A systematic literature review of the association between global brain atrophy and the Expanded Disability Status Scale score in people with multiple sclerosis.
Robert Zivadinov, Hoa H Le, Alexander Keenan, Susan Jill Stocks
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引用次数: 0
Abstract
Background: Brain atrophy (BA) is a useful predictor of clinical outcomes in people with multiple sclerosis (PwMS). For this reason, MAGNIMS (Magnetic Resonance Imaging in Multiple Sclerosis), an expert consensus group, recommended that global brain volume loss (BVL) is included as a secondary outcome in therapeutic clinical trials. However, there has not been a recent review of the evidence of the association, or strength of association, between global BA and disability in PwMS.
Objectives: Our aim is to review articles from 2013 onward measuring the associations between percentage of brain volume loss (PBVL), normalized brain volumes (NBV) or normalized brain parenchymal volume (NBPV), and the Expanded Disability Status Scale (EDSS), or disability progression (DP) measured by EDSS in PwMS.
Design: Systematic review.
Methods: We searched Medline, Embase, Cochrane Library, Cochrane Clinical Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cumulative Index to Nursing and Allied Health Literature for observational studies, clinical trials and modelling studies measuring the association between global BVL, PBVL, NBV or NBPV, and EDSS score or DP in PwMS. We included people with clinically isolated syndrome and excluded studies with a population greater than 20% primary progressive multiple sclerosis patients.
Results: We found 58 studies were eligible for the review. Most longitudinal studies (19/23) observed a significant association between global BVL and change in EDSS score or DP. Similarly the majority of cross-sectional studies (26/29) observed an association between baseline BV measures and EDSS. Most studies investigating the association between baseline brain volume (BV) measures and follow-up EDSS, that is, asking if baseline BV is a predictor of DP, or future EDSS score, did not find an association (4/15 observed an association).
Conclusion: Around a 1% (range 0.4%-1.3%) decrease in global BV per year was associated with DP, but caution in comparing studies is recommended due to variations in the definition of DP.
背景：脑萎缩（BA）是多发性硬化症（PwMS）患者临床预后的有效预测指标。因此，专家共识小组MAGNIMS（多发性硬化症磁共振成像）建议，在治疗性临床试验中，将总脑容量损失（BVL）作为次要结果。然而，最近还没有证据表明全球BA与PwMS中残疾之间存在关联或关联强度。目的：我们的目的是回顾2013年以来测量脑容量损失百分比（PBVL）、规范化脑容量（NBV）或规范化脑实质体积（NBPV）与扩展残疾状态量表（EDSS）或残疾进展（DP）之间关系的文章。设计：系统回顾。方法：我们检索Medline、Embase、Cochrane Library、Cochrane Clinical Register of Controlled Trials、Cochrane Database of Systematic Reviews和Cumulative Index to Nursing and Allied Health文献，以获得观察性研究、临床试验和模型研究，测量全球BVL、PBVL、NBV或NBPV与PwMS患者EDSS评分或DP之间的关系。我们纳入了临床孤立综合征患者，排除了原发性进行性多发性硬化症患者超过20%的研究。结果：我们发现58项研究符合本综述的条件。大多数纵向研究（19/23）观察到总体BVL与EDSS评分或DP变化之间存在显著关联。同样，大多数横断面研究（26/29）观察到基线BV测量与EDSS之间存在关联。大多数研究调查基线脑容量（BV）测量与随访EDSS之间的关系，即询问基线脑容量是否是DP或未来EDSS评分的预测因子，但没有发现相关性（4/15观察到相关性）。结论：每年全球BV下降约1%（范围0.4%-1.3%）与DP有关，但由于DP定义的差异，建议在比较研究时谨慎。
期刊介绍：
Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.
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