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May 2018; 5 (3) ArticleOpen Access

Treatment choices and neuropsychological symptoms of a large cohort of early MS

Olga von Bismarck, Theresa Dankowski, Björn Ambrosius, Nicole Hessler, Gisela Antony, Andreas Ziegler, Muna-Miriam Hoshi, Lilian Aly, Felix Luessi, Sergiu Groppa, Luisa Klotz, Sven G. Meuth, Björn Tackenberg, Muriel Stoppe, Florian Then Bergh, Hayrettin Tumani, Tania Kümpfel, Martin Stangel, Christoph Heesen, Brigitte Wildemann, Friedemann Paul, Antonios Bayas, Clemens Warnke, Frank Weber, Ralf A. Linker, Ulf Ziemann, Uwe K. Zettl, Frauke Zipp, Heinz Wiendl, Bernhard Hemmer, Ralf Gold, Anke Salmen
First published March 1, 2018, DOI: https://doi.org/10.1212/NXI.0000000000000446
Olga von Bismarck
From the Department of Neurology (O.v.B., B.A., R.G., A.S.), St. Josef-Hospital, Ruhr-University Bochum; Institute of Medical Biometry and Statistics (T.D., N.H., A.Z.), University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck; Central Information Office (CIO) (G.A.), Philipps-University Marburg, Germany; School of Mathematics (A.Z.), Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Department of Neurology (M.-M.H., L.A., B.H.), Klinikum rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (L.A., B.H.); Department of Neurology (F.L., S.G., F.Z.), University Medicine Mainz, Johannes Gutenberg University Mainz; Department of Neurology (L.K., S.G.M., H.W.), University Hospital Münster; Department of Neurology (B.T.), Philipps-University Marburg; Department of Neurology (M.Stoppe, F.T.B.), University of Leipzig; Department of Neurology (H.T.), University of Ulm; Clinic of Neurology Dietenbronn (H.T.), Schwendi; Institute of Clinical Neuroimmunology (T.K.), Ludwig Maximilian University of Munich; Department of Neurology (M.Stangel), Hannover Medical School; Institut für Neuroimmunologie und Multiple Sklerose (C.H.), Universitätsklinikum Hamburg-Eppendorf; Department of Neurology (B.W.), University of Heidelberg; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Charité—University Medicine Berlin and Max Delbrueck Center for Molecular Medicine; Department of Neurology (A.B.), Klinikum Augsburg; Department of Neurology (C.W.), Heinrich-Heine-University, Düsseldorf; Department of Neurology (C.W.), University Hospital Köln; Neurology (F.W.), Max-Planck-Institute of Psychiatry, Munich; Neurological Clinic (F.W.), MATERNUS Kliniken AG, Bad Oeynhausen; Department of Neurology (R.A.L.), University Hospital Erlangen; Department of Neurology & Stroke (U.Z.), Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen; Department of Neurology (U.K.Z.), University of Rostock, Germany; and Department of Neurology (A.S.), Inselspital Bern, University Hospital and University of Bern, Switzerland.
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Theresa Dankowski
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Björn Ambrosius
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Nicole Hessler
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Gisela Antony
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Andreas Ziegler
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Muna-Miriam Hoshi
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Lilian Aly
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Felix Luessi
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Sergiu Groppa
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Luisa Klotz
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Sven G. Meuth
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Björn Tackenberg
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Muriel Stoppe
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Florian Then Bergh
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Hayrettin Tumani
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Tania Kümpfel
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Martin Stangel
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Christoph Heesen
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Brigitte Wildemann
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Friedemann Paul
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Antonios Bayas
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Clemens Warnke
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Frank Weber
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Ralf A. Linker
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Ulf Ziemann
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Uwe K. Zettl
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Frauke Zipp
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Heinz Wiendl
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Bernhard Hemmer
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Ralf Gold
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Anke Salmen
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Citation
Treatment choices and neuropsychological symptoms of a large cohort of early MS
Olga von Bismarck, Theresa Dankowski, Björn Ambrosius, Nicole Hessler, Gisela Antony, Andreas Ziegler, Muna-Miriam Hoshi, Lilian Aly, Felix Luessi, Sergiu Groppa, Luisa Klotz, Sven G. Meuth, Björn Tackenberg, Muriel Stoppe, Florian Then Bergh, Hayrettin Tumani, Tania Kümpfel, Martin Stangel, Christoph Heesen, Brigitte Wildemann, Friedemann Paul, Antonios Bayas, Clemens Warnke, Frank Weber, Ralf A. Linker, Ulf Ziemann, Uwe K. Zettl, Frauke Zipp, Heinz Wiendl, Bernhard Hemmer, Ralf Gold, Anke Salmen
Neurol Neuroimmunol Neuroinflamm May 2018, 5 (3) e446; DOI: 10.1212/NXI.0000000000000446

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Abstract

Objective To assess clinical characteristics, distribution of disease-modifying treatments (DMTs), and neuropsychological symptoms in a large cohort of patients with early-stage MS.

Methods The German National MS Cohort is a multicenter prospective longitudinal cohort study that has recruited DMT-naive patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) since 2010. We evaluated their baseline characteristics and the prevalence of neuropsychological symptoms.

Results Of 1,124 patients, with a 2.2:1 female-to-male ratio and median age at onset of 31.71 years (interquartile range [IQR]: 26.06–40.33), 44.6% and 55.3% had CIS and RRMS, respectively. The median Expanded Disability Status Scale (EDSS) score at baseline was 1.5 (IQR: 1.0–2.0). A proportion of 67.8% of patients started DMT after a median time of 167.0 days (IQR 90.0–377.5) since the first manifestation. A total of 64.7% and 70.4% of the 762 patients receiving early DMT were classified as CIS and RRMS, respectively. Fatigue, depressive symptoms, and cognitive dysfunction were detected in 36.5%, 33.5%, and 14.7% of patients, respectively.

Conclusion Baseline characteristics of this large cohort of patients with early, untreated MS corroborated with other cohorts. Most patients received early DMT within the first year after disease onset, irrespective of a CIS or RRMS diagnosis. Despite the low EDSS score, neuropsychological symptoms affected a relevant proportion of patients.

Glossary

BDI-II=
Beck Depression Inventory II;
BMI=
body mass index;
CI=
confidence interval;
CIS=
clinically isolated syndrome;
DMT=
disease-modifying treatment;
EDSS=
Expanded Disability Status Scale;
FSMC=
Fatigue Scale for Motor and Cognitive Functions;
IQR=
interquartile range;
MSFC=
Multiple Sclerosis Functional Composite;
MUSIC=
Multiple Sclerosis Inventory of Cognition;
RRMS=
relapsing-remitting MS

Footnotes

  • ↵* These authors contributed equally to the manuscript.

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/NN.

  • The Article Processing Charge was funded by the authors.

  • Received November 5, 2017.
  • Accepted in final form January 12, 2018.
  • Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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