is often delayed. To identify the length of time required to re-classify relapsing–remitting MS (RRMS) patients whom have clinically transitioned to secondary progressive MS (SPMS) in clinical practice. We reviewed 123 patients with long-term follow-up and identified a sub-group whom transitioned from RRMS to SPMS, then characterized this transition period. There were 14/20 patients who transitioned during the follow-up period that had visits with uncertainty related to the clinical phenotype characterized by possible, but not definitive progression. The mean duration of this period of uncertainty was 2.9 ± 0.8 years. A period of diagnostic uncertainty regarding the transition from RRMS to SPMS existed in many of our patients. Potential reasons included the subtle nature of early progressive disease and caution in applying a progressive label, in light of the lack of evidence-based treatments as well as third-party payer concerns. Delay in definitive identification of an SPMS phenotype has a variety of implications related to patient care and research.

scholarly journals A 10-year follow-up of the European multicenter trial of interferon β-1b in secondary-progressive multiple sclerosis

2015 ◽  
Vol 22 (4) ◽  
pp. 533-543 ◽  
Author(s):  
J Kuhle ◽  
M Hardmeier ◽  
G Disanto ◽  
K Gugleta ◽  
M Ecsedi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Controlled Trial ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Analysis Of Covariance ◽  
Long Term Effects ◽  
Long Term Outcome ◽  
Secondary Progressive

Objectives: To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b). Methods: We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied. Results: Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R2: 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited ( R2: 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability. Conclusions: The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.

scholarly journals Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026421 ◽  
Author(s):  
Angeliki Bogosian ◽  
Myfanwy Morgan ◽  
Rona Moss-Morris
Keyword(s):  
Multiple Sclerosis ◽  
Qualitative Interviews ◽  
Healthcare Services ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Multiple Challenges ◽  
Physical Challenges ◽  
Progressive Stage

ObjectivesTransitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years).DesignSemistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis.SettingUK.ParticipantsWe interviewed 21 people at baseline and 17 participated in the follow-up interviews.ResultsThe majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS.ConclusionsAfter transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management.

scholarly journals Guanidinoacetate–creatine in secondary progressive multiple sclerosis: a case report

2022 ◽  
Vol 50 (1) ◽  
pp. 030006052110733
Author(s):  
Sergej M. Ostojic ◽  
Jelena Ostojic ◽  
Dragana Zanini ◽  
Tatjana Jezdimirovic ◽  
Valdemar Stajer
Keyword(s):  
Multiple Sclerosis ◽  
Interferon Beta ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Resonance Spectroscopy ◽  
Limited Disease ◽  
Secondary Progressive ◽  
Oral Corticosteroids ◽  
Disease Modifying

Acute secondary progressive multiple sclerosis (SPMS) is characterized by escalating neurological disability, with limited disease-modifying therapeutic options. A 48-year-old woman with acute SPMS being treated with interferon beta-1a and oral corticosteroids presented as a clinical outpatient with no disease-modifying effects after treatment. A decision was made to treat her with a combination of guanidinoacetate and creatine for 21 days. She had made clinical progress at follow-up, with the intensity of fatigue dropping from severe to mild. Magnetic resonance spectroscopy revealed increased brain choline, creatine, N-acetylaspartate, and glutathione. Patients with SPMS may benefit from guanidinoacetate–creatine treatment in terms of patient- and clinician-reported outcomes; this requires additional study.

scholarly journals Decreasing impact of late relapses on disability worsening in secondary progressive multiple sclerosis

2019 ◽  
Vol 26 (8) ◽  
pp. 924-935
Author(s):  
Kevin Ahrweiller ◽  
Chloé Rousseau ◽  
Emmanuelle Le Page ◽  
Emma Bajeux ◽  
Emmanuelle Leray ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Short Term ◽  
Secondary Progressive ◽  
Increased Risk ◽  
Disability Status ◽  
Long Term Follow Up

Background: Changes in relapse activity during secondary progressive multiple sclerosis (SPMS) need to be accurately characterized in order to identify patients who might benefit from continuing disease-modifying therapies. Objective: To describe relapse occurrence in patients with SPMS during long-term follow-up and assess its impact on disability worsening. Methods: This retrospective cohort study included 506 patients. We assessed the influence of relapses on time from SPMS onset to an Expanded Disability Status Scale score of 6 (EDSS 6), and on irreversible worsening of EDSS scores across different periods. Results: The annualized relapse rate (ARR) decreased with patient’s age (mean reduction of 43% per decade) and SPMS duration (mean reduction of 46% every 5 years). Post-progression relapses were associated with shorter time from secondary progressive (SP) phase onset to EDSS 6 (hazard ratio (HR) = 1.29, 95% confidence interval (CI) = (1.01, 1.64)). Relapse occurrence during the first 3 years and 3–5 years after SP onset was associated with an increased risk of irreversible EDSS worsening (OR = 3.12 (1.54, 6.31) and 2.04 (1.16, 3.58)). This association was no longer significant after 5 years. Conclusion: The occurrence of relapses was a marker of short-term disability progression during early SPMS, but did not have decisive impact in later SPMS.

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