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Prevalence and prognostic value of prodromal symptoms in relapsing-remitting multiple sclerosis
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- Poznan University of Medical Sciences, Poznan, Poland
- Division of Neurochemistry and Neuropathology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
open access
Abstract
Introduction. Several studies have suggested the possibility that disease prodromes might occur months or even years before a multiple sclerosis diagnosis. Objectives. To describe the profile of prodromal symptoms and the possible relationship between the occurrence of individual symptoms and clinical course characteristics in patients with relapsing-remitting multiple sclerosis (RRMS), and to assess their role as predictors of further disease course. Material and methods. The cohort included 564 patients with RRMS. Patients were stratified based on their current EDSS score, and the annual EDSS growth rate was calculated. Logistic Regression Analysis was used to study the relationship between prodromal symptoms and disease progression. Results. The most commonly reported prodromal symptom was fatigue (42%). The following symptoms were significantly more common in women than in men: headache (39.7% vs. 26.5%, p < 0.05), excessive sleepiness (19.1% vs. 11.1%, p < 0.05) and constipation (18.0% vs. 11.1%, p < 0.05). Prodromal urinary and cognitive disturbances, fatigue and pain complaints were significantly more common in patients with the highest annual EDSS increase (p < 0.05). Multivariate analysis revealed some potential predictors of long-term disability progression: hesitancy in starting urination predicted EDSS increase by 0.6 point (p < 0.05), while deterioration in everyday functioning because of cognitive disturbances, and pain complaints, were associated with an EDSS increase of 0.5 (p < 0.05), and 0.4 (p < 0.05), respectively. Conclusions. Prodromal pain, urinary and cognitive complaints (especially when these lead to deterioration of everyday functioning) were associated with a higher EDSS increase rate, and may thus be regarded as possible predictors of worse clinical outcomes in RRMS patients.
Abstract
Introduction. Several studies have suggested the possibility that disease prodromes might occur months or even years before a multiple sclerosis diagnosis. Objectives. To describe the profile of prodromal symptoms and the possible relationship between the occurrence of individual symptoms and clinical course characteristics in patients with relapsing-remitting multiple sclerosis (RRMS), and to assess their role as predictors of further disease course. Material and methods. The cohort included 564 patients with RRMS. Patients were stratified based on their current EDSS score, and the annual EDSS growth rate was calculated. Logistic Regression Analysis was used to study the relationship between prodromal symptoms and disease progression. Results. The most commonly reported prodromal symptom was fatigue (42%). The following symptoms were significantly more common in women than in men: headache (39.7% vs. 26.5%, p < 0.05), excessive sleepiness (19.1% vs. 11.1%, p < 0.05) and constipation (18.0% vs. 11.1%, p < 0.05). Prodromal urinary and cognitive disturbances, fatigue and pain complaints were significantly more common in patients with the highest annual EDSS increase (p < 0.05). Multivariate analysis revealed some potential predictors of long-term disability progression: hesitancy in starting urination predicted EDSS increase by 0.6 point (p < 0.05), while deterioration in everyday functioning because of cognitive disturbances, and pain complaints, were associated with an EDSS increase of 0.5 (p < 0.05), and 0.4 (p < 0.05), respectively. Conclusions. Prodromal pain, urinary and cognitive complaints (especially when these lead to deterioration of everyday functioning) were associated with a higher EDSS increase rate, and may thus be regarded as possible predictors of worse clinical outcomes in RRMS patients.
Keywords
multiple sclerosis, prodromes, disease predictors, RIS, preclinical phase
Title
Prevalence and prognostic value of prodromal symptoms in relapsing-remitting multiple sclerosis
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
289-296
Published online
2023-05-05
Page views
1532
Article views/downloads
527
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2023;57(3):289-296.
Keywords
multiple sclerosis
prodromes
disease predictors
RIS
preclinical phase
Authors
Karolina Kania
Wojciech Ambrosius
Klara Dyczkowska
Wojciech Kozubski
Alicja Kalinowska-Lyszczarz
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