Author Of 8 Presentations
P0459 - Factors associated with access to disability certificate in patients with MS and NMOSD in Argentina (ID 1156)
Abstract
Background
Disability certificate (DC) is a free public document valid throughout Argentina. DC offers economic and social benefits to people with disabilities and improves barriers to accessing health services. Multiple sclerosis (MS) and neuromyelitis optic spectrum diseases (NMSD) are disabling diseases that affect economically active people.
Objectives
To analyze access to DC in patients with MS (PwMS) and NMOSD (PwNMOSD) in patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).
Methods
Demographical, clinical and social data from RelevarEM were analyzed. Parametric and nonparametric statistics were performed, to define significance a p value <0.05 was accepted.
Results
2979 patients were included (2814 MS and 165 NMOSD). For PwMS 80.7% were relapsing remitting MS, female 65.2%, mean age 43.5±12.9 years, mean EDSS 2.8, mean disease evolution 10.8±8.9 years, 33.9% unemployed and 43.1% had DS. For PwNMOSD 77% were female, mean age 44.7 ± 14.8 years, mean EDSS 3.3 mean disease evolution 7.3±5.9 years, 43.6% unemployed and 41.2% had DC. Overall, 11.8% of patients had public health insurance. When comparing the demographic and clinical variables of PwMS and PwNMOSD between those with and without DC, statistically significant differences were found (p≤0.05). For PwMS Multivariate analysis showed that EDSS (OR=1.60, p<0.01), time to treatment (OR=1.06, p=0.01), comorbidity index (OR=3.19, p<0.01), place of residence (OR=0.66, p<0.01), healthcare insurance (OR=1.36, p=0.02), and employment status (OR=0.41, p<0.01) were independently associated with access to DC. In PwNMOSD it was associated with EDSS (OR=1.57, p<0.01), place of residence (OR=0.34, p=0.03), healthcare insurance (OR=5.72, p=0.01), and employment status (OR=0.22, p=0.01)
Conclusions
this research is the largest to explore DC access and related factors in Argentinian PwMS and PwNMOSD. Future research should explore which factors affect the decisions of individuals to seek DC and how neurologists can assist in that process.
P0768 - Optical Coherence Tomography and unconventional neuro-ophthalmological evaluation of patients with Multiple Sclerosis (ID 1536)
Abstract
Background
The afferent visual pathway (AVP) is frequently affected in Multiple Sclerosis (MS) patients and visual quality of life (VQL) is commonly compromised, also with no history of optic neuritis (ON). High contrast visual acuity (HCVA) and confrontation visual field (VF) exam are performed in clinical practice to assess visual impairment. However, this tests may be normal in a high percentage of patients with visual complaints. Therefore, this evaluation methodology has a low sensitivity to detect AVP impairment in MS patients.
Objectives
To conduct an objective and subjective assessment of the AVP in MS patients in order to find a more sensitive parameter that demonstrate its damage.
Methods
A prospective cohort study was conducted. Neuro-ophthalmological assessment was performed: HCVA (Snellen chart), color vision (Ishihara chart), LCLA (Pelli-Robson chart) and confrontation VF exam. VQL questionnaire was performed using the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25I) from which a numerical scale is obtained according to the VFQ25 Score Algorithm. Optical Coherence Tomography (OCT) study was performed using a spectral domain equipment. Statistical analysis was performed using the SPSS package.
Results
We evaluated 117 eyes of 59 patients, 59% were women, mean age 38 years, 91% with relapsing remitting MS. Visual complaints were present in 83%. Of 117 eyes, 30% had history of ON, HCVA was normal in 92% and LCLA was altered in 63%. Color vision and VF exams were normal in 82% and 97% respectively. The VQL was mild affected in 75% of the patients and moderate in 17%, the rest were normal. We found a correlation between NEI-VFQ-25I results and LCLA (r = 0.52 p = 0.013) not found with HCVA or VF exam. OCT was performed in 71 eyes, of which 25.3% had history of ON. The RNFL thinning was found in 50.7% and the temporal quadrant was the most frequently altered (70.4%). The GCL thinning was observed in 58.3%. We found a correlation between RNFL and GCL thickness (r = 0.325, p <0.01) and between decreased RNFL thickness with LCLA deterioration (r = - 0.389, p <0.01), as well as between RNFL thickness and HCVA (r = 0.336, p <0.01).
Conclusions
We detected a high percentage of patients with AVP compromise and normal conventional evaluation. Since we found a correlation between LCLA, NEI-VFQ-25I and OCT we consider the relevance of its use in clinical practice routine to assess visual function. We could demonstrate that those are more sensitive measurable parameters of visual disability in MS patients.
P0804 - Dual task during walking in patients with Multiple Sclerosis: cognitive or motor interference?
(ID 1453)
Abstract
Background
Impairment in dual task (DT) activities has been previously reported in patients with multiple sclerosis (MS). Most studies analyze DT during walking whether incorporating a second cognitive or motor task. More research is needed in order to define what type of task (cognitive or motor) determines the severity of the interference produced in the DT.
Objectives
1) To compare DT performance between patients with MS and healthy controls. 2) To analyze DT performance according to the type of task that interferes (cognitive or motor).
Methods
94 patients with relapsing remitting MS and 25 healthy controls (HC) were included. Patient age: 38.61 ± 11.44; Education: 13.26 ± 3.77; Disability (EDSS): 2.13 ± 1.16; Evolution: 9.66 ± 8.96. HC age: 34.00 ± 14.25; Education: 14.50 ± 2.65. Measuring instruments: Clinical variables: EDSS; Fatigue severity scale; Beck Depression Inventory II. Cognitive variables: BICAMS battery; DT: cognitive-motor task (walking while performing cognitive task) and motor-motor task (walking while performing motor task). The difference between performance in the single task and in the dual task situation was obtained. Parametric and non-parametric statistics were used, to define significance a value of p <0.05 was accepted
Results
: patients and HC did not differ in age (p = 0.12) and education (p = 0.11). Patient presented poorer performance than HC in cognitive-motor DT (U: between 334.50 and 238.50; p <0.05) but not in motor-motor DT (p> 0.05). Patients with EDSS> 2, presented lower performance than the controls in both types of task (p <0.05). The motor-motor task differentiated patients with EDSS <y> 2 (t: 2.85 and 3.51; p <0.05).
Conclusions
MS patients show impairment in the DT performance when the second task is cognitive. In patients with greater disability, alteration is found in both DT. Studying patient’s performance in DT allows a more ecological approach to their symptoms in order to directly intervene in daily life alterations.
P0819 - Perceived Social Support in Multiple Sclerosis: Impact on patient’s quality of life. (ID 1241)
Abstract
Background
Social support plays an extremely important role in treatment and evolution of patients with multiple sclerosis (MS). However, there are scarce data that describes the size and quality of social network in MS patients, as well as its impact on their quality of life.
Objectives
(a) to analyze differences in perceived social support (PSS) between MS patients and healthy controls. (b) to study the associations between PSS and clinical and health-related quality of life (HRQoL) variables in MS patients, and (c) to analyze the influence of PSS on HRQoL.
Methods
151 MS patients and 89 healthy controls (HC) were studied. HC: Age: 42.01±12.25 years; Education: 14.60±2.44 years; Patients: Age: 41.46±9.97; Education:14.05±3.26 years; EDSS:2.88±2.10; Disease evolution:12.46±10.07 years. Instruments: PSS: MOS (Medical Outcomes Study Social Support Survey); Clinical Variables: EDSS, Fatigue Scale (FSS); Depression Inventory (BDI-II); HRQoL: MusiQol. Parametric and non-parametric statistics were used, significance p value<0.05.
Results
Patients presented lower scores than HC in global score of PSS (t(238)=- 1.99, p=0.04) and in each functional dimension (t(238)=between-2.59 and -2.09, p<0.05). Associations were found between PSS with depression and fatigue (r = between-0.20 and -0.29, p <0.05) and with the different dimensions of the MusiQol (r = between-0.18 and 0.48, p <0.05). In multiple regression analysis, the four models tested contributed significantly to the explained variance of HRQoL (between 41 and 47%). The model constituted with emotional/informational support explained the greatest variation of HRQoL (47%).
Conclusions
Patients with MS perceive a decrease in their social support impacting on their quality of life. This should be considered for a better therapeutic approach.
P0930 - Usage trend of oral drugs for multiple sclerosis in Argentina (ID 1183)
Abstract
Background
Over the past decade, numerous disease modifying drugs (DMDs) for relapsing multiple sclerosis (RMS) have been approved in Argentina. It is believed that the use of oral DMDs (oDMDs) i.e. fingolimod, teriflunomide and dimetil fumarate has increased in recent years, although the real-life data in our country is limited.
Objectives
Our aim was to describe the tendency of the use of oDMDs (as first treatment option or after switch) regarding its approval in Argentina.
Methods
A retrospective study was conducted in a cohort of MS patients follow-up in five Argentinian MS centers incorporated in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Patients who started their treatment since 2012 were included. Regarding to the availability of different oDMDs in Argentina, we define three period (P1-3): P1: 2012 – 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency of oDMDs use over time. Three scenarios were defined: initial treatment, first switch and second switch. For the switch scenarios, only P1 and P2 were analyzed considering that the patients belonging P3 have a short evolution time and a scarce patient’s number required treatment changes.
Results
Out of 202 patients, 58% were female, mean age 32.4 ±11.0 years, mean disease evolution 8.0 ±5.5 years, 46 % started with oDMDs and 64% was the first choice after a switch. Injectable therapies were the most frequently withdrawn in relation to oDMDs and monoclonal antibodies (p<0.01). The main cause of switching treatment was treatment failture (39%). We found an increase in the use of oDMDs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; p <0.01). We found a tendency in increasing use of oDMDs after a first switch (P1: 59.6%, P2: 73.1%) or second switch (P1: 59.6%, P2: 73.1%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of starting treatment (OR=0.66, p<0.01) were independently associated with choice of oDMDs.
Conclusions
We have identified an increasing tendency in the use of oDMDs as initial treatment of RMS regarding its approval in Argentina.
P1012 - Coping Strategies: Seeking personalized care in Multiple Sclerosis. A patient reported measure– Coping Responses Inventory. (ID 1548)
Abstract
Background
Background: Coping is defined as a set of cognitive and behavioral efforts made to master stressful specific demands. Adaptation to chronic diseases, such as Multiple Sclerosis (MS), depends on the effectiveness of coping.
Objectives
Objective: to assess the psychometric properties of the Coping Responses Inventory (CRI-A) in the subpopulation of MS patients, to verify the transferability of the instrument, which has already been validated in the Argentine general population and to assess the analysis of external criterion validity, by studying the relationship between coping styles and physical disability, depression, fatigue and years of evolution of the disease and clinical course.
Methods
Methods: 90 MS patients were included; Outcomes measures: CRI-A Inventory, Expanded Disability Status Scale (EDSS), Beck Depression Inventory and Fatigue Severity Scale.
Results
Results: 95.56% of the patients had Relapsing-Remitting MS (RRMS), 2.22% Primary-Progressive MS (PPMS), and 2.22% Secondary-Progressive MS (SPMS). The group comprised 59 women (65.56%), with a mean age of 40.97±12.85 years and mean education of 13.46±3.93 years. The group shows a mean of 13.92±10.45 for depression, 3.77±1.72 for fatigue, 10.76±9.72 for disease evolution and 2.48±1.79 for disability. CRI-A Inventory maintains the psychometric properties of the Argentine general population in the MS subpopulation, with adequate validity and reliability. The respondents most frequently utilized a problem focused coping style. A significant positive correlation was found between the problem-focused coping style and education (r= 0.31). As regards clinical variables, significant positive correlations were found between the emotion‑focused coping style and fatigue (r=0.21) and depression (r= 0.43). Nevertheless, when studying each of the 8 coping strategies on their own, a significant positive correlation was found between 3 strategies of the emotion-focused coping style: avoidance (r=0.27), acceptance (r=0.27) and emotional discharge (r=0.42), and depression. In addition, the seeking alternative rewards strategy was linked to the disease evolution and fatigue (r= 0.24/-0.22).
Conclusions
Conclusions: The results demonstrate the transferability of the CRI-A of the general population of Argentina in the subpopulation of patients with MS. Patients with MS develop more problem-focused strategies.
P1014 - Decision Making Process in Argentinian Patients with Multiple Sclerosis (ID 1223)
Abstract
Background
Considering the complexity of the disease and its treatment, patients with multiple sclerosis (PwMS) need up-to-date evidence-based information in order to make an informed decision together with their physicians based on their preferences. There is scarce information regarding decision-making-process (DMP) in PwMS from Latin America.
Objectives
We aimed to evaluate DMP in Argentinian PwMS and to assess its relationship with patient preferences and clinical-demographic characteristics.
Methods
Twelve hundred seventy-five PwMS from the patient organization Esclerosis Múltiple Argentina (EMA) were invited to participate in a self-administered web-based survey. Participants were asked to provide clinical-demographic information and to complete a questionnaire assessing perceived information provision, the Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and were inquired on preferred sources of information about MS. Descriptive analyses, parametric and nonparametric statistics were performed, p value <0.05 was accepted.
Results
Three hundred seventy-nine PwMS completed the survey. Most were females (67%); mean age was 40.3 (SD=11.1) years; mean disease duration was 7.9 (SD= 7.2) years. The majority of PwMS were satisfied with information provision from their neurologist on MS characteristics, prognosis, complementary studies and treatment. Patients decisional control preference role was active in 47%, shared in 27%, and passive in 26%. A moderate agreement (weighted kappa 0.55) was observed between patients’ preferences and self-reported DMP. Seventy-two percent of the PwMS participated in the DMP according to their preferences (concordance rates: active 66%, shared 87%, passive 51%). Most patients (83%) declared receiving information from their neurologists, matching their preferences (94%). Social networks were the least preferred source of information (40%).
Conclusions
Argentinian PwMS have distinctive preferences regarding information management and decision-making compared to other populations. This may be probably due to cultural, religious, or idiosyncratic issues, among others. More studies are needed to corroborate our findings in order to improve understanding of patients’ needs.
P1033 - Health-related quality of life in relapsing multiple sclerosis patients from Argentina: impact of clinical features and coping strategies (ID 1032)
Abstract
Background
Multiple sclerosis (MS) patients have reported decreased health-related quality of life (HRQoL). Identifying factors that contribute to a worse HRQoL is needing in order to improve the HRQoL of these patients.
Objectives
We aimed to investigate the HRQoLin an Argentinean population of MS patients and their correlation with clinical variables and coping strategies.
Methods
Nationwide cross-sectional study. Screening instruments: Demographics and clinical data, HRQoL (MS Impact Scale, [MSIS-29]), Fatigue Severity Scale and physical disability (self-administrated Expanded Disability Status Scale, [EDSS]) and coping strategies (Brief Coping Orientation to Problems Experienced, [COPE-28]).
Results
We included 249 (74.7% women) MS patients with a mean age at survey of 38.6 (±10.7), a MS duration of 7.3 years (range: 1-43 years) and a mean EDSS of 1.9 (±1.8). The multivariate analysis via linear regression showed: lower fatigue scores and higher EDSS score, perception of severity of MS score and dysfunctional (maladaptive) coping strategies score significantly correlated with both higher (worse) HRQoL total (from p=0.009 to p<0.0001) and MSIS-physical scores (from p=0.04 to p<0.0001). Additionally, higher age and lower fatigue, dysfunctional coping strategies and perception of severity of MS scores were significantly correlated with worse MSIS-psychological (from p=0.006 to p<0.0001). An inverse correlation between live alone (p=0.04) and emotion-focused strategies (p=0.02) was significantly associated with a better MSIS-psychological.
Conclusions
This study showed a negative impact of physical disability and maladaptive coping strategies on HRQoL in MS patients from Argentina. Therefore, it would be necessary to increase interdisciplinary interventions and based on adaptive coping strategies to improve the HRQoL of these patients.
Presenter Of 2 Presentations
P0804 - Dual task during walking in patients with Multiple Sclerosis: cognitive or motor interference?
(ID 1453)
Abstract
Background
Impairment in dual task (DT) activities has been previously reported in patients with multiple sclerosis (MS). Most studies analyze DT during walking whether incorporating a second cognitive or motor task. More research is needed in order to define what type of task (cognitive or motor) determines the severity of the interference produced in the DT.
Objectives
1) To compare DT performance between patients with MS and healthy controls. 2) To analyze DT performance according to the type of task that interferes (cognitive or motor).
Methods
94 patients with relapsing remitting MS and 25 healthy controls (HC) were included. Patient age: 38.61 ± 11.44; Education: 13.26 ± 3.77; Disability (EDSS): 2.13 ± 1.16; Evolution: 9.66 ± 8.96. HC age: 34.00 ± 14.25; Education: 14.50 ± 2.65. Measuring instruments: Clinical variables: EDSS; Fatigue severity scale; Beck Depression Inventory II. Cognitive variables: BICAMS battery; DT: cognitive-motor task (walking while performing cognitive task) and motor-motor task (walking while performing motor task). The difference between performance in the single task and in the dual task situation was obtained. Parametric and non-parametric statistics were used, to define significance a value of p <0.05 was accepted
Results
: patients and HC did not differ in age (p = 0.12) and education (p = 0.11). Patient presented poorer performance than HC in cognitive-motor DT (U: between 334.50 and 238.50; p <0.05) but not in motor-motor DT (p> 0.05). Patients with EDSS> 2, presented lower performance than the controls in both types of task (p <0.05). The motor-motor task differentiated patients with EDSS <y> 2 (t: 2.85 and 3.51; p <0.05).
Conclusions
MS patients show impairment in the DT performance when the second task is cognitive. In patients with greater disability, alteration is found in both DT. Studying patient’s performance in DT allows a more ecological approach to their symptoms in order to directly intervene in daily life alterations.
P0819 - Perceived Social Support in Multiple Sclerosis: Impact on patient’s quality of life. (ID 1241)
Abstract
Background
Social support plays an extremely important role in treatment and evolution of patients with multiple sclerosis (MS). However, there are scarce data that describes the size and quality of social network in MS patients, as well as its impact on their quality of life.
Objectives
(a) to analyze differences in perceived social support (PSS) between MS patients and healthy controls. (b) to study the associations between PSS and clinical and health-related quality of life (HRQoL) variables in MS patients, and (c) to analyze the influence of PSS on HRQoL.
Methods
151 MS patients and 89 healthy controls (HC) were studied. HC: Age: 42.01±12.25 years; Education: 14.60±2.44 years; Patients: Age: 41.46±9.97; Education:14.05±3.26 years; EDSS:2.88±2.10; Disease evolution:12.46±10.07 years. Instruments: PSS: MOS (Medical Outcomes Study Social Support Survey); Clinical Variables: EDSS, Fatigue Scale (FSS); Depression Inventory (BDI-II); HRQoL: MusiQol. Parametric and non-parametric statistics were used, significance p value<0.05.
Results
Patients presented lower scores than HC in global score of PSS (t(238)=- 1.99, p=0.04) and in each functional dimension (t(238)=between-2.59 and -2.09, p<0.05). Associations were found between PSS with depression and fatigue (r = between-0.20 and -0.29, p <0.05) and with the different dimensions of the MusiQol (r = between-0.18 and 0.48, p <0.05). In multiple regression analysis, the four models tested contributed significantly to the explained variance of HRQoL (between 41 and 47%). The model constituted with emotional/informational support explained the greatest variation of HRQoL (47%).
Conclusions
Patients with MS perceive a decrease in their social support impacting on their quality of life. This should be considered for a better therapeutic approach.