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Disability progression
Learning objectives
This module was produced during the 2021 quarantine, where filming has been conducted remotely to adhere to social distancing guidelines. For this reason, please forgive a lower production quality than you are used to seeing from us.This module is intended to help you:
- Understand the mechanisms underlying disability progression
- Appreciate the evolving relationship between disability progression and relapses
- Be aware of different ways to assess disability progression
- Be able to implement steps to improve the management of disability progression
Please click continue to proceed.
What is the most important predictor
of permanent disability?
Select the correct answer(s)
The extent of axonal loss in the spinal cord is the most important predictor of permanent disability.1,2
Please click continue to proceed.
Which of the following instruments can
be used to evaluate cognitive function?
Select the correct answer(s)
The EDSS measures cerebral functions, although it has been found to be inadequate
in evaluating cognitive function.1 The MSFC also examines cognitive function via the Paced Auditory Serial Addition
Test (PASAT), as part of its clinical dimensions.1
in evaluating cognitive function.1 The MSFC also examines cognitive function via the Paced Auditory Serial Addition
Test (PASAT), as part of its clinical dimensions.1
- Giovannoni G, et al. Mult Scler Relat Disord 2016;9(Suppl. 1):S5–48.
- Hauser SL, et al. Am J Med 2020;133:1380–90.
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- Smith AL, et al. Neurotherapeutics 2017;14:952–60.
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- Craner MJ, et al. Glia 2005;49:220–9.
- Faissner S, et al. Nat Rev Drug Discov 2019;18:905–22.
- Nourbakhsh B, et al. Contin (Minneap Minn) 2019;25:596–610.
- Rojas JI, et al. Arq Neuropsiquiatr 2016;74:235–43.
- Filippi M, et al. Brain 2003;126:433–7.
- Bjartmar C, et al. Ann Neurol 2000;48:893–901.
- De Stefano N, et al. Ann Neurol 1995;38:901–9.
- Fisniku LK, et al. Ann Neurol 2008;64:247–54.
- Kappos L, et al. JAMA Neurol 2020;77:1–9.
- Cree BAC, et al. Ann Neurol 2019;85:653–66.
- Jokubaitis VG, et al. Ann Neurol 2016;80:89–100.
- Meyer-Moock S, et al. BMC Neurol 2014;14:58.
- Rudick RA, et al. Arch Neurol 2010;67:1329–35.
- Kurtzke JF. Neurology 1983;33:1444–52.
- Demir S. Noro Psikiyatr Ars 2018;55(Suppl. 1):S66–8.
- Kalincik T, et al. Brain 2015;138:3287–98.
- LaRocca NG, et al. Mult Scler 2018;24:1469–84.
- Angelini L, et al. J Neurol 2020;267:2897–909.
- Renner A, et al. J Neuropsychol 2020;14:347–69.
- Nolan RC, et al. J Neuroophthalmol 2018;38:202–9.
- D’Amico E, et al. Mult Scler Relat Disord 2019;33:61–6.
- Tarlov AR. JAMA 1989;262:925–30.
- Penner IK, et al. Mult Scler 2009;15:1509–17.
- Beck AT, et al. J Pers Assess 1996;67:588–97.
- Atkinson MJ, et al. Health Qual Life Outcomes 2004;2:12.
- Managing disability progression. Neurologybytes. 2018. https://www.neurologybytes.com/events-cme/34th-congress-of-the-european-committee-for-treatment-and-research-in-multiple-sclerosis-ectrims/meet-the-experts---francesco-patti/ (accessed June 25, 2020).
- D’Amico E, et al. Funct Neurol 2016;31:21–3.
- Thompson AJ, et al. Lancet 2018;391:1622–36.
- Hedström AK, et al. Neurology 2014;82:865–72.
- Hempel S, et al. Mult Scler 2017;23:525–33.
- Manouchehrinia A, et al. Brain 2013;136:2298–304.
- Degelman ML, et al. Mult Scler Relat Disord 2017;17:207–16.
- Handel AE, et al. PLoS One 2011;6:e16149.
- Dobson R, et al. Eur J Neurol 2019;26:27–40.
- Palace J, et al. J Neurol Neurosurg Psychiatry 2019;90:251–60.
- Chalmer TA, et al. Eur J Neurol 2018;25:1262-e110.
- Brown JWL, et al. JAMA 2019;321:175–87.
- He A, et al. Lancet Neurol 2020;19:307–16.
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- Ontaneda D, et al. Contemp Clin Trials 2020;95:106009.
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- Henstridge CM, et al. Front Cell Neurosci 2019;13:63.
- MS Trust. Expanded Disability Status Scale (EDSS) 2020. Available at https://www.mstrust.org.uk/a-z/expanded-disability-status-scale-edss. Accessed September 2020.
- Balcer LJ, et al. Brain 2015;138:11–27.
- Benedict RH, et al. Mult Scler 2017;23:721–33.
- Goldman MD, et al. Neurology 2019;93:E1921–31.
- Balcer LJ, et al. Mult Scler 2017;23:734–47.
Which of the following is NOT a patient-reported outcomes measure (PROM) that can be used to assess patients with MS?
Select the correct answer(s)
The Symbol Digit Modalities Test (SDMT) is an objective screening instrument that detects cognitive impairment by measuring concentration and decision-making.1
- Benedict RH, et al. Mult Scler 2017;23(5):721–33.
Of the answers provided, what time period is considered most accurate to estimate accumulation of permanent disability in clinical trials?
Select the correct answer
12- or 24-month confirmed disability progression may provide more accurate evaluation of irreversible disability accrual compared to 3- or 6-months.1
- Kalincik T, et al. Brain 2015;138:3287–98.
In the Danish register-based cohort study, in what range was the percentage increase in hazard rate of reaching an EDSS of 6 for starting DMT later vs early-treated patients?
Select the correct answer
A Danish register-based cohort study observed that patients who started injectable DMT later* showed a 42% increased hazard rate of reaching an EDSS score of 6 compared with the early-treated* patients.1
*‘Early-treated’ is defined as starting within two years after first MS symptom, ‘later’ is defined as treatment started between 2–8 years after clinical onset. DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale.
DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale.
- Chalmer TA, et al. Eur J Neurol 2018;25:1262–e110.
Which of the following does the MSFC currently fail to evaluate?
Select the correct answer(s)
The MSFC currently lacks a visual dimension.1 However, several studies have suggested adding low-contrast visual acuity (a test of visual impairment) to the composite of tests.2,3
MSFC, Multiple Sclerosis Functional Composite.
- Meyer-Moock S, et al. BMC Neurol 2014;14:58.
- Goldman MD, et al. Neurology 2019;93:E1921–31.
- Balcer LJ, et al. Mult Scler 2017;23:734–47.
Congratulations!
You have completed module 7
Disability progression
Disability progression can impact a patient’s quality of life. This module outlines our current understanding of the mechanisms underlying disability progression, and looks at ways to prevent, assess and manage it.
Length
12 min course
Job code
NPS-TPE-NP-00176
