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Diagnosing secondary progressive multiple sclerosis

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Abstract

A 36-year-old woman initially presented to her neurologist for evaluation of diplopia. A subsequent MRI of the brain without gadolinium enhancement revealed evidence of demyelinating lesions in both cerebral hemispheres demonstrating dissemination in space, including two lesions in the brainstem and one in the pons. On further questioning, the patient recalled a transient episode of right arm numbness 8 years earlier that had fully resolved spontaneously after 4 weeks. At the time, the symptoms were mild and not investigated any further. Four months after her neurological assessment, she had an episode consistent with a partial transverse myelitis, specifically bilateral paresthesias that started in her feet and migrated up to the buttock area over a week, and then in to her fingers bilaterally, with positive Lhermitte’s sign (electric sensation in back and/or limbs). Her Expanded Disability Severity Scale (EDSS) at this time was 2.5. She was diagnosed with relapsing-remitting multiple sclerosis (RRMS) and started on disease-modifying therapy (DMT).

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References

  1. Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain. 1989;112(Pt 1):133-146.

    Google Scholar 

  2. Koch M, Kingwell E, Rieckmann P, Tremlett H, Neurologists UMC. The natural history of secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2010;81:1039-1043.

    Google Scholar 

  3. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46:907-911.

    Google Scholar 

  4. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83:278-286.

    Google Scholar 

  5. Polman C, Reingold SC, Banwell, B., et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald Criteria. Ann Neurol. 2011;69:292-302.6.

    Google Scholar 

  6. Katz Sand I, Krieger S, Farrell C, Miller AE. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis. Mult Scler. 2014;20:1654-1657.

    Google Scholar 

  7. Bosma L, Kragt JJ, Polman CH, Uitdehaag BM. Walking speed, rather than Expanded Disability Status Scale, relates to long-term patient-reported impact in progressive MS. Mult Scler. 2013;19:326-333.

    Google Scholar 

  8. Bosma LV, Kragt JJ, Knol DL, Polman CH, Uitdehaag BM. Clinical scales in progressive MS: predicting long-term disability. Mult Scler. 2012;18:345-350.

    Google Scholar 

  9. Coleman CI, Sobieraj DM, Marinucci LN. Minimally important clinical difference of the Timed 25-Foot Walk Test: results from a randomized controlled trial in patients with multiple sclerosis. Curr Med Res Opin. 2012;28:49-56.

    Google Scholar 

  10. Hobart J, Blight AR, Goodman A, Lynn F, Putzki N. Timed 25-foot walk: direct evidence that improving 20% or greater is clinically meaningful in MS. Neurology. 2013;80:1509-1517.

    Google Scholar 

  11. Schwid SR, Goodman AD, McDermott MP, Bever CF, Cook SD. Quantitative functional measures in MS: what is a reliable change? Neurology. 2002;58:1294-1296.

    Google Scholar 

  12. Kragt JJ, van der Linden FA, Nielsen JM, Uitdehaag BM, Polman CH. Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis. Mult Scler. 2006;12:594-598.

    Google Scholar 

  13. van Winsen LM, Kragt JJ, Hoogervorst EL, Polman CH, Uitdehaag BM. Outcome measurement in multiple sclerosis: detection of clinically relevant improvement. Mult Scler. 2010;16:604-610.

    Google Scholar 

  14. Lassmann H, van Horssen J, Mahad D. Progressive multiple sclerosis: pathology and pathogenesis. Nat Rev Neurol. 2012;8:647-656.

    Google Scholar 

  15. Placebo-controlled multicentre randomised trial of interferon beta-1b in treatment of secondary progressive multiple sclerosis. European Study Group on interferon beta-1b in secondary progressive MS. Lancet. 1998;352:1491-1497.

    Google Scholar 

  16. Panitch H, Miller A, Paty D, Weinshenker B; North American Study Group on Interferon beta-1b in Secondary Progressive MS. Interferon beta-1b in secondary progressive MS: results from a 3-year controlled study. Neurology. 2004;63:1788-1795.

    Google Scholar 

  17. Kappos L, Weinshenker B, Pozzilli C, et al. Interferon beta-1b in secondary progressive MS: a combined analysis of the two trials. Neurology. 2004;63:1779-1787.

    Google Scholar 

  18. Cohen JA, Cutter GR, Fischer JS, Goodman AD, Heidenreich FR, Kooijmans MF, et al. Benefit of interferon beta-1a on MSFC progression in secondary progressive MS. Neurology. 2002;59:679-687.

    Google Scholar 

  19. Secondary Progressive Efficacy Clinical Trial of Recombinant Interferon-Beta-1a in MS (SPECTRIMS) study group. Randomized controlled trial of interferon- beta-1a in secondary progressive MS: clinical results. Neurology. 2001;56:1496-1504.

    Google Scholar 

  20. Andersen O, Elovaara I, Farkkila M, et al. Multicentre, randomised, double blind, placebo controlled, phase III study of weekly, low dose, subcutaneous interferon beta-1a in secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2004;75:706-710.

    Google Scholar 

  21. La Mantia L, Vacchi L, Di Pietrantonj C, et al. Interferon beta for secondary progressive multiple sclerosis. Cochrane Database Syst Rev. 2012;1:CD005181.

    Google Scholar 

  22. Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000;343:1430-1438.

    Google Scholar 

  23. Paz Soldan MM, Novotna M, Abou Zeid N, et al. Relapses and disability accumulation in progressive multiple sclerosis. Neurology. 2015;84:81-88.

    Google Scholar 

  24. Martinelli Boneschi F, Vacchi L, Rovaris M, Capra R, Comi G. Mitoxantrone for multiple sclerosis. Cochrane Database Syst Rev. 2013;5:CD002127.

    Google Scholar 

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Author information

Authors and Affiliations

  1. London Health Sciences Multiple Sclerosis Clinic, University of Western Ontario, London, Ontario, Canada

    Sarah Morrow

  2. University of Western Ontario, London, Ontario, Canada

    Sarah Morrow

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  1. Sarah Morrow
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Editors and Affiliations

  1. McGill University , MONTREAL, Québec, Canada

    Paul S. Giacomini

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Morrow, S. (2017). Diagnosing secondary progressive multiple sclerosis. In: Giacomini, P. (eds) Case Studies in Multiple Sclerosis. Adis, Cham. https://doi.org/10.1007/978-3-319-31190-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-31190-6_10

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  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-31188-3

  • Online ISBN: 978-3-319-31190-6

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