Related Experiment Video
Updated: Sep 4, 2025
11:35
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
58.1K
EDSS 0 is not normal: Multiple sclerosis disease burden below the clinical threshold
Stephen C Krieger1, Ali Antoine1, James F Sumowski1
1Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|July 14, 2022
Summary
Early multiple sclerosis (MS) patients with a neurologically normal score (Expanded Disability Status Scale [EDSS] 0) show subtle balance and coordination deficits. These sub-threshold impairments correlate with brain lesions and reduced brain reserve.
Area of Science:
- Neurology
- Neuroimmunology
- Neuroimaging
Background:
- Early multiple sclerosis (MS) often presents with minimal or no apparent disability.
- The Expanded Disability Status Scale (EDSS) is a standard clinical scale, with a score of 0 indicating neurological normality.
- The topographical model suggests functional reserve compensates for early, sub-threshold MS pathology.
Purpose of the Study:
- To investigate if sub-threshold neurological deficits exist in early MS patients classified as neurologically normal (EDSS 0).
- To explore the relationship between these subtle deficits and established markers of MS.
- To assess the utility of high-challenge functional tasks in detecting early MS-related impairments.
Main Methods:
- Recruitment of early MS patients with an EDSS score of 0 and age-matched healthy controls.
- Administration of physically high-challenge tests assessing balance and upper extremity coordination.
- Correlation analysis between challenge task performance and neuroimaging markers (lesional burden, brain volume).
Main Results:
- Patients with MS (EDSS 0) exhibited significant deficits in high-challenge balance and coordination tasks compared to healthy controls.
- Performance on these challenging tasks was inversely correlated with imaging markers of MS, including lesional burden.
- Task performance also correlated with volumetric measures indicative of brain reserve.
Conclusions:
- Physically demanding functional assessments can reveal sub-threshold neurological deficits in early MS, even in individuals with an EDSS score of 0.
- These findings support the topographical model, highlighting the role of functional reserve in masking early disease.
- Sub-threshold deficits identified through challenge tasks are associated with underlying MS pathology and brain reserve, suggesting potential for early detection and monitoring.
