Search

To compare the ability of different evoked potential scores (EPS) to monitor and predict the disease course in multiple sclerosis (MS).Seventy-two patients with MS or clinically isolated syndrome were investigated by visual, motor, and somatosensory EP and expanded disability status scale (EDSS) at baseline (T0) and months 6, 12, 24, 36 (T4). EP results were rated according to ordinal (o), semi-quantitative (sq), and quantitative (q) EPS. Spearman rank correlation and multivariable linear regression were used to investigate the associations between EPS and clinical disability.All EPS correlated with EDSS cross-sectionally (0.72⩽rho⩽0.87, all p0.001) and longitudinally (0.39⩽rho⩽0.47, all p⩽0.004). EPS(T0) and EDSS(T0) together explained 85-86% of EDSS(T4) variance. A posteriori power calculation showed that the sample sizes needed to detect significant changes over 6 months in q-EPS, sq-EPS and o-EPS with 90% certainty would be 50, 129 and 222, respectively. q-EPS change(T1-T0) correlated with EDSS change(T4-T0) (rho=0.56, p0.001), while sq-EPS and o-EPS changes(T1-T0) did not.All three EPS allow disease course monitoring in MS. However, the quantitative EPS detects clinically relevant short-term changes with a smaller sample size than semi-quantitative or ordinal EPS.These results underscore the potential of EPS to characterize MS disease evolution.

In his commentary (Kurtzke, 2015) Dr. Kurztke recapitulates the rationale and the underlying evidence for the development of the Functional Systems (FS), the Disability Status Scale (DSS) and the Expanded Disability Status Scale (EDSS). This commentary and several of the author's previous publications on this topic (Kurtzke, 1955, 1965, 1970, 1983, 1989, 2007, 2008) underline his unique and widely appreciated contribution: Dr. Kurtzke created a scale that was a major step in comprehensively assessing neurologic impairment and disability in people with MS in the course of their disease. Although frequently criticized and challenged by other scales, the (E)DSS and its FS have persisted and hold a central role as an assessment tool in MS observational and therapeutic studies and have also – with some caveats – entered daily practice for the description and communication about the status of individual patients. Reemphasizing a statement from a previous review (Kurtzke, 2008), Dr. Kurtzke acknowledges that following his publications, the (E)DSS and FS entered the public domain and started being used in variable contexts all over the world. With increasing experience it was inevitable that investigators would also realize the scale's limitations. Many peer reviewed original publications, reviews and consensus statements (Willoughby

Objective To prospectively assess combined evoked potentials (EP) as markers and predictors of the disease course of early MS over 3 years. Methods Fifty patients in the early phase of relapsing remitting MS prospectively received visual, somatosensory and motor EP and EDSS assessments at baseline (T1) and at 6 months intervals during 3 years. Spearman rank correlation was used to determine the relationship between z -transformed EP-latencies ( z -EPL) and EDSS. Multivariable linear regression was performed to predict EDSS at year 3 (T7) in function of z -EPL T1 . Validity of the models was assessed using group cross-validation. Results At each of the seven points in time, EDSS correlated with the sum of z -EPL (0.64 ⩽ rho ⩽ 0.79, p z -EPL T7–T1 correlated with the change of EDSS T7–T1 (rho = 0.51, p = 0.001). EDSS T7 as predicted by the sum of z -scores of EP latencies or by the number of pathological EP results at baseline correlated with the observed clinical values after 3 years (rho > 0.70, p Conclusions Multimodal EPs correlate well with clinical disability in cross-sectional and longitudinal comparison in early MS and allow prediction of disease evolution over 3 years. Significance EPs seem well suited as markers of the disease course in early MS in clinical trials and bear potential for supporting decision-finding in individual patients.