Author Of 2 Presentations
P0134 - Preliminary validation of static posturography as a disability outcome measure in progressive multiple sclerosis. (ID 685)
Abstract
Background
People with multiple sclerosis (pwMS) frequently experience impairment in postural control, a multifaceted measure related but distinct to walking ability.
Objectives
To assess clinical validity of static posturography as a disability outcome measure in people with progressive MS; to assess feasibility of use of the force platform in pwMS with moderate-to-severe disability; to explore the relationship between multiple cognitive domains and postural control in pwMS with a high burden of cognitive and physical impairments.
Methods
Twenty-three pwMS with Expanded Disability Status Scale (EDSS) 3.5–6.0 stood on a force platform under various test conditions (single task: Eyes Open (EO), Eyes Closed (EC); dual-task: posturography with concurrent cognitive tasks, N-Back, and Sustained Attention Response Task) and completed a battery of ambulation, balance and cognitive tests.
Results
EO Centre of Pressure (COP) Path Length correlated with proprioceptive (r=0.65, p=0.001), cerebellar (r=0.62, p=0.002), vestibular (r=0.46, p=0.027) and visual (r=0.53, p=0.009) dysfunction, but not with age, gender, body mass index, anxiety, or standard walking measures (EDSS, Timed 25 Foot Walk). EO Path Length significantly predicted the Dynamic Gait Index (adjusted R2=25.8%, p=0.008), Dizziness Handicap Inventory score (adjusted R2=24.9%, p=0.008) and 9 Hole Peg Test score (adjusted R2=14.2%, p=0.043). Of pwMS with EDSS 6.0, EO mediolateral displacement predicted distance walked during the Two Minute Walk Test (adjusted R2=53.2%, p=0.016). Diminished postural control was associated with mediolateral direction of sway (p<0.001), EC (p=0.004), fampridine use (p=0.004) and poorer physical (p=0.039) and psychological (p=0.026) quality of life. A consistent pattern of poorer cognitive function associated with better postural control was observed across multiple cognitive domains (information processing speed, verbal memory, visuospatial memory, attentional capacity). No significant differences in postural control were detected between EO and dual-tasks. During the N-Back task, poorer postural control correlated with lower % N-Back scores (p=0.049).
Conclusions
Static posturography is a non-invasive, brief and easy-to-administer test with high construct and concurrent validity as a disability outcome measure in people with progressive MS. The finding of diminished postural control with fampridine use suggests that static posturography can identify effects of treatment in pwMS. Demonstration of cognitive-postural interference in pwMS provided insight into distinct postural control strategies adopted by pwMS with different levels of cognitive and physical disability, and may complement balance rehabilitation methods in falls prevention programmes.
P0703 - Clinical, radiological features and management of twenty patients diagnosed with anti-MOG demyelinating syndrome in a tertiary referral centre. (ID 1857)
Abstract
Background
Myelin Oligodendrocyte Glycoprotein (MOG) – antibody demyelinating disease has emerged as a distinct clinical entity in recent years. Prevalence is also likely higher than previously recognized. MOG antibody testing is standard of care in new presentations, however a significant population remains undiagnosed. Identifying this cohort requires clinical vigilance.
Objectives
To characterize the clinical course, treatment and outcomes in 20 patients diagnosed with MOG demyelinating syndrome between 2018 and 2020.
Methods
We evaluated clinical phenotype, demographic data, historical episodes and radiological findings in 20 patients attending the demyelination clinic in our institution who tested positive for myelin oligodendrocyte glycoprotein between 2018 and 2020. This patient cohort included new presentations with optic neuritis and myelitis and patients with a previous diagnosis of multiple sclerosis and chronic relapsing idiopathic optic neuropathy.
Results
52% of the cohort were female. The median age at diagnosis was 35 years, however the median age at initial clinical presentation was 22.5 years (age range 4-60). 70% had optic neuritis as their initial presenting complaint. 95% had clinical or radiological evidence of optic neuritis during their clinical course. ADEM had occurred in 3/4 patients who had presented before the age of 10. Recurrence was common - 75% of the cohort had subsequent clinical episodes. 65% of those with recurrence had a second event within six months of presentation. The longest duration between first and second clinical episodes was 25 years. 60% of the cohort had CSF sampling and OCBs were negative in all cases. Long term antibody positivity despite clinical and radiological quiescence was common. Radiological features included retrobulbar high signal of the optic nerves, chiasmal atrophy, leptomeningeal enhancement and spinal cord lesions. Resolution of radiological features was common.
Conclusions
MOG antibody associated demyelination frequently presents with optic neuritis. Recurrence is common and can occur many years after the initial presentation, making long term management challenging. There is an excellent response to steroids in the acute phase. Asymptomatic optic nerve lesions and cord lesions do occur, and imaging of the neuraxis at presentation should be considered. Consideration should be given to MOG antibody testing in patients transitioning to adult MS services from the paediatric population. The role of longer-term immunosuppression in the cohort is typically reserved for those with recurrence.
Presenter Of 1 Presentation
P0703 - Clinical, radiological features and management of twenty patients diagnosed with anti-MOG demyelinating syndrome in a tertiary referral centre. (ID 1857)
Abstract
Background
Myelin Oligodendrocyte Glycoprotein (MOG) – antibody demyelinating disease has emerged as a distinct clinical entity in recent years. Prevalence is also likely higher than previously recognized. MOG antibody testing is standard of care in new presentations, however a significant population remains undiagnosed. Identifying this cohort requires clinical vigilance.
Objectives
To characterize the clinical course, treatment and outcomes in 20 patients diagnosed with MOG demyelinating syndrome between 2018 and 2020.
Methods
We evaluated clinical phenotype, demographic data, historical episodes and radiological findings in 20 patients attending the demyelination clinic in our institution who tested positive for myelin oligodendrocyte glycoprotein between 2018 and 2020. This patient cohort included new presentations with optic neuritis and myelitis and patients with a previous diagnosis of multiple sclerosis and chronic relapsing idiopathic optic neuropathy.
Results
52% of the cohort were female. The median age at diagnosis was 35 years, however the median age at initial clinical presentation was 22.5 years (age range 4-60). 70% had optic neuritis as their initial presenting complaint. 95% had clinical or radiological evidence of optic neuritis during their clinical course. ADEM had occurred in 3/4 patients who had presented before the age of 10. Recurrence was common - 75% of the cohort had subsequent clinical episodes. 65% of those with recurrence had a second event within six months of presentation. The longest duration between first and second clinical episodes was 25 years. 60% of the cohort had CSF sampling and OCBs were negative in all cases. Long term antibody positivity despite clinical and radiological quiescence was common. Radiological features included retrobulbar high signal of the optic nerves, chiasmal atrophy, leptomeningeal enhancement and spinal cord lesions. Resolution of radiological features was common.
Conclusions
MOG antibody associated demyelination frequently presents with optic neuritis. Recurrence is common and can occur many years after the initial presentation, making long term management challenging. There is an excellent response to steroids in the acute phase. Asymptomatic optic nerve lesions and cord lesions do occur, and imaging of the neuraxis at presentation should be considered. Consideration should be given to MOG antibody testing in patients transitioning to adult MS services from the paediatric population. The role of longer-term immunosuppression in the cohort is typically reserved for those with recurrence.