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Multiple Sclerosis l: Introduction01:19

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Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
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The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
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Estimating typical multiple sclerosis disability progression speed from clinical observations.

Murray G Brown1, Mark Asbridge2, Vern Hicks3

  • 1Department of Community Health and Epidemiology, Dalhousie University and Capital District Health Authority, Centre for Clinical Research, Halifax, Nova Scotia, Canada.

Plos One
|October 21, 2014
PubMed
Summary
This summary is machine-generated.

Adjusting for missing data in multiple sclerosis (MS) studies reveals faster disability progression. This method reduces variability in natural history estimates for relapsing-onset MS patients.

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Area of Science:

  • Neurology
  • Clinical Epidemiology

Background:

  • Multiple sclerosis (MS) is a chronic central nervous system disease with variable natural history (NH) disability progression estimates.
  • Discrepancies in MS progression speed estimates may stem from censoring bias and assumptions about irreversible disability events.

Purpose of the Study:

  • To evaluate if midpoint survival time assumptions yield faster and more stable MS disability progression estimates compared to maximum survival time assumptions.
  • To assess the impact of censoring-bias-reduction methods on the variability of MS natural history progression estimates.

Main Methods:

  • Utilized data from 2,240 relapsing-onset MS (R-MS) patients in Nova Scotia (1979-2010) with 18,078 Expanded Disability Status Scale (EDSS) observations.
  • Measured progression speed via rate-of-change in EDSS (0-6) and survival time at irreversible endpoints (EDSS 1-9).
  • Applied midpoint censoring-bias-reduction methods to clinical observations.

Main Results:

  • Estimates assuming midpoint survival time were significantly faster (16-21% faster) than those assuming maximum survival time.
  • Typical EDSS increase per year was estimated at 0.168 for all R-MS patients.
  • Variability in progression speed estimates decreased across study groups and time periods when midpoint survival time was assumed.

Conclusions:

  • MS natural history disability progression speed estimates are sensitive to censoring bias and survival time assumptions.
  • Censoring-bias-adjusted estimates for R-MS patients are faster and less variable, offering potentially greater relevance.
  • Applying these bias-reduction methods to other MS databases could decrease worldwide variability in progression speed estimates.