Comparison of physical, psychosocial and cognitive parameters used inassessment of multiple sclerosis exacerbation severity: A prospective cohort study

Multiple sclerosis (MS) is a heterogenous disease and Expanded Disability Status Scale (EDSS) is widely used for clinical assessment of exacerbations. However, it is well known that the EDSS has an inadequate assessment of upper extremity function, cognitive decline, and psychosocial impact of the disease. We aimed to design a model to reflect attack severity and changes in EDSS score by using patient demographics together with well-approved tests and surveys. 120 Relapsing Remitting Multiple Sclerosis (RRMS) and 6 Secondary Progressive Multiple Sclerosis patients (SPMS) were enrolled during the relapse phase of the disease. One hundred three of those patients were evaluated during remission. Before Intravenous Methylprednisolone treatment and at least one month after that, physical: Nine-Hole Peg Test (9HPT, Timed 25-Foot Walk (T25FW), Two-Minute Walking Test (2MWT), Six Step Spot Test (SSST), cognitive: Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Paced Auditory Serial Additional Test (PASAT) and psychosocial: Twelve Item MS Walking Scale (MSWS-12), Modified Fatigue Impact Scale (MFIS), Manual Ability Measurement (MAM-36), Multiple Sclerosis International Quality of Life (MUSIQoL), Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale (HADS) tests were applied. Patient demographics (age, gender, marital status, job, education, disease duration, smoking, alcohol consumption, regular physical exercise, height, weight, Body Mass Index (BMI) were gathered before treatment. Linear regression analyses were used to evaluate the impact of demographics, physical, cognitive, and psychosocial factors on EDSS. The significance level was accepted at p<0.05. No significant improvement was found in T25FW test and in five subgroups of MUSIQoL survey (Relationships with Friends, Relationships with Family, Relationship with the Healthcare System, Rejection) by using Wilcoxon Signed Rank test. Statistically significant negative correlation was found between the SDMT (Symbol Digit Modalities Test), marital status, 2MWT and BMI. Our model correlated with 23% of EDSS improvement. Because of the multisystemic and polyregional effects of MS, we need more comprehensive tests for evaluation. We have shown the importance of demographic, physical, and cognitive parameters that is SDMT, marital status, 2MWT, BMI on EDSS improvement. Patient assessment should include various parameters, and more comprehensive studies in this field encompassing neuroimaging, biomarker, and genetic tests should be carried out. Keywords: Multiple sclerosis, attack, EDSS