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Open Access Research article

Exploring the predictive value of the evoked potentials score in MS within an appropriate patient population: a hint for an early identification of benign MS?

Nicolò Margaritella1, Laura Mendozzi2, Massimo Garegnani1, Raffaello Nemni3, Elena Colicino4, Elisabetta Gilardi1 and Luigi Pugnetti1*

Author affiliations

1 Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, Via Capecelatro 66, Milan, 20148, Italy

2 Multiple Sclerosis Rehabilitation Unit, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, Via Capecelatro 66, Milan, 20148, Italy

3 Neurological Rehabilitation Unit, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, Via Capecelatro 66, Milan, 20148, Italy

4 Department of Agriculture Food and Environmental Economics, University of Milan, Via G. Celoria, Milan, 2-20133, Italy

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Citation and License

BMC Neurology 2012, 12:80  doi:10.1186/1471-2377-12-80

Published: 22 August 2012

Abstract

Background

The prognostic value of evoked potentials (EPs) in multiple sclerosis (MS) has not been fully established. The correlations between the Expanded Disability Status Scale (EDSS) at First Neurological Evaluation (FNE) and the duration of the disease, as well as between EDSS and EPs, have influenced the outcome of most previous studies. To overcome this confounding relations, we propose to test the prognostic value of EPs within an appropriate patient population which should be based on patients with low EDSS at FNE and short disease duration.

Methods

We retrospectively selected a sample of 143 early relapsing remitting MS (RRMS) patients with an EDSS < 3.5 from a larger database spanning 20 years. By means of bivariate logistic regressions, the best predictors of worsening were selected among several demographic and clinical variables. The best multivariate logistic model was statistically validated and prospectively applied to 50 patients examined during 2009–2011.

Results

The Evoked Potentials score (EP score) and the Time to EDSS 2.0 (TT2) were the best predictors of worsening in our sample (Odds Ratio 1.10 and 0.82 respectively, p=0.001). Low EP score (below 15–20 points), short TT2 (lower than 3–5 years) and their interaction resulted to be the most useful for the identification of worsening patterns. Moreover, in patients with an EP score at FNE below 6 points and a TT2 greater than 3 years the probability of worsening was 10% after 4–5 years and rapidly decreased thereafter.

Conclusions

In an appropriate population of early RRMS patients, the EP score at FNE is a good predictor of disability at low values as well as in combination with a rapid buildup of disability. Interestingly, an EP score at FNE under the median together with a clinical stability lasting more than 3 years turned out to be a protective pattern. This finding may contribute to an early identification of benign patients, well before the term required to diagnose Benign MS (BMS).

Keywords:
Multiple Sclerosis; EP score; Disability prediction; Multivariate analysis; ROC analysis; Benign MS; Evoked potentials