Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS?

Nicolò Margaritella; Laura Mendozzi; Massimo Garegnani; Raffaello Nemni; Elena Colicino; Elisabetta Gilardi; Luigi Pugnetti

doi:10.1186/1471-2377-12-80

Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS?

Nicolò Margaritella, Laura Mendozzi, Massimo Garegnani, Raffaello Nemni, Elena Colicino, Elisabetta Gilardi, Luigi Pugnetti^*

^*Corresponding author for this work

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Abstract

Background: The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration.

Methods: We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009-2011.

Results: The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15-20 points), short TT2 (lower than 3-5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4-5 years and rapidly decreased thereafter.

Conclusions: In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).

Original language	English
Article number	80
Number of pages	11
Journal	BMC Neurology
Volume	12
DOIs	https://doi.org/10.1186/1471-2377-12-80
Publication status	Published - 22 Aug 2012

Keywords

Adult
Early diagnosis
Electroencephalography/methods
Evoked potentials, somatosensory
Female
Humans
Male
Multiple Sclerosis/diagnosis
Reproducibility of results
Sensitivity and specificity
Severity of illness index

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Margaritella_2012_BMC-N_predictive-value-evoked-potenitals-score-MS_CC
Copyright © 2012 Margaritella et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Cite this

@article{b0ed7aaea3cc417aa66ac582c75b7117,

title = "Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS?",

abstract = "Background: The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration.Methods: We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009-2011.Results: The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15-20 points), short TT2 (lower than 3-5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4-5 years and rapidly decreased thereafter.Conclusions: In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).",

keywords = "Adult, Early diagnosis, Electroencephalography/methods, Evoked potentials, somatosensory, Female, Humans, Male, Multiple Sclerosis/diagnosis, Reproducibility of results, Sensitivity and specificity, Severity of illness index",

author = "Nicol{\`o} Margaritella and Laura Mendozzi and Massimo Garegnani and Raffaello Nemni and Elena Colicino and Elisabetta Gilardi and Luigi Pugnetti",

note = "This study was supported by the Italian Ministry of Health, Ricerca Corrente funding plan to the institutional research activity of the Scientific Institute S. Maria Nascente of the Don C. Gnocchi Foundation.",

year = "2012",

month = aug,

day = "22",

doi = "10.1186/1471-2377-12-80",

language = "English",

volume = "12",

journal = "BMC Neurology",

issn = "1471-2377",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population

T2 - a hint for an early identification of benign MS?

AU - Margaritella, Nicolò

AU - Mendozzi, Laura

AU - Garegnani, Massimo

AU - Nemni, Raffaello

AU - Colicino, Elena

AU - Gilardi, Elisabetta

AU - Pugnetti, Luigi

N1 - This study was supported by the Italian Ministry of Health, Ricerca Corrente funding plan to the institutional research activity of the Scientific Institute S. Maria Nascente of the Don C. Gnocchi Foundation.

PY - 2012/8/22

Y1 - 2012/8/22

N2 - Background: The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration.Methods: We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009-2011.Results: The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15-20 points), short TT2 (lower than 3-5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4-5 years and rapidly decreased thereafter.Conclusions: In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).

AB - Background: The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration.Methods: We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009-2011.Results: The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15-20 points), short TT2 (lower than 3-5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4-5 years and rapidly decreased thereafter.Conclusions: In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).

KW - Adult

KW - Early diagnosis

KW - Electroencephalography/methods

KW - Evoked potentials, somatosensory

KW - Female

KW - Humans

KW - Male

KW - Multiple Sclerosis/diagnosis

KW - Reproducibility of results

KW - Sensitivity and specificity

KW - Severity of illness index

U2 - 10.1186/1471-2377-12-80

DO - 10.1186/1471-2377-12-80

M3 - Article

C2 - 22913733

SN - 1471-2377

VL - 12

JO - BMC Neurology

JF - BMC Neurology

M1 - 80

ER -

Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS?

Abstract

Keywords

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