Relapse Sequela is Not Rare in Aggressive Forms of Relapsing MS Throughout the First Decade of Disease (P1.110)

OBJECTIVE: We aimed to show that relapse sequela is frequently seen in aggressive forms of MS throughout the first decade of disease. BACKGROUND: We previously defined a group of patients with aggressive MS (AMS) within two large longitudinally studied independent datasets. The contribution of sequela from relapses has not been characterized in the context of patients with relatively AMS. DESIGN/METHODS: We retrospectively examined the presence of relapse sequela in 176 longitudinally studied, consecutively seen patients at the Allegheny MS Treatment Center and meeting our definition for AMS. We examined relapse activity and disability in the first two five-year epochs of disease duration. We used previously defined phenotypes: no worsening due to relapse or secondary progression (type A), relapse with worsening seen without secondary progression (type B), secondary progression with or without relapse but no worsening due to relapse (type C), worsening due to relapses mixed with worsening due to secondary progression (type D). A standard definition for relapse sequela was used (relating to change in EDSS score). Patients with less severe relapsing MS were also studied for relapse sequela. RESULTS: Many patients meeting our definition for AMS worsened in a stepwise fashion related to sequela from relapse as determined by EDSS score changes measured. In Epoch 1 there were 1/12 (8.3[percnt]) patients with AMS and type A; 23/107(21.5[percnt]) with type B; 7/28(25[percnt]) with type C and 8/28(28.6[percnt]) with type D, p = 0.06, ηp2 = 0.42. In epoch 2 14/92(15.2[percnt]) patients had type A; 10/25(40.0[percnt]) were characterized as type B; 9/52(17.3[percnt]) with type C; and 6/7 (85.7[percnt]) with type D, p <0.001, ηp2 = 0.42. CONCLUSIONS: Relapse sequela seem to account for a significant proportion of worsening disability in our patients with AMS. Disclosure: Dr. Hackett has nothing to disclose. Dr. Gettings has nothing to disclose. Dr. Schramke has nothing to disclose. Dr. Ramanathan has nothing to disclose. Dr. Scott has received personal compensation for activities with Acorda Therapeutics, Biogen Idec, Genzyme Corporation, Novartis, and Teva Neuroscience as a consultant and/or speaker.