Paroxysmal and unusual symptoms as first clinical manifestation of multiple sclerosis do not indicate benign prognosis—The PaSiMS II study
July
Paroxysmal and unusual symptoms as first clinical manifestation of multiple sclerosis do not indicate benign prognosisÐThe PaSiMS II study
Gabriel Bsteh 0 1
Rainer Ehling 0 1
Lisa-Maria Walchhofer 0
Harald Hegen 0 1
Michael Auer 0 1
Sebastian Wurth 0 1
Franziska Di Pauli 0 1
Michaela Wagner 0
Markus Reindl 0 1
Florian Deisenhammer 0 1
Thomas Berger 0 1
☯ These authors contributed equally to this work. 0
0
0 Editor: Sreeram V. Ramagopalan, University of Oxford , UNITED KINGDOM
1 Department of Neurology, Medical University of Innsbruck , Innsbruck , Austria , 2 Department of Neurology, Clinic for Rehabilitation Muenster , Muenster , Austria , 3 Department of Neuroradiology, Medical University of Innsbruck , Innsbruck , Austria
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annualized relapse rate or lower EDSS over time.
Conclusion
In addition to a similar conversion rate to CDMS, patients presenting with PS/US at
disease onset display very similar relapse and disability rates as patients with CS onset.
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OPEN ACCESS
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This research did not receive any specific
grant from funding agencies in the public,
commercial, or not-for-profit sectors.
Competing interests: Markus Reindl is an
academic editor for PLOS ONE. We declare the
following conflicts of interest. GB has participated
in meetings sponsored by Biogen, Merck Serono,
Background
unclear.
Methods
Results
Novartis, Genzyme and Teva Ratiopharm. RE has
participated in meetings sponsored by and
received honoraria (lectures and consultations)
from Biogen, Merck Serono and Teva Ratiopharm,
has received grants for educational purposes from
Biogen, BoÈhringer Ingelheim, Merck Serono,
Novartis Pharma GmbH, Ottobock and Teva
Ratiopharm, and has received honoraria for acting
as consultant for Teva Pharmaceuticals Europe.
LMW has participated in meetings sponsored by
Bayer and Stryker. HH has participated in meetings
sponsored by, received speaker honoraria or travel
funding from Bayer Schering, Biogen, Merck
Serono and Novartis, and received honoraria for
acting as consultant for Teva Pharmaceuticals
Europe. MA received speaker honoraria from
Novartis. SW has participated in meetings
sponsored by, received honoraria or travel funding
from Biogen, Merck Serono, Novartis, Sanofi
Genzyme, Teva Ratiopharm, Allergan, Ipsen
Pharma and Roche. FDP has received speaking
honoraria from Biogen-Idec and Sanofi-Aventis
Austria. MW reports no conflict of interest. MR
reports no conflict of interest. FD has participated
in meetings sponsored by or received honoraria for
acting as an advisor/speaker for Bayer Healthcare,
Biogen, Genzyme-Sanofi, Merck, Novartis Pharma,
Roche and TEVA. TB has participated in meetings
sponsored by and received honoraria (lectures,
advisory boards, consultations) from
pharmaceutical companies marketing treatments
for MS: Bayer, Biogen, Genzyme, Merck, Novartis,
Octapharma, Ratiopharm, Roche, Sanofi Aventis,
TEVA. His institution has received financial support
in the past 12 months by unrestricted research
grants (Biogen, Bayer, Merck, Novartis,
Ratiopharm, Sanofi Aventis) and for participation in
clinical trials in multiple sclerosis sponsored by
Alexion, Bayer, Biogen, Merck, Novartis,
Octapharma, Roche, Sanofi Aventis, TEVA. This
does not alter our adherence to PLOS ONE policies
on sharing data and materials.
Consequently, initial presentation with PS/US does not indicate benign or atypical MS, but
requires DMT initiation based on the same criteria as in CS patients.
1. Introduction
Paroxysmal symptoms (PS) are brief (lasting seconds to minutes) symptoms occurring
suddenly and many times a day. They are often stereotyped and continue in clusters with great
intensity for days up to a few months[1]. While their pathophysiology is well characterised,
they are among the most frequently misinterpreted manifestations of multiple sclerosis (MS)
(1). Since the latest revision of the definition of a MS relapse, PS (historical or current) are now
accepted as relapses as long as they consist of multiple episodes occurring over not less than 24
hours [2]. ªUnusual symptomsº (US) are thought to represent the clinical correlate of mainly
cortical MS lesions [3,4]. Most frequently, focal epileptic seizures and various types of aphasia
are classified as US in MS [1]. In a previous large scale study, Paroxysmal and Unusual
Symptoms in MS (PaSiMS I), we found a prevalence rate of 1.1% and 0.5% for PS and US as initial
manifestation of MS, respectively [5]. Prediction of long-term prognosis at disease onset is
generally challenging in MS. Female sex, young age, complete remission of initial symptoms,
absence of oligoclonal bands (OCB), low T2 lesion load and absence of contrast-enhancing
(CE) lesions have consistently been identified as predictive factors for favourable long-term
outcome [6±12]. Recently, we have demons (...truncated)