Year: 2015
Type: dissertation
Abstract: __Abstract__ \n \nMS is a complex disease characterized by a large heterogeneity in radiological and pathological \nfindings but also in clinical disease course and treatment response. \nPrognostic factors are needed to. reliably counsel patients about their prognosis, differentiate \nbetween CIS/MS and other causes of the symptoms, . be able to start the appropriate \ntreatment at the right moment in the right patient, and . gain more insight into the \npathogenesis of MS (and . to try to prevent MS in some cases, knowing that the incidence \nof MS is increasing, probably caused by a, so far unknown, environmental factor). \nThis thesis focuses on predictive factors in patients with CIS and relapsing-remitting MS \n(RRMS). In this introduction, an overview of the known prognostic factors is given, including \nclinical and bedside factors as well as genetics and body fluid biomarkers. First, an overview \nof risk factors for MS in the general population is given. Second, predictive factors for the \nnext attack are described for patients with CIS and RRMS. For patients with CIS, the next \nattack is disease-defining, leading to the diagnosis of clinically definite MS (CDMS). In patients \nwith RRMS, there is some controversy regarding the importance of relapses. Because \nthe progressive phase of the disease (see figure 1) causes most of the long-term disability \nin MS patients, and this is independent of the location, severity and recovery of previous \nrelapses, some people feel that relapses do not matter in relation to long-term disability. \nHowever, it is also known that relapses are associated with residual neurological deficit in \n40-50% of cases, and that relapses early in the disease course (year 1 and 2) do seem \nto affect later disability. Furthermore, relapses have physical, emotional and financial \nconsequences, and may lead to hospitalization and time away from work and home. \nEspecially in early disease, relapses are the main cause of disability in MS patients. Because \nrelapses are also the main target for all current MS therapies, it is an important topic in MS \nresearch. Because progressive MS was not investigated in the research described in this \nthesis, these MS subtypes are not discussed here.
Author: Tessel F. Runia
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W120414884