Abstract Details

Title Correlation Between Neurologic Challenge Task Performance and Lesion Localization of Sub-Threshold Lesions in Multiple Sclerosis Patients with EDSS Score of 0

Topic Multiple Sclerosis

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-028

Objective To assess if physically high challenge tests reveal sub-threshold deficits in patients with EDSS Score of 0.

Background

Sub-threshold lesions in Multiple Sclerosis (MS), as characterized by the topographical model, are compensated for and yield no physical deficits. As silent lesions cross the clinical threshold, clinical symptoms become apparent.

Design/Methods

In 185 patients with early MS (diagnosed <5 years), 63 patients with an EDSS=0 were analyzed, as well as 50 healthy controls. Patients and controls completed standard motor tasks (Nine Hole Peg Test, NHPT; Timed 25 Foot Walk, T25FW) and higher challenge tasks of upper extremity function (Grooved Pegboard, Finger Tapping, Grip Strength with dynamometer) and balance (NIH-TB Balance Test, novel Balance Board test). Tasks were adjusted for age, sex, height and weight. T-tests assessed differences between MS patients (EDSS=0) and controls on all tasks. Patients underwent MRI, yielding infratentorial lesion counts (midbrain, pons, cerebellum, medulla, c-spine). Correlations assessed links between performance and infratentorial lesions.

Results EDSS=0 patients performed worse than controls on higher challenge upper extremity tasks (Grooved Pegboard, p=.038; Grip Strength, p=.030) but not the standard task (NHPT, p=.177). Despite a normal EDSS and T25FW (mean=4.0s, sd=0.5s, range: 2.8-4.9), patients exhibited worse balance than controls on higher challenge tasks (NIH-TB Balance Test, p=.043; Balance Board test, p=.034). Likewise, infratentorial lesions were associated with performance higher challenge tasks (Grooved Pegboard p=.028; Balance Board p=.036) but not standard tests (NHPT p=.087, T25FT p=.943).

Conclusions Challenge tests were sensitive to performance differences between healthy controls and MS patients with EDSS=0. Grip strength identified motor differences between these patients and healthy controls and correlated with patient reported outcomes on MSIS-29. The Balance Board Test was sensitive to detect subthreshold balance deficiencies and correlated with infratentorial lesions. Recognition of sub-threshold deficits in apparently neurologically normal MS patients may help clinicians understand and predict disease course.

Authors/Disclosures
Ali M. Antoine (Wesleyan University) PRESENTER	No disclosure on file
James F. Sumowski (Icahn School of Medicine At Mount Sinai)	Mr. Sumowski has nothing to disclose.
Stephen Krieger, MD, FAAN (Mount Sinai Dept of Neurology)	Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle. The institution of Dr. Krieger has received research support from Novartis. The institution of Dr. Krieger has received research support from Bristol Myers Squibb. The institution of Dr. Krieger has received research support from Biogen. The institution of Dr. Krieger has received research support from Sanofi.

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