University of Kansas Medical Center
Neurology

Author Of 2 Presentations

Imaging Poster Presentation

P0657 - Utility of Gadolinium in Multiple Sclerosis Radiographic Monitoring (ID 1753)

Speakers
Presentation Number
P0657
Presentation Topic
Imaging

Abstract

Background

Magnetic resonance imaging (MRI) is frequently utilized to assess activity of disease in multiple sclerosis (MS). Repeated gadolinium-based contrast agent use has been shown to deposit in the brain by a dose-dependent fashion. As a result, the Food and Drug Administration issued a warning regarding gadolinium use and has prompted the reexamination of its utility in clinical practice.

Objectives

To evaluate gadolinium utility in brain MRIs for routine monitoring of asymptomatic MS in an academic neurology clinic.

Methods

Retrospective chart review identified patients diagnosed with MS seen at the Landon Center of the University of Kansas Health System who had a MRI brain performed from December 16, 2016 to December 16, 2017. Data was collected regarding demographics, MS history, MRI ordered (with and/or without gadolinium), MRI results, and treatment decisions.

Results

Two-hundred forty charts were reviewed to date, identifying 124 completed MRIs in the study timeframe. All but 2 were ordered with gadolinium. Average age was 41.0 with 69.0% female and 85.2% with relapsing remitting MS. MRIs were then subdivided into the following indications: asymptomatic monitoring (n=85), diagnostic (n=15), and symptomatic (n=15). Of the monitoring MRIs, 79 (93%) had prior MRIs available for comparison, 19 (22.4%) had a new nonenhancing lesion, 10 (11.8%) had an enhancing lesion, and 22 (25.9%) had either a new nonenhancing or enhancing lesion. Of those who had radiographic progression of MS, 59% had a change in MS disease modifying therapy at follow up visit (RR 34.4, 95% CI 5.9-196.7; p=0.001). There were 17 (26.2%) enhancing lesions identified of 65 new nonenhancing or enhancing lesions. By direct comparison of unenhanced sequences, only 4.7% (n=3) of new lesions were not apparent without the aid of contrast, though each of these MRIs had other evidence of progression (total of 4 enhancing, 3 new nonenhancing lesions). In those without an available prior comparison MRI (n=6), none had enhancing lesions.

Conclusions

Preliminary results show gadolinium was useful in identifying only 4.7% additional lesions on asymptomatic monitoring MRIs and was not of additional benefit in identifying overall radiographic progression by MRI study nor in those without a prior comparator. Further data collection is planned to verify these initial trends.

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Symptom Management Poster Presentation

P1105 - Polypharmacy in MS: Correlations with pain, fatigue, and mood. (ID 823)

Speakers
Presentation Number
P1105
Presentation Topic
Symptom Management

Abstract

Background

Pain, fatigue, and mood disorders are typical in multiple sclerosis (MS) and are associated with negative outcomes such as disability and health-related quality of life. Polypharmacy is linked to adverse effects in the aging population, but little is known about how polypharmacy contributes to pain, fatigue, and mood symptoms in MS.

Objectives

The objective of this study is to describe the interaction of pain, fatigue, mood, and polypharmacy in a sample of older individuals with and without MS.

Methods

We recruited 2 groups of subjects aged 55 and older, including 50 patients with MS (PwMS; RRMS=25, PPMS=14, and SPMS=11) and 55 persons without MS (PwoMS). We gathered validated assessments to evaluate pain (MOS Pain), fatigue (Modified Fatigue Impact Scale [MFIS]), and mood (Hospital Anxiety and Depression Scale [HADS]). Medication lists were reviewed with subjects to assess polypharmacy.

Results

PwMS reported more pain (p<.001) and fatigue (p<.001) than PwoMS. Total HADS score was higher in PwMS (p=.001), indicating more mood symptoms. Disparity in HADS score appears to be driven by differences in the depression subscale (p<.001), as there was no difference in the anxiety subscale (p=.4). PwMS reported more medications (p<.01). Use of anticholinergic (p<.001), antiepileptic (p<.01), and stimulant (p=.01) was more common in PwMS. In PwMS, number of medications was correlated with depression (p<.01), fatigue (p<.05), and pain (p<.05); no such relationship emerged in PwoMS. Most common medications reported by PwMS were muscle relaxants, vitamin D, anticonvulsants, antidepressants, and analgesics (excluding aspirin). Most common medications in PwoMS were statins, antihypertensives, aspirin, analgesics (excluding aspirin), and vitamin D.

Conclusions

Polypharmacy may be associated with pain, fatigue, and mood symptoms in MS. Clinicians should consider a careful medication review in MS patients reporting these symptoms. Additionally, researchers investigating fatigue, pain, and mood in MS should measure and control for the effects of polypharmacy.

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