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Background:Predicting disease progression over time is challenging despite the available literature data.Aim: To assess whether baseline clinical variables of MS patients would predict the conversion to progressive phase of the disease.Materials & methods: Utilizing the national MS registry, patients who had relapsing onsets and had confirmed EDSS score at baseline and follow-up visits were included. Primary progressive MS and CIS patients were excluded. Clinical variables (gender, age at onset, disease duration, number of relapses, EDSS score) were collected. The end point was conversion to secondary progressive MS. Chi Square and multivariable logistic regression were used to determine the influence of clinical variables on disease progression.Results:Data of 803 MS patients with relapsing onset were analyzed. Eighty five (10.6%) patients reached the end point. The risk of disease progression was significantly higher in men (p= 0.015), in patients who developed MS ≥ 40 years of age (p= 0.041) and who had ≥ 3 relapses during their disease course (p< 0.001). Spinal cord presentation at onset was predictive of progression (aOR = 2.01;p= 0.06) while optic neuritis at onset was associated with lower risk of progression (aOR = 0.30;p= 0.03). EDSS score at first visit did not influence disease progression when tested at 2 different cutoffs (EDSS < 4 vs. ≥ 4 and EDSS < 6 vs. ≥ 6) using multivariable logistic regression analysis (p= 0.960 andp= 0.866), respectively.Conclusion: Men and patients who presented at age 40 yeas or beyond had increased risk of MS progression. Spinal cord symptoms at onset and 3 or more relapses were predictive of progression. [ABSTRACT FROM PUBLISHER]

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need re-evaluation and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate multiple sclerosis (MS) therapy selection is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, and primary progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience. [ABSTRACT FROM AUTHOR]

Abstract The diagnosis of multiple sclerosis (MS) is dependent on the presence of clinical and paraclinical evidence demonstrating dissemination of central nervous system lesions in both space and time, as well as the exclusion of other disorders. Diagnostic criteria were originally promulgated in 1965 by the Schumacher committee and modified subsequently by the Poser committee to include paraclinical evidence. The most recent criteria are the 2010 modifications of the 2001 McDonald criteria, which are focused on making an earlier diagnosis of MS. This article provides guidelines, derived from clinical experience as well as evidence-based medicine, for the diagnosis and management of MS with special emphasis on practices in the Middle East. [ABSTRACT FROM AUTHOR]

Background: Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed to be associated with multiple sclerosis (MS). Zamboni et al. reported significant improvement in neurological outcomes in MS patients who underwent percutaneous transluminal angioplasty (PTA). Objectives: To retrospectively evaluate the neurological outcomes in MS patients who underwent PTA. Method: Relapsing remitting MS patients who underwent PTA and completed at least 1 year post-PTA were assessed. Patients with clinically isolated syndrome or progressive forms of MS were excluded. Primary endpoint was the proportion of relapse-free patients at 1 year. Secondary endpoints were change in mean Expanded Disability Status Scale (EDSS) score and proportion of patients with new magnetic resonance imaging (MRI) activity (defined as either gadolinium-enhancing or new T2 lesions) at 1 year. Results: Forty-five patients satisfied the inclusion criteria. Females constituted 71.1%. The mean age and mean disease duration were 33.76 and 7.16 years, respectively. At 1-year post-PTA, the proportion of relapse-free patients decreased from 84.44% to 66.67% ( p = 0.085), whereas the mean EDSS score increased ( p = 0.017). The proportion of patients with new MRI activity increased significantly from 17.78% to 44.44% ( p = 0.012). A total of 35.6% of patients stopped their disease modifying therapies (DMTs). There was no difference among the patients who stopped their DMTs with respect to relapses, EDSS score or new MRI activity. Conclusion: The study revealed that PTA in relapsing remitting MS patients was not associated with any neurological improvement. However, there was an increase in disease activity irrespective of the adherence to DMTs. Further evidence of the association between CCSVI and MS is required. [ABSTRACT FROM AUTHOR]

Objectives: To study clinical characteristics of multiple sclerosis (MS) patients in Kuwait and to collect data on annual relapse rates and disability measures. Method: An MS Registry was created in Amiri Hospital. Demographic, clinical characteristics, and disability measures using Expanded Disability Status Scale (EDSS) score at last visit were collected. Results: Data from 218 patients formed the basis of the study cohort. Female to male ratio was 1.95. Mean age of onset of MS was 26.8 years. Seventy-eight percent had a relapsing-remitting course, 9.2%% had secondary progressive course, and 2.8%% had primary progressive course. The clinically isolated syndrome (CIS) group constituted 10.1%%. The mean disease duration was 8 ± 7.2 years. Forty-five percent of patients had ≤5 years of disease duration, followed by 24.3%% and 25.2%% in the 5-10 and 10-20 years durations. Only 5.5%% had MS for >20 years; 77.1%% of patients had <1 relapse per year, while 22%% had 1-2 relapses per year; 67.89%% of patients had EDSS score <4, whereas 17.89%% were found to have EDSS of ≥6. Summary: MS in Kuwait predominantly affects female. The mean age of onset and frequency of MS types are comparable to worldwide figures. The annual relapse rates and the EDSS scores were relatively low in our cohort. [ABSTRACT FROM AUTHOR]