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Peter Joseph Jongen,1,2 Wim A Lemmens,3 Raymond Hupperts,4 Erwin LJ Hoogervorst,5 Hans M Schrijver,6 Astrid Slettenaar,7 Els L de Schryver,8 Jan Boringa,9 Esther van Noort,10 Rogier Donders3 1Department of Community and Occupational Medicine, University Medical Centre Groningen, University Groningen, Groningen, 2MS4 Research Institute, 3Department for Health Evidence, Radboud university medical center, Nijmegen, 4Department of Neurology, Zuijderland Medisch Centrum Sittard, Sittard, 5Department of Neurology, St Antonius Hospital, Nieuwegein, 6Department of Neurology, Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, 7Department of Neurology, Medisch Spectrum Twente, Enschede, 8Department of Neurology, Alrijne Ziekenhuis, Leiderdorp, 9Department of Neurology, Meander Medisch Centrum, Amersfoort, 10Curavista BV, Geertruidenberg, the Netherlands Background: In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. Methods: In an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes. Results: It was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed

Objective: To validate the newly developed Multiple Sclerosis Impact Scale (MSIS-29) in a large, well characterized, independent group of MS patients by investigating the relation between the MSIS-29 and the Guy's Neurological Disability Scale (GNDS), the Expanded Disability Status Scale (EDSS) and the MS Functional Composite (MSFC). Methods: Two hundred MS patients were recruited at our outpatient department. At the same visit GNDS, EDSS, MSFC and MSIS-29 were assessed. Data obtained from GNDS, EDSS and MSFC assessment were compared to both physical and psychological impact scores of the MSIS-29. In addition the contribution of GNDS subcategories, EDSS functional systems and MSFC components to the physical and psychological impact scores of the MSIS-29 was studied. Results: Median scores were 37.5 for the physical and 22.2 for the psychological impact score of the MSIS-29, 13.0 for GNDS and 4.0 for EDSS. Mean MSFC was 0.07. The physical impact score showed good correlations with both GNDS (0.79) and EDSS (0.68) and a moderate correlation with the MSFC ( (-0.53). The psychological impact score showed weak correlations with EDSS (0.22) and MSFC ( (-0.30) and a moderately strong correlation with the GNDS (0.58). In 50 (25%) patients, scores on physical and psychological impact scales diverted, i. e., a relative high score on one scale combined with a relative low score on the other scale. This was related to the clinical disease course. Conclusion: Our study supports the use of the MSIS-29 as a measure for the assessment of physical impact of MS on normal daily life. In addition, our data provides a deeper understanding of the factors that determine both physical and psychological disease impact. Discrepancies between the latter two aspects deserve further attention. [ABSTRACT FROM AUTHOR]

Objective: Multiple sclerosis (MS) patients develop varying degrees of cerebral atrophy, which may already begin at disease onset. The purpose of this study is to examine the effect of steroid treatment on cerebral volume in MS patients. Methods: Thirty-five MS patients participating in a clinical trial of oral interferon beta, which included monthly MRI, were included in this study. They suffered from an acute relapse and were treated with intravenous methylprednisolone (IV-MP); 13 of the patients were treated with oral prednisolone tapering after IV-MP. The last MRI scan before and the first (and second for oral tapering patients) scan after IV-MP treatment were used for measuring parenchymal fraction (PF) and ventricular fraction (VF). Changes in PF and VF were analysed using Student's t test. Results: For the total population no significant changes in PF or VF were found. However, the subgroup of patients receiving oral tapering after IV-MP showed changes, compatible with atrophy in both PF and VF, that were significant immediately after IV-MP treatment and still persisted (though not statistically significant anymore) after a mean interval of 30 days. The magnitude of these changes was about the same as the annual change in cerebral volume as reported in natural history studies. Conclusion: Our data indicate that short courses of intravenous steroids (restricted to three or five days) have no major impact, whereas prolonged treatment with oral tapering does significantly affect brain volume. These findings are important for longitudinal studies and clinical trials in which brain volume is used as an outcome measure. [ABSTRACT FROM AUTHOR]