1. Mary,* 37 Years

Mary,* 37 Years

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? 

 

 

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

  • One relapse in the past year

  • Resolved symptoms:

    •  Leg muscle weakness 

    • Balance issues

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

 

 

 

I'm afraid to discuss progression with my doctor—I don't want to discuss it. I don't want to find out that I am progressing. The thought of transitioning to SPMS from my current diagnosis, which I've known for years, frightens me. It's an unknown, even though I've been involved with the MS community for so long.1**

**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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