IDENTIFYING PATIENT TRANSITIONS IN MULTIPLE SCLEROSIS

Mary,* 37 Years

Diagnosed with RRMS in 2015

 

A high school science teacher who initally presented in 2014 with leg weakness, foot drop, and a history of optic neuritis. Mary is currently on disease modifying therapy.

 

What is Mary's current Diagnosis? 

 

 

Patient Notes*

Expanded Disability Status Scale (EDSS)2

Sustained progression of disease is predicted by a minimum score of 4,3 and an increase in EDSS score of at least one point (for scores ≤5.5), measured over two time points, at least three months apart.4

 


 

Patient Notes*

Relapses

  • Four relapses in the past year

  • Unresolved symptoms since most recent relapse:

    • Double vision

    • Balance issues

    • Problems picking things up (fine motor skills)

    • Leg pain

    • Increasing fatigue

Current Symptoms

  • Double vision

  • Balance issues

  • Numbness and tingling in the fingers

  • Leg pain

  • Increasing fatigue

  • Difficulty with processing information

Functioning

Symptoms have impacted Jennifer's ability to care
for her children and other daily activities

 

 

 

As a physical sensation it reminds me of falling into quicksand/a swamp - it's a viscous, heavy, pulling feeling, but if I try to fight it, it hurts like hell and robs me of breath. As a sound, it's like a muted background noise of violins, scratching away, that seem to be ever increasing in speed and out of sync - while the outside world seems dampened and fading.12**

**Actual patient testimonial.


Patient History*

Clinical data6 from 6 months ago

Lab work

  • A lumbar puncture demonstrated oligoclonal bands and mildly elevated CSF protein

 

Evoked potentials

  • Somatosensory evoked potentials (SSEPs) normal

T25FW7,8

3.9


Modified Fatigue Impact Scale9,10

35 

Total Score

 


Brain MRI

 

Multiple periventricular lesions

 

 

 

 

 

 

 

Permission granted by Medscape5

Spinal MRI

 

Not available

 

 

 

 

 

 

 
 
 

 

Current Test Results*

Current results

Lab work

  • CSF not available

 

Evoked potentials

  • SSEPs within normal limits

T25FW7,8

 3.9


Modified Fatigue Impact Scale9,10

 35 

Total Score


Brain MRI

 

MRI of the head 3 months later

 

 

 

 

 

 

 

Permission granted by Medscape5

Spinal MRI

 

Not available

 

 

 

 

 

 
 
Permission granted by Springer International Publishing11

*Not a real patient.
CSF, cerebrospinal fluid; EDSS, Expanded Disability Status Scale; MRI, magnetic resonance imaging; RRMS, relapsing-remitting multiple sclerosis; SSEP, somatosensory evoked potential; T25FW, timed 25-foot walk.
  1. Burtchell J, Fetty K, Miller K, Minden K, et al. Two sides to every story: Perspectives from four patients and a healthcare professional on multiple sclerosis disease progression. Neurol Ther. 2019;8:185-205.
  2. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-1452.
  3. Lorscheider J, Buzzard K, Jokubaitis V, et al. Defining secondary progressive multiple sclerosis. Brain. 2016;139(Pt 9):2395-2405.
  4. Kalincik T, Cutter G, Spelman T, et al. Defining reliable disability outcomes in multiple sclerosis. Brain. 2015;138(Pt 11):3287-3298.
  5. Luzzio C. Multiple sclerosis. Accessed March 13, 2020. https://emedicine.medscape.com/article/1146199
  6. Tur C, Moccia M, Markhof F, et al. Assessing treatment outcomes in multiple sclerosis trials and in the clinical setting. Nat Rev Neurol. 2018;14(2):75-93.
  7. Fischer JS, Jak AJ, Kniker JE, et al. Multiple Sclerosis Functional Composite (MSFC). Accessed March 29, 2020. Administration and Scoring Manual. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFile...
  8. Phan-Ba R, Pace A, Calay P, et al. Comparison of the timed 25-foot and the 100-meter walk as performance measures in multiple sclerosis. Neurorehabil Neural Repair. 2011;25(7):672-679
  9. Ritvo PG, Fischer JS, Miller DM, et al. Multiple Sclerosis Quality of Life Inventory: A User’s Manual. National Multiple Sclerosis Society. New York, NY:1997;47-49. Accessed March 27, 2020. https://www.nationalmssociety.org/For- Professionals/Researchers/Resources-for- Researchers/Clinical-Study-Measures/Multiple- Sclerosis-Quality-of-Life-Inventory-(MSQ
  10. Hadjimichael O, Vollmer T, Oleen-Burkey M. Fatigue characteristics in multiple sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes. 2008;6:100
  11. Eckstein C. Established relapsing-remitting multiple sclerosis. In: Giacomini PS, ed. Case Studies in Multiple Sclerosis. Springer International Publishing; 2017:35-57
  12. Multiple Sclerosis Trust. Describing fatigue to others. Accessed March 6, 2020. https:// www.mstrust.org.uk/news/views-and-comments/ describing-fatigue-other
  13. Benedict RHB, DeLuca J, Phillips G, et al. Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Mult Scler J. 2017;23(5):721-733
  14. Zivadinov R, Bakshi R. Role of MRI in multiple sclerosis II: Brain and spinal cord atrophy. Front Biosci. 2004;9:647-664
  15. Science Photo Library. Accessed March 30, 2020. https:www.sciencephoto.com/media/779202/view
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