Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis
Minh V Le, Charles B. Malpas, Sifat Sharmin, Dana Horáková, Eva Havrdová, María Trojano, Guillermo Izquierdo, Sara Eichau, Serkan Özakbaş, Alessandra Lugaresi, Alexandre Prat, Marc Girard, Pierre Duquette, Catherine Larochelle, Raed Alroughani, Roberto Bergamaschi, Patrizia Sola, Diana Ferraro, Pierre Grammond, Francois Grand’ Maison, Murat Terzi, Cavit Boz, Raymond Hupperts, Helmut Butzkueven, Eugenio Pucci, Franco Granella, Vincent Van Pesch, Aysun Soysal, Bassem Yamout, Jeannette Lechner‐Scott, Daniele Spitaleri, Radek Ampapa, Recai Türkoğlu, Gerardo Iuliano, Cristina Ramo‐Tello, José Luis Sánchez-Menoyo, Youssef Sidhom, Riadh Gouider, Vahid Shaygannejad, Julie Prévost, Ayşe Altıntaş, Yára Dadalti Fragoso, Pamela McCombe, Thor Petersen, Mark Slee, Michael Barnett, Steve Vucic, Anneke van der Walt, Tomáš Kalinčík
Abstract
Background: Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear. Objective: The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms. Methods: This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores. Results: The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = −0.06, p < 0.001). Neither presentation was associated with changes in relapse risk. Conclusion: Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.