Dynamic disability measures decrease the clinico-radiological gap in people with severely affected multiple sclerosis

Dejan Jakimovski; Bianca Weinstock-Guttman; Alex Burnham; Zachary Weinstock; Taylor R Wicks; Murali Ramanathan; Tommaso Sciortino; Mark Ostrem; Christopher Suchan; Michael G Dwyer; Jessica Reilly; Niels Bergsland; Ferdinand Schweser; Cheryl Kennedy; David Young-Hong; Svetlana P Eckert; David Hojnacki; Ralph Hb Benedict; Robert Zivadinov

doi:10.1016/j.msard.2024.105630

Dynamic disability measures decrease the clinico-radiological gap in people with severely affected multiple sclerosis

Mult Scler Relat Disord. 2024 Apr 22:87:105630. doi: 10.1016/j.msard.2024.105630. Online ahead of print.

Authors

Dejan Jakimovski¹, Bianca Weinstock-Guttman², Alex Burnham³, Zachary Weinstock¹, Taylor R Wicks⁴, Murali Ramanathan⁵, Tommaso Sciortino¹, Mark Ostrem³, Christopher Suchan¹, Michael G Dwyer⁶, Jessica Reilly⁷, Niels Bergsland¹, Ferdinand Schweser⁶, Cheryl Kennedy¹, David Young-Hong³, Svetlana P Eckert², David Hojnacki², Ralph Hb Benedict², Robert Zivadinov⁶

Affiliations

¹ Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
² Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
³ The Boston Home, Dorchester, MA, USA.
⁴ Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
⁵ Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
⁶ Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
⁷ The Boston Home, Dorchester, MA, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.

PMID: 38678969
DOI: 10.1016/j.msard.2024.105630

Abstract

Background: Expanded Disability Status Scale (EDSS) is limited when utilized in highly disabled people with multiple sclerosis (pwMS).

Objetive: To explore the relationship between disability measures and MRI outcomes in severely-affected pwMS.

Methods: PwMS recruited from The Boston Home (TBH), a specialized residential facility for severly-affected pwMS and University at Buffalo (UB) MS Center were assessed using EDSS, MS Severity Scale, age-related MSS, Scripps Neurological Rating Scale (SNRS) and Combinatorial Weight-Adjusted Disability Score (CombiWISE). In all scores except SNRS, higher score indicates greater disability. MRI measures of T1, T2-lesion volume (LV), whole brain, gray matter, medulla oblongata and thalamic volumes (WBV, GMV, MOV, TV) and thalamic dysconnectivity were obtained.

Results: Greatest disability differences between the TBH and UB pwMS were in SNRS (24.4 vs 71.9, p < 0.001, Cohen's d = 4.05) and CombiWISE (82.3 vs. 38.9, p < 0.001, Cohen's d = 4.02). In combined analysis of all pwMS, worse SNRS scores were correlated with worse MRI pathology in 8 out of 9 outcomes. EDSS only with 3 measures (GMV, MOV and TV). In severely-affected pwMS, SNRS was associated with T1-LV, T2-LV and WBV (not surviving false discovery rate (FDR) correction for multiple comparisons) whereas EDSS did not.

Conclusion: Granular and dynamic disability measures may bridge the clinico-radiologcal gap present in severely affected pwMS.

Keywords: Clinico-radiological paradox; Disability scales; EDSS; MSSS; Multiple sclerosis; SNRS; Severely disabled ms.