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Radzik AM, Amezcua L, Anderson A, Gilmore S, Ahmad S, Brandstadter R, Fabian MT, Graham EL, Hodgkinson S, Horton L, Jacobs DA, Katz Sand IB, Kohli A, Levine L, McLemore M, Okai AF, Patel J, Poole S, Riley C, Satyanarayan S, Tardo L, Verter E, Villacorta V, Zimmerman V, Zuroff L, Williams MJ, Houtchens MK, Bove R. Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With Multiple Sclerosis: A Diverse Multicenter Cohort. Neurology 2024; 102:e208100. [PMID: 38261988 PMCID: PMC10962915 DOI: 10.1212/wnl.0000000000208100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/15/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities exist in both neurologic and obstetric populations, underscoring the importance of evaluating pregnancy outcomes in diverse women with multiple sclerosis (MS). The objective of this multicenter retrospective study was to compare pregnancy care and outcomes between Black and Hispanic (underrepresented) and White women with MS. METHODS Demographic and clinical data were extracted from medical records of 9 US MS centers for women with MS/clinically isolated syndrome who delivered live births between 2010 and 2021. Sites identified at last 15 consecutive Black/Hispanic women and a matching number of White women. Socioeconomic factors, pregnancy, and MS care/outcomes were compared between groups (underrepresented and White and then Black and Hispanic) using Wilcoxon rank sum (U statistic and effect size r reported), χ2, t tests and logistic regressions as appropriate to data type. Multiple imputation by chained equation was used to account for missing data. RESULTS Overall, 294 pregnancies resulting in live births were analyzed ( 81 Black, 67 Hispanic, and 146 White mothers). Relative to underrepresented women, White women lived in areas of higher median (interquartile range [IQR]) Child Opportunity Index (79 [45.8] vs 22 [45.8], U = 3,824, r = 0.56, p < 0.0001) and were more often employed (84.9% vs 75%, odds ratio [OR] 2.57, CI 1.46-4.50, p = 0.0008) and privately insured (93.8% vs 56.8%, OR 11.6, CI 5.5-24.5, p < 0.0001) and more received a 14-week ultrasound (98.6% vs 93.9%, OR 4.66, CI 0.99-21.96, p = 0.027). Mode of delivery was significantly different between the three groups (X2(10,294) = 20.38, p = 0.03); notably, Black women had the highest rates of emergency cesarean deliveries, and Hispanic women highest rates of uncomplicated vaginal deliveries. Babies born to underrepresented women had lower median (IQR) birthweights than babies born to White women (3,198 g [435.3 g] vs 3,275 g [412.5 g], U = 9,255, r = 0.12, p = 0.04) and shorter median (IQR) breastfeeding duration (4.5 [3.3] vs 6.0 [4.2] months, U = 8,184, r = 0.21, p = 0.003). While underrepresented women were younger than White women (mean [SD] 30.9 [4.8] vs 33.8 [4.0], t = 1.97, CI 1.96-3.98, p < 0.0001), their median (Q1-Q3, IQR) Expanded Disability Status Scale was higher (1.5 [1-2.5, 1.5] vs 1 [0-1.5, 1.5], U = 7,260, r = 0.29, p < 0.0001) before pregnancy. Finally, medical records were missing more key data for Black women (19.7% missing vs 8.9% missing, OR 2.54, CI 1.25-5.06, p = 0.008). DISCUSSION In this geographically diverse multicenter cohort, underrepresented women entered pregnancy with higher disability and fewer health care resources. Pregnancy represents a pivotal window where structural factors affect maternal and fetal health and neurologic trajectories; it is a critical period to optimize care and health outcomes.
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Affiliation(s)
- Anne Marie Radzik
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lilyana Amezcua
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Annika Anderson
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Serena Gilmore
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sophie Ahmad
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Rachel Brandstadter
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Michelle T Fabian
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Edith L Graham
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sophia Hodgkinson
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lindsay Horton
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Dina A Jacobs
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Ilana B Katz Sand
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Amit Kohli
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Libby Levine
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Monica McLemore
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Annette F Okai
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Jasmin Patel
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Shane Poole
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Claire Riley
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sammita Satyanarayan
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lauren Tardo
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Elizabeth Verter
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Veronica Villacorta
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Vanessa Zimmerman
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Leah Zuroff
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Mitzi J Williams
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Maria K Houtchens
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Riley Bove
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
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Brandstadter R, Ayeni O, Krieger SC, Harel NY, Escalon MX, Katz Sand I, Leavitt VM, Fabian MT, Buyukturkoglu K, Klineova S, Riley CS, Lublin FD, Miller AE, Sumowski JF. Detection of subtle gait disturbance and future fall risk in early multiple sclerosis. Neurology 2020; 94:e1395-e1406. [PMID: 32102980 DOI: 10.1212/wnl.0000000000008938] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To test the hypothesis that higher-challenge gait and balance tasks are more sensitive than traditional metrics to subtle patient-reported gait dysfunction and future fall risk in early multiple sclerosis (MS). METHODS Persons with early MS (n = 185; ≤5 years diagnosed) reported gait function (MS Walking Scale) and underwent traditional disability metrics (Expanded Disability Status Scale [EDSS], Timed 25 Foot Walk). Patients and healthy controls (n = 50) completed clinically feasible challenge tasks of gait endurance (2-Minute Walk Test), standing balance (NIH Toolbox), and dynamic balance (balance boards; tandem walk on 2 ten-foot boards of different widths, 4.5 and 1.5 in). MRI assessed global and regional brain volumes, total T2 lesion volume (T2LV), infratentorial T2LVs and counts, and cervical cord lesion counts. Falls, near falls, and fall-related injuries were assessed after 1 year. We examined links between all tasks and patient-reported gait, MRI markers, and fall data. RESULTS Patients performed worse on higher challenge balance, but not gait, tasks compared with healthy controls. Worse patient-reported gait disturbance was associated with worse performance on all tasks, but only dynamic balance was sensitive to mild patient-reported gait difficulty. Balance tasks were more correlated with MRI metrics than were walking tasks or EDSS score. Thirty percent of patients reported either a fall or near fall after 1 year, with poor dynamic balance as the only task independently predicting falls. CONCLUSIONS Balance plays a leading role in gait dysfunction early in MS. Clinically feasible higher-challenge balance tasks were most sensitive to patient-reported gait, MRI disease markers, and risk of future falls, highlighting potential to advance functional outcomes in clinical practice and trials.
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Affiliation(s)
- Rachel Brandstadter
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Oluwasheyi Ayeni
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Stephen C Krieger
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Noam Y Harel
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Miguel X Escalon
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Ilana Katz Sand
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Victoria M Leavitt
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Michelle T Fabian
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Korhan Buyukturkoglu
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Sylvia Klineova
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Claire S Riley
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Fred D Lublin
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - Aaron E Miller
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY
| | - James F Sumowski
- From the Department of Neurology (R.B.), University of Pennsylvania, Philadelphia; Department of Neurology (O.A.), Kaiser Permanente, Atlanta, GA; Department of Neurology (S.C.K., N.Y.H., M.X.E., I.K.S., M.T.F., S.K., F.D.L., A.E.M., J.F.S.), Icahn School of Medicine at Mount Sinai; James J. Peters Veterans Affairs Medical Center (N.Y.H.); and Department of Neurology (V.M.L, K.B., C.S.R..), Columbia University Medical Center, New York, NY.
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Katz Sand I, Fabian MT, Telford R, Kraus TA, Chehade M, Masilamani M, Moran T, Farrell C, Ebel S, Cook LJ, Rose J, Lublin FD. Open-label, add-on trial of cetirizine for neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm 2018; 5:e441. [PMID: 30426035 PMCID: PMC6201737 DOI: 10.1212/nxi.0000000000000441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/12/2017] [Indexed: 12/19/2022]
Abstract
Objective This pilot study preliminarily examined the efficacy and tolerability of cetirizine as an add-on to standard therapy for neuromyelitis optica (NMO). Methods Eligible participants met the Wingerchuk 2006 diagnostic criteria or had a single typical episode along with positive NMO immunoglobulin G. After baseline clinical and laboratory assessments, participants began treatment with cetirizine 10 mg orally daily, in addition to their usual disease-modifying therapy for NMO, and continued for 1 year. The primary end point was the annualized relapse rate (ARR) while on the same disease-modifying therapy before starting cetirizine compared with after taking cetirizine. Additional end points included disability (Expanded Disability Status Scale [EDSS]), relapse severity, tolerability, especially with respect to drowsiness measured by the Epworth Sleepiness Scale (ESS), and laboratory parameters. Results The ARR before cetirizine was 0.4 ± 0.80 and after cetirizine was 0.1 ± 0.24 (p = 0.047). There was no statistically significant difference in the EDSS (mean 3.9 ± 2.18 before the start of the study and 3.2 ± 2.31 at the conclusion of the study, p = 0.500). The ESS remained fairly consistent throughout the study (mean 6.5 ± 5.33 at baseline and 6.9 ± 4.50 at month 12, p = 0.740). Laboratory studies were unrevealing. Conclusions In this pilot study, cetirizine was well tolerated, and the prespecified primary efficacy end point was satisfied. However, the open-label design and the small sample size of this pilot study preclude definitive conclusions. Further research is needed. Classification of evidence This study provides Class IV evidence that in patients with NMO, the addition of cetirizine to standard therapy is safe, well tolerated, and reduces relapses.
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Affiliation(s)
- Ilana Katz Sand
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Michelle T Fabian
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Russell Telford
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Thomas A Kraus
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Mirna Chehade
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Madhan Masilamani
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Thomas Moran
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Colleen Farrell
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Shelly Ebel
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Lawrence J Cook
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - John Rose
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
| | - Fred D Lublin
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis (I.K.S., M.F., C.F., S.E., F.L.), Department of Neurology, Icahn School of Medicine at Mount Sinai, NY; Department of Pediatrics (R.T., L.C.), University of Utah, Salt Lake City; Drug Discovery Institute (T.A.K.), Mount Sinai Center for Eosinophilic Disorders (M.C.), Jaffe Food Allergy Institute (M.M.), Department of Pediatrics, and Department of Microbiology (T.M.), Icahn School of Medicine at Mount Sinai, NY; Department of Neurology (J.R.), University of Utah, Salt Lake City
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