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Thread: Refining the criteria for diagnosing SPMS

  1. #1
    Distinguished Community Member agate's Avatar
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    Default Refining the criteria for diagnosing SPMS

    Sometimes there's a question about how it's decided whether you have SPMS.

    They've either revised their criteria for diagnosing SPMS or become more specific. I can't provide a link to this because it seems to be for subscribers only even though I get e-mails with the content. It's from NEJM Journal Watch, September 6, 2016. Dr. Naismith is reviewing an article that appeared in Brain (July 7):


    August 31, 2016

    Refining the Criteria for Diagnosing Secondary Progressive Multiple Sclerosis

    Robert T. Naismith, MD Reviewing Lorscheider J et al., Brain 2016 Jul 7

    The diagnosis of secondary progressive multiple sclerosis (SPMS) is challenging and often made in retrospect. Investigators used the MSBase dataset to develop an objective measure that reflected long-term disease worsening. MSBase includes clinical data from more than 34,154 patients and 113 MS centers in 34 countries.

    SPMS definitions were based on the following criteria: amount of Expanded Disability Status Scale (EDSS) worsening, minimum EDSS at progression, minimum pyramidal Functional System (FS) score at progression, time to confirmed progression, confirmation within the same FS that triggered the progression, relapse activity prior to progression event, and relapse activity after.

    Of 17,356 patients with sufficient follow-up and complete data, SPMS was diagnosed in 2360 (14%). The best definition included:

    ~A 1-point EDSS worsening with EDSS ≤5.5 or a 0.5-point EDSS worsening with EDSS ≥6.0, in the absence of a relapse

    ~A minimum EDSS score of 4

    ~Pyramidal FS score of ≥2

    ~Confirmed worsening over ≥3 months, and

    ~Confirmation of worsening within the same FS as worsening onset.

    This definition identified 18% of the patients as converting to SPMS. Among those with ≥5 years of follow-up after SPMS diagnosis by this definition, 78% had continuing disability worsening and 70% needed to use at least a cane to walk 100 m. This definition also enabled diagnosis 3 years earlier than a clinical diagnosis of SPMS by the treating physician.


    This refinement of the SPMS research definition will increase the sensitivity and speed of the diagnosis compared with current clinical practice. Most patients who met these criteria continued worsening in subsequent years. Although the criteria may not be 100% specific (86% vs. 95% for clinician diagnosis), they help define a particular high-risk population. With possible therapies for progressive MS on the horizon, making an accurate diagnosis of primary and secondary MS will be increasingly important.
    The Functional Systems (FS) Score ratings:

    A FS score of 2 or higher would mean minimal disability or worse. Level 3 is:

    Mild to moderate paraparesis or hemiparesis (detectable weakness but mostfunction sustained for short periods, fatigue a problem); severe monoparesis (almostno function)
    When they're talking about pyramidal functions, they're talking about the extent to which paralysis is a problem for us.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member SalpalSally's Avatar
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