The proportions of LOMS and YOMS patients who reached EDSS 6.0 during follow-up were 19.2% and 15.7% respectively Table 2. probability estimates of not attaining a score of 6.0 on Expanded Disability Status Scale (EDSS) among cohorts with young-onset (YOMS) or late-onset (LOMS). All patients gave their written informed consents for the use of their data for research purposes. The institutional research board (IRB) of Ministry Of Health approved data collection of the national MS registry. The adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were used to interpret the final model. Multivariable Cox proportional hazards model was used to identify demographic and clinical factors significantly ( p < 0.05) and independently associated with time to EDSS 6.0 in LOMS compared to YOMS cohort. The variables significantly ( p ≤ 0.15) related with time to EDSS 6.0 on univariable analysis were considered for inclusion in multivariable analysis. Kaplan-Meier survival curves were used to compare the EDSS 6.0-free experience of LOMS and YOMS cohorts during the follow-up period.
Baseline characteristics of both LOMS and YOMS cohorts were summarized as frequencies (%) or median with inter-quartile range (IQR) and compared using log-rank or Mann-Whitney tests as appropriate. We assessed the risk of attaining EDSS 6.0 in LOMS and YOMS cohorts during follow-up. The EDSS score had to be confirmed by a subsequent visit (at least 6 months from the baseline entry) and sustained such that every subsequent disability score was EDSS 6 or higher. The main outcome was time to a sustained EDSS 6.0, defined as “intermittent or unilateral constant assistance required to walk about 100 meters with or without resting”. Symptoms at onset were classified as supratentorial, visual pathway, cerebellar/ brainstem and spinal in order to improve the understanding of the anatomical location and functional impact of the first symptomatic lesion. Patients with pediatric-onset ( 40 years were classified as late-onset MS (LOMS) cohort while those who presented between 18 and 40 years of age were classified as young-onset MS (YOMS).įor both LOMS and YOMS cohorts, data on gender, presentation at onset, disease duration, number of relapses, expanded disability status scale (EDSS) scores, prior/ ongoing DMTs were extracted from the registry database on December 31, 2015. MS patients with a relapsing onset and who had at least two EDSS assessments (in order to assess for EDSS changes) were included in the study. Once entered in the registry, patients were followed prospectively on regular basis (at least one visit every 6 months as per the registry protocol irrespective of relapses) and their clinical data were updated in the registry. An initial and a follow-up assessment sheets were provided to all hospitals to be filled by the treating neurologists. All patients had been assessed by neurologists experienced in MS diagnosis using the revised 2010 McDonald diagnostic criteria, and classified either as relapsing remitting (RR), secondary progressive (SP), or primary progressive (PP) MS. The registry included the neurology tertiary hospital and other peripheral hospitals that have neurology units and MS clinics. Established in 2010, this registry accounted for nearly 98% of the MS patients diagnosed in Kuwait. This cross-sectional cohort study was conducted using data from Kuwait National MS Registry (KNMSR). In this study, we aimed to assess the risk of reaching sustained EDSS 6.0 among LOMS and YOMS cohorts and to evaluate associated demographic and clinical predictors using techniques of time to event analysis. Despite the increasing MS prevalence in the Middle East, published epidemiological data on LOMS patients are scarce. It was suggested that LOMS was associated with a poor prognosis that might have implications for initiation of aggressive therapy. There were conflicting reports on the rate of disease progression in this particular group. The clinical presentation and course of LOMS seem to be different from those with young onset MS (YOMS), which may lead to possible misdiagnosis with other white matter diseases. Since the diagnosis of MS in older patients presents unique challenges, few studies have studied the natural history of late onset MS (LOMS). As the general population ages, the MS prevalence in older adults rises and approximately 20% of MS patients experienced their first symptoms after age 40. The onset of multiple sclerosis (MS) typically occurs between the ages of 20 and 40 years however, a wide spectrum exists since patients outside the age range have been increasingly diagnosed.
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