Highlights of the 29th Congress of the European Committee for Treatment and Research in MS (ECTRIMS), Copenhagen, DK, October 2-5, 2013 – Secondary-progressive MS (SPMS) has been variously defined, but physicians’ determinations may substantially delay the diagnosis, according to an analysis by the MSBase group (Spelman et al. ECTRIMS 2013; abstract 125).
The MSBase database (n=21,348) was used to determine the frequency of SPMS according to three commonly-used definitions: Physician designation; EDSS 4.0; and EDSS 3.0 with a minimum 1-point change in EDSS over the previous two years. Overall, 16.6% of patients met at least one of these definitions of SPMS. Physician designation of SPMS was more specific than EDSS-based definitions: at 9-year follow-up, the median EDSS score was 6.5, and only 28% of patients showed regression of EDSS scores.
With a definition of SPMS as an EDSS score of 4.0, an SPMS diagnosis was made three years earlier, but a majority (57%) showed EDSS regression during follow-up. A definition of EDSS 3.0 with a 1-point change in EDSS enabled an SPMS diagnosis to be made seven years earlier, but 78% showed a regression in EDSS score during follow-up and 79% of patients continued to have relapses.
The authors concluded that physician identification of SPMS is more specific, but occurs later than if EDSS-based definitions are used. This may delay the diagnosis of SPMS and could limit treatment choices if these become available for progressive MS.
Guest Reviewer: Dr. Paul S. Giacomini, Associate Director, MS Clinic, Montreal Neurological Hospital and Institute, Assistant Professor, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec.