TY - JOUR
T1 - The topographical model of MS
T2 - Empirical evaluation of the recapitulation hypothesis
AU - Laitman, Benjamin M.
AU - Cook, Karin
AU - Fletcher, Madhuri
AU - Krieger, Stephen C.
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2018
Y1 - 2018
N2 - Objective: Using the topographical model of multiple sclerosis (MS) to evaluate a longitudinal cohort we (1) test the recapitulation hypothesis, positing that patients’ “disease topography” predicts the clinical pattern of disability accumulation; and (2) identify leading indicators of progression. Methods: 10 patients who transitioned from relapsing–remitting MS to secondary progressive MS (SPMS) were evaluated. Neurologic exams were analyzed from relapses, at time of SPMS diagnosis, and most recent visit. Functional systems (FS), location/laterality, and recovery were recorded. The pyramidal/motor system was the target FS assessing symptom laterality and severity at relapse and SPMS time-points. Each patient's clinical course was mapped using the topographical model software. Results: Cohort was 80% female, age 31.6 ± 8.6 years at diagnosis, followed average 23.8 ± 8.8 years, mean 3.1 relapses before SPMS. 83.3 ± 0.2% of relapse symptoms were present at transition to SPMS, increasing to 91.0 ± 0.2% at most recent visit. This demonstrates concordance between the topographical distribution of relapse symptoms and deficits from subsequent progression. In the topographical model, progression became apparent 7.75 years earlier than SPMS was diagnosed in practice. Conclusions: We demonstrate the model's utility in depicting patients' disease topography as the loci of clinical progression. This could allow for earlier recognition of progressive disease by identifying leading indicators of progression.
AB - Objective: Using the topographical model of multiple sclerosis (MS) to evaluate a longitudinal cohort we (1) test the recapitulation hypothesis, positing that patients’ “disease topography” predicts the clinical pattern of disability accumulation; and (2) identify leading indicators of progression. Methods: 10 patients who transitioned from relapsing–remitting MS to secondary progressive MS (SPMS) were evaluated. Neurologic exams were analyzed from relapses, at time of SPMS diagnosis, and most recent visit. Functional systems (FS), location/laterality, and recovery were recorded. The pyramidal/motor system was the target FS assessing symptom laterality and severity at relapse and SPMS time-points. Each patient's clinical course was mapped using the topographical model software. Results: Cohort was 80% female, age 31.6 ± 8.6 years at diagnosis, followed average 23.8 ± 8.8 years, mean 3.1 relapses before SPMS. 83.3 ± 0.2% of relapse symptoms were present at transition to SPMS, increasing to 91.0 ± 0.2% at most recent visit. This demonstrates concordance between the topographical distribution of relapse symptoms and deficits from subsequent progression. In the topographical model, progression became apparent 7.75 years earlier than SPMS was diagnosed in practice. Conclusions: We demonstrate the model's utility in depicting patients' disease topography as the loci of clinical progression. This could allow for earlier recognition of progressive disease by identifying leading indicators of progression.
KW - Phenotype
KW - disease course
KW - localization
KW - prognosis
KW - progression
KW - topography
UR - http://www.scopus.com/inward/record.url?scp=85071263170&partnerID=8YFLogxK
U2 - 10.1177/2055217318806527
DO - 10.1177/2055217318806527
M3 - Article
AN - SCOPUS:85071263170
SN - 2055-2173
VL - 4
JO - Multiple Sclerosis Journal - Experimental, Translational and Clinical
JF - Multiple Sclerosis Journal - Experimental, Translational and Clinical
IS - 4
ER -