Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. The progression and severity of MS varies by individual, but it is generally a disabling disease. Although medications have been developed to slow the disease progression and help manage symptoms, MS research has yet to result in a cure. Early diagnosis and treatment of the disease have been shown to be effective at slowing the development of disabilities. However, early MS diagnosis is difficult because symptoms are intermittent and shared with other diseases. Thus most previous works have focused on uncovering the risk factors associated with MS and predicting the progression of disease after a diagnosis rather than disease prediction. This paper investigates the use of data available in electronic medical records (EMRs) to create a risk prediction model; thereby helping clinicians perform the difficult task of diagnosing an MS patient. Our results demonstrate that even given a limited time window of patient data, one can achieve reasonable classification with an area under the receiver operating characteristic curve of 0.724. By restricting our features to common EMR components, the developed models also generalize to other healthcare systems.
Scoring systems have also been developed to assess the risk of disability. A study showed that MS Functional Composite, originally proposed as a clinical outcome measure, could be used to determine risk of severe physical disability @cite_8 . The Magnetic Resonance Disease Severity Scale (MRDSS) combined MRI measures into a composite score to predict the progression of physical disabilities @cite_13 . Bazelier @cite_10 derived a score using Cox proportional hazard models to estimate the long-term risk of osteoporotic and hip fractures in MS patients. Another study conducted by Margaritella et. al @cite_30 used Evoked Potentials score to predict the progression of disability and identify patients with benign MS.
@cite_30 @cite_10 @cite_13 @cite_8
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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. Objective: To derive a simple score for estimating the long-term risk of osteoporotic and hip fracture in individual patients with MS. Methods: Using the UK General Practice Research Database linked to the National Hospital Registry (1997–2008), we identified patients with incident MS (n 5,494). They were matched 1:6 by year of birth, sex, and practice with patients without MS (control subjects). Cox proportional hazards models were used to calculate the long-term risk of osteoporotic and hip fracture. We fitted the regression model with general and specific risk factors, and the final Cox model was converted into integer risk scores. Results: In comparison with the FRAX calculator, our risk score contains several new risk factors that have been linked with fracture, which include MS, use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. We estimated the 5- and 10-year risks of osteoporotic and hip fracture in relation to the risk score. The C-statistic was moderate (0.67) for the prediction of osteoporotic fracture and excellent (0.89) for the prediction of hip fracture. Background Individual magnetic resonance imaging (MRI) disease severity measures, such as atrophy or lesions, show weak relationships to clinical status in patients with multiple sclerosis (MS). Objective To combine MS-MRI measures of disease severity into a composite score. Design Retrospective analysis of prospectively collected data. Setting Community-based and referral subspecialty clinic in an academic hospital. Patients A total of 103 patients with MS, with a mean (SD) Expanded Disability Status Scale (EDSS) score of 3.3 (2.2), of whom 62 (60.2 ) had the relapsing-remitting, 33 (32.0 ) the secondary progressive, and 8 (7.8 ) the primary progressive form. Main Outcome Measures Brain MRI measures included baseline T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volume and brain parenchymal fraction (BPF), a marker of global atrophy. The ratio of T1LV to T2LV (T1:T2) assessed lesion severity. A Magnetic Resonance Disease Severity Scale (MRDSS) score, on a continuous scale from 0 to 10, was derived for each patient using T2LV, BPF, and T1:T2. Results The MRDSS score averaged 5.1 (SD, 2.6). Baseline MRI and EDSS correlations were moderate for BPF, T1:T2, and MRDSS and weak for T2LV. The MRDSS showed a larger effect size than the individual MRI components in distinguishing patients with the relapsing-remitting form from those with the secondary progressive form. Models containing either T2LV or MRDSS were significantly associated with disability progression during the mean (SD) 3.2 (0.3)–year observation period, when adjusting for baseline EDSS score. Conclusion Combining brain MRI lesion and atrophy measures can predict MS clinical progression and provides the basis for developing an MRI-based continuous scale as a marker of MS disease severity. Objective: To determine whether the MS Functional Composite (MSFC) can predict future disease progression in patients with relapsing remitting MS (RR-MS). Background: The MSFC was recommended by the Clinical Outcomes Assessment Task Force of the National MS Society as a new clinical outcome measure for clinical trials. The MSFC, which contains a test of walking speed, arm dexterity, and cognitive function, is expressed as a single score on a continuous scale. It was thought to offer improved reliability and responsiveness compared with traditional clinical MS outcome measures. The predictive value of MSFC scores in RR-MS has not been determined. Methods: The authors conducted a follow-up study of patients with RR-MS who participated in a phase III study of interferon β-1a (AVONEX) to determine the predictive value of MSFC scores. MSFC scores were constructed from data obtained during the phase III trial. Patients were evaluated by neurologic and MRI examinations after an average interval of 8.1 years from the start of the clinical trial. The relationships between MSFC scores during the clinical trial and follow-up status were determined. Results: MSFC scores from the phase III clinical trial strongly predicted clinical and MRI status at the follow-up visit. Baseline MSFC scores, and change in MSFC score over 2 years correlated with both disability status and the severity of whole brain atrophy at follow-up. There were also significant correlations between MSFC scores during the clinical trial and patient-reported quality of life at follow-up. The correlation with whole brain atrophy at follow-up was stronger for baseline MSFC than for baseline EDSS. Conclusion: MSFC scores in patients with RR-MS predict the level of disability and extent of brain atrophy 6 to 8 years later. MSFC scores may prove useful to assign prognosis, monitor patients during early stages of MS, and to assess treatment effects.