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Cerebellar pathology and disability worsening in relapsing‐remitting multiple sclerosis: A retrospective analysis from the CombiRx trial
Author(s) -
Petracca Maria,
Cutter Gary,
Cocozza Sirio,
Freeman Leorah,
Kangarlu John,
Margoni Monica,
Moro Matteo,
Krieger Stephen,
El Mendili Mohamed Mounir,
Droby Amgad,
Wolinsky Jerry S.,
Lublin Fred,
Inglese Matilde
Publication year - 2022
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.15157
Subject(s) - medicine , expanded disability status scale , multiple sclerosis , demographics , relapsing remitting , magnetic resonance imaging , proportional hazards model , hazard ratio , physical medicine and rehabilitation , radiology , confidence interval , demography , psychiatry , sociology
Background and purpose Cerebellar damage is a valuable predictor of disability, particularly in progressive multiple sclerosis. It is not clear if it could be an equally useful predictor of motor disability worsening in the relapsing‐remitting phenotype. Aim We aimed to determine whether cerebellar damage is an equally useful predictor of motor disability worsening in the relapsing‐remitting phenotype. Methods Cerebellar lesion loads and volumes were estimated using baseline magnetic resonance imaging from the CombiRx trial ( n = 838). The relationship between cerebellar damage and time to disability worsening (confirmed disability progression [CDP], timed 25‐foot walk test [T25FWT] score worsening, nine‐hole peg test [9HPT] score worsening) was tested in stagewise and stepwise Cox proportional hazards models, accounting for demographics and supratentorial damage. Results Shorter time to 9HPT score worsening was associated with higher baseline Expanded Disability Status Scale (EDSS) score (hazard ratio [HR] 1.408, p = 0.0042) and higher volume of supratentorial and cerebellar T2 lesions (HR 1.005 p = 0.0196 and HR 2.211, p = 0.0002, respectively). Shorter time to T25FWT score worsening was associated with higher baseline EDSS (HR 1.232, p = 0.0006). Shorter time to CDP was associated with older age (HR 1.026, p = 0.0010), lower baseline EDSS score (HR 0.428, p < 0.0001) and higher volume of supratentorial T2 lesions (HR 1.024, p < 0.0001). Conclusion Among the explored outcomes, single time‐point evaluation of cerebellar damage only allows the prediction of manual dexterity worsening. In clinical studies the selection of imaging biomarkers should be informed by the outcome of interest.