Disability in multiple sclerosis A reference for patients and clinicians

作者：Kister Ilya^*; Chamot Eric; Salter Amber R; Cutter Gary R; Bacon Tamar E; Herbert Joseph

来源：Neurology, 2013, 80(11): 1018-1024.

DOI：10.1212/WNL.0b013e3182872855

Objective: To create a reference table of disability outcomes in multiple sclerosis (MS) that would enable patients to rank their disability relative to others%26apos; with similar disease duration and to develop a cost-effective research tool for comparing MS severity across patient populations and time periods. %26lt;br%26gt;Methods: The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry collects disability data from patients with MS on a validated, 9-point Patient-Determined Disease Steps (PDDS) scale. We compiled the Disability Expectancy Table, which displays cumulative frequencies of PDDS scores for each year of disease duration, from 0 to 45 years. We also tabulated disease duration-adjusted mean ranks of PDDS scores, referred to as Patient-derived MS Severity Scores (P-MSSS). %26lt;br%26gt;Results: The cohort consisted of 27,918 NARCOMS enrollees, 72.7% of whom were female and 90.1% of whom were white. Mean age at symptom onset was 30.1 +/- 10.1 years, and age at enrollment was 47.1 +/- 11.0 years. The Disability Expectancy Table and P-MSSS afford a detailed overview of disability outcomes in a large MS cohort over a 45-year period. In the first year of disease, 15% of patients reported need of ambulatory aid, and 4% needed bilateral assistance or worse; after 45 years of disease, 76% of patients required ambulatory aid, and 52% bilateral assistance or worse. Proportion of patients who reported minimal or no interference in daily activities (PDDS %26lt;= 1) declined from 63% in the first year to 8% after 45 years of disease. %26lt;br%26gt;Conclusion: The Disability Expectancy Table allows individual patients to determine how their disability ranks relative to NARCOMS enrollees with the same disease duration. P-MSSS may be used to compare disability across patient populations and to track disease progression in patient cohorts. P-MSSS does not require a formal neurologic examination and may therefore find wide applicability as a practical and cost-effective outcome measure in epidemiologic studies. Neurology (R) 2013; 80: 1018-1024

• 出版日期2013-3