Author Of 2 Presentations
P0423 - A history of migraine headache may not be associated with worse disability or worse neurologic function (ID 1929)
Abstract
Background
Migraine headaches are common in people with multiple sclerosis (MS). Whether migraine has a role in MS course or symptom severity is poorly understood.
Objectives
To assess the association between a history of migraine, disability and neurological function in MS patients. Secondly, to evaluate the association between migraine and frequency of MS relapses, and to determine whether migraine co-occurs with other comorbid conditions in MS patients.
Methods
We conducted an observational study of MS patients who completed the MS Performance Test-based (MSPT) (iPad version of the MS Functional Composite) assessment of neurologic function and had a documented diagnosis of migraine in their electronic medical record. Other queried comorbidities included: diabetes, hypertension, dyslipidemia, history of myocardial infarction, sleep apnea, depression and anxiety. We evaluated the association between a positive history of migraines and MS outcomes, including disability (Patient Determined Disease Steps [PDDS]), annualized relapse rate, rate of brain lesion development on MRI, and objective neurological outcomes (walking speed, manual dexterity and processing speed) using generalized linear models adjusting for age, sex, race, employment status, insurance status, BMI and MS subtype/duration. We also tested whether the pre-specified comorbidities were overrepresented in MS-migraineurs vs. MS-non-migraineurs.
Results
We analyzed cross-sectional data from 2017 participants with MS, 336 of whom had one mention of migraine diagnosis in their chart in either the problem list or past medical history, who completed the MSPT. Relative to MS-non-migraineurs, MS-migraineurs tended to be younger (mean age 42.6y[11.7y] vs. 46.6y[12.6y]; p<0.001), and have a history of depression (46.52[7.64] vs 48.16[7.72]; p<0.001), anxiety (50.29[9.08] vs 52.81[8.76]; p<0.01) as measured by NeuroQoL scores, and obstructive sleep apnea (109 [6.5] vs 53[15.8]); p<0.001). MS-migraineurs were less likely to have severe disability (5.4% vs 12%, p<0.003), and did not show differences in objective neurological outcomes such as walking speed, manual dexterity or processing speed. There was similarly no significant difference in annualized relapse rate or rate of new brain lesion development in MS-migraineurs vs non-migraineurs.
Conclusions
Traditional migraine risk factors such as depression, anxiety as well as obstructive sleep apnea were overrepresented in our cohort of MS-migraineurs. A history of migraine was not associated with greater disability. Migraine may not be adequately captured in the electronic medical record when patients are presenting for MS related care. Evidence to date on this topic is conflicting and warrants future longitudinal studies.
P0510 - Vascular comorbidity is associated with lower brain volumes in a large multiple sclerosis cohort (ID 1671)
Abstract
Background
Vascular comorbidities like diabetes, hypertension and dyslipidemia are overrepresented in people with multiple sclerosis (MS) and may contribute to adverse MS outcomes. Existing studies evaluating vascular comorbidity and MS course were often limited by relatively small sample sizes or lack large-scale corresponding quantitative neuroimaging studies.
Objectives
To assess the association between vascular comorbidity burden with clinical and imaging features of disease severity in a large population of people with MS.
Methods
We included participants from the Multiple Sclerosis Partners Advancing Technology Health Solutions (MS PATHS) cohort. We evaluated if metabolic and vascular comorbidities (diabetes, hypertension and dyslipidemia) or a composite sum of vascular comorbidities was associated with MS characteristics, including objective neurologic function assessments and quantitative brain MRI measurements, after adjusting for covariates using propensity score weighted models.
Results
11,506 participants (6409 [55%] with brain MRI) were included in the analysis. Participants were on average aged 48.9 years (standard deviation [SD]: 12.4 years), were 74% female, and were 24% non-white; 1881 (16.3%) individuals had 2+ comorbidities. Individuals with 2+ vascular comorbidities had slower walking speed (-0.49 SD times slower; 95% CI: -0.78 to -0.19; p=0.001), slower manual dexterity (-0.41 SD times slower; 95% CI: -0.57 to -0.26; p<0.0001), and fewer correct scores on cognitive processing speed (-0.11 SD lower scores; -0.20 to -0.02; p=0.03) relative to those with none of these comorbidities. Those with 2+ had lower brain parenchymal (-0.41%, 95% CI -0.64%, -0.17%; p=-0.0001) and gray matter fractions (-0.30%, 95% CI -0.49, -0.10; p=0.002), including reduced cortical (-10.10 mL, 95% CI -15.42, -4.78; p=0.0002) and deep (-0.44 mL, 95% CI -0.84, -0.04; p=0.03) gray matter volumes, when compared to those with no comorbidity. Comorbidity burden was not associated with T2 lesion volume. Individually, diabetes and dyslipidemia were generally associated with poorer neuroperformance and brain imaging outcomes.
Conclusions
Increased vascular comorbidity burden was associated with clinical and imaging markers of MS severity in this large study. Strategies to optimize comorbidity management in people with MS are warranted.
Presenter Of 1 Presentation
P0423 - A history of migraine headache may not be associated with worse disability or worse neurologic function (ID 1929)
Abstract
Background
Migraine headaches are common in people with multiple sclerosis (MS). Whether migraine has a role in MS course or symptom severity is poorly understood.
Objectives
To assess the association between a history of migraine, disability and neurological function in MS patients. Secondly, to evaluate the association between migraine and frequency of MS relapses, and to determine whether migraine co-occurs with other comorbid conditions in MS patients.
Methods
We conducted an observational study of MS patients who completed the MS Performance Test-based (MSPT) (iPad version of the MS Functional Composite) assessment of neurologic function and had a documented diagnosis of migraine in their electronic medical record. Other queried comorbidities included: diabetes, hypertension, dyslipidemia, history of myocardial infarction, sleep apnea, depression and anxiety. We evaluated the association between a positive history of migraines and MS outcomes, including disability (Patient Determined Disease Steps [PDDS]), annualized relapse rate, rate of brain lesion development on MRI, and objective neurological outcomes (walking speed, manual dexterity and processing speed) using generalized linear models adjusting for age, sex, race, employment status, insurance status, BMI and MS subtype/duration. We also tested whether the pre-specified comorbidities were overrepresented in MS-migraineurs vs. MS-non-migraineurs.
Results
We analyzed cross-sectional data from 2017 participants with MS, 336 of whom had one mention of migraine diagnosis in their chart in either the problem list or past medical history, who completed the MSPT. Relative to MS-non-migraineurs, MS-migraineurs tended to be younger (mean age 42.6y[11.7y] vs. 46.6y[12.6y]; p<0.001), and have a history of depression (46.52[7.64] vs 48.16[7.72]; p<0.001), anxiety (50.29[9.08] vs 52.81[8.76]; p<0.01) as measured by NeuroQoL scores, and obstructive sleep apnea (109 [6.5] vs 53[15.8]); p<0.001). MS-migraineurs were less likely to have severe disability (5.4% vs 12%, p<0.003), and did not show differences in objective neurological outcomes such as walking speed, manual dexterity or processing speed. There was similarly no significant difference in annualized relapse rate or rate of new brain lesion development in MS-migraineurs vs non-migraineurs.
Conclusions
Traditional migraine risk factors such as depression, anxiety as well as obstructive sleep apnea were overrepresented in our cohort of MS-migraineurs. A history of migraine was not associated with greater disability. Migraine may not be adequately captured in the electronic medical record when patients are presenting for MS related care. Evidence to date on this topic is conflicting and warrants future longitudinal studies.