Virginia Devonshire

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (27)147.61 Total impact

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    ABSTRACT: Background We explored health-related quality of life (HRQoL) and psychosocial aspects in a cohort of patients with a history of longstanding benign MS (BMS). Methods Patients with BMS (EDSS≤3 after 20 years disease duration) were re-assessed 25–30 years post-MS symptom onset for: EDSS, HRQoL (MSQoL-54), depression (Beck Depression Inventory-II), and fatigue (Modified Fatigue Impact Scale). Associations between these measures and patient characteristics (age, disease duration, ‘benign status’ [remained benign (EDSS≤3) vs. no longer benign (EDSS>3)]) were examined. Results Of the 61 patients included, 36 (49%) remained benign and 25 (41%) progressed (EDSS>3). Overall, physical and mental HRQoL scores were positively associated with each other (r=0.63;p<0.0001) and both negatively correlated with fatigue (r=−0.76 and −0.44, respectively;p<0.0005) and depression (r=−0.55 and r=−0.77;p<0.0001). Patients who remained benign reported better physical HRQoL vs. those no longer benign (mean(SD)=67.3±18.1 vs 50.7±19.9, p=0.001), but not mental health (mean(SD)=67.4±19.3 vs 65.0±20.6, p=0.639). Generally, neither age nor disease duration were strongly associated with HRQoL (r<0.35). Conclusion Lower self-reported physical or mental HRQoL were associated with worsening fatigue and depression. However, EDSS progression was associated with the physical, but not mental aspects of HRQoL. Patient-reported HRQoL in ‘benign MS’ provides insight on the impact of MS beyond EDSS alone.
    Multiple Sclerosis and Related Disorders 10/2014; 4(1). DOI:10.1016/j.msard.2014.09.211 · 0.88 Impact Factor
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    ABSTRACT: Since the first development of diagnostic criteria for multiple sclerosis (MS), there have been reg-ular revisions of disease definitions and diagnostic thresholds aimed at improving specificity while maintaining sensitivity. The central requirements for diagnosis of MS are dissemination in space (DIS) and dissemination in time (DIT) of lesions in the CNS, with the proviso that there should be no alternate diagnosis that better explains the clinical presentation. The most definitive diagnosis is the purely clinical one, with 2 separate attacks of symptoms (fulfilling DIT criteria) involving at least 2 different areas of the CNS (fulfilling DIS criteria). In patients who have had a first but not a second clinical attack, the McDonald criteria provide guidance on how paraclinical evidence can be used to support a diagnosis of MS. Recently, the McDonald criteria were revised and new definitions for DIS and DIT proposed. In response to that revision, a panel of Canadian MS neu-rologists and one neuroradiologist created this commentary regarding the clinical implications and applications of the 2010 McDonald criteria. Neurology â 2012;79 (Suppl 2):S1–S15
    Neurology 12/2012; 79(23 Suppl 2):S1-15. DOI:10.1212/WNL.0b013e318277d144. · 8.29 Impact Factor
  • Ludwig Kappos · Virginia Devonshire · Dieter Adrian Häring ·

    The Lancet Neurology 09/2012; 11(9):747-8. DOI:10.1016/S1474-4422(12)70183-7 · 21.90 Impact Factor
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    ABSTRACT: Fingolimod 0·5 mg once daily is approved for treatment of relapsing multiple sclerosis (MS). In the phase 3, 2-year FREEDOMS (FTY720 Research Evaluating Effects of Daily Oral therapy in MS) study, fingolimod significantly reduced annualised relapse rates (ARRs) and the risk of confirmed disability progression compared with placebo. We aimed to investigate whether the beneficial treatment effect reported for the overall population is consistent in subgroups of patients with different baseline characteristics. We did subgroup analyses of ARRs (primary outcome) and confirmed disability progression (a secondary outcome) over 24 months in the FREEDOMS study, a randomised, double-blind study that included 1272 patients with relapsing-remitting MS who were assigned 1:1:1 to fingolimod (0·5 mg or 1·25 mg) or placebo once daily for 24 months. Subgroups were predefined, predefined and slightly modified, or defined post hoc, by demographic factors (including sex and age), disease characteristics (including baseline disability scores, relapse rates, and lesion parameters), and response to previous therapy (including analyses in patients eligible for fingolimod treatment according to the European label). Data were analysed by intention to treat. The FREEDOMS study is registered with, number NCT00289978. Treatment with fingolimod 0·5 mg was associated with significantly lower ARRs versus placebo across all subgroups except for patients aged over 40 years. ARR ratios ranged from 0·76 (95% CI 0·54-1·09; p=0·13) in patients aged over 40 years to 0·29 (0·16-0·52; p<0·0001) in patients who had relapse activity despite receiving interferon beta during the year before study enrolment. Hazard ratios for confirmed disability progression over 24 months with fingolimod 0·5 mg versus placebo ranged from 0·85 (95% CI 0·53-1·36; p=0·50) in patients with a T2 lesion volume of 3300 mm(3) or less to 0·32 (0·14-0·73; p=0·0066) in patients with an EDSS over 3·5. In patients who relapsed and had lesion activity despite treatment with interferon beta in the previous year, the ARR ratio for fingolimod 0·5 mg versus placebo was 0·38 (95% CI 0·21-0·68, p=0·0011), and for treatment-naive patients with rapidly evolving severe disease it was 0·33 (0·18-0·62, p=0·0006). Hazard ratios for confirmed disability progression over 24 months were 0·68 (0·29-1·62; p=0·39) and 0·73 (0·25-2·07; p=0·55), respectively, in these groups. Patients with relapsing-remitting MS with a wide spectrum of clinical and MRI features including subgroups specified by the European label can potentially benefit from treatment with 0·5 mg fingolimod. Novartis.
    The Lancet Neurology 04/2012; 11(5):420-8. DOI:10.1016/S1474-4422(12)70056-X · 21.90 Impact Factor
  • Virginia A Devonshire · Elisabetta Verdun di Cantogno ·
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    ABSTRACT: Multiple sclerosis is a chronic disease requiring lifelong treatment with disease-modifying drugs that aim to prevent relapses and slow the progression of disability. The established first-line treatments for multiple sclerosis all require regular injections, and real-world observations suggest that long-term adherence to treatment is low. Indeed, poor adherence to disease-modifying drug treatment has been associated with poorer clinical outcomes. Autoinjectors have been developed to improve the success of self-injection, whilst also making injections more comfortable for patients, with the aim of minimizing obstacles to treatment adherence. RebiSmart™ is a new electronic autoinjector for subcutaneous administration of interferon β-1a (Rebif®) that includes several unique features designed to further reduce barriers to adherence, including a dosing log and adjustable comfort settings.
    Therapeutic delivery 11/2011; 2(11):1455-65. DOI:10.4155/tde.11.116
  • Ana-Luiza Sayao · Anna-Marie Bueno · Virginia Devonshire · Helen Tremlett ·
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    ABSTRACT: Benign multiple sclerosis (BMS) is typically defined using the Expanded Disability Status Scale (EDSS), which relies heavily on ambulation. We set out to examine important psychosocial and cognitive outcomes in patients with longstanding BMS compared with patients who had recently progressed to 'no longer benign' (NLB). A previously reported cohort of BMS (EDSS ≤3 at 20 years disease duration) were re-assessed 25-30 years post-onset. Patients remaining benign (EDSS ≤3 at re-assessment) were compared with those NLB for: depression (Beck Depression Inventory), fatigue (Modified Fatigue Impact Scale), health-related quality of life (MSQoL-54), cognition (Rao's Neuropsychological Screening Battery), and employment status. A total of 75% (66/88) of the original cohort were located. A total of 61 patients were re-assessed. Twenty-five patients (41%) had progressed in EDSS and were NLB. Compared with benign patients, those NLB were more likely to have: significant fatigue (15/36 [42%] vs. 18/25 [72%], p = 0.019); poorer physical functioning (mean MSQoL-54 = 67.30 vs. 50.89, p = 0.002); an MS-related negative change in employment status (13/36 [36%] vs. 21/25 [84%], p < 0.0001) and cognitive impairment (3/28 [11%] vs. 5/19 [26%]; trend only, p = 0.317). Depression and mental health quality if life differed little between the benign and NLB patients (p > 0.6). Despite remaining benign for 20 years, a significant proportion of patients progressed with further follow up. While neither depression nor patient-reported mental health quality of life was associated with EDSS progression, patients with longstanding 'benign' MS (EDSS ≤3 for 25+ years) had less fatigue, better physical quality of life and employment outcomes and infrequent cognitive impairment. Remaining benign over the long term, as defined by the EDSS, carried some advantages beyond ambulation.
    Multiple Sclerosis 06/2011; 17(11):1375-83. DOI:10.1177/1352458511410343 · 4.82 Impact Factor
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    ABSTRACT: most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS. this was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs. two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment. identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs.
    European Journal of Neurology 01/2011; 18(1):69-77. DOI:10.1111/j.1468-1331.2010.03110.x · 4.06 Impact Factor
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    ABSTRACT: Multiple sclerosis (MS) currently requires long-term treatment with disease-modifying drugs, administered parenterally up to once daily. The need for regular self-injection can be a barrier to treatment for many patients. Autoinjectors can help patients overcome problems or concerns with self-injection and could, therefore, improve treatment adherence. This study was performed to assess the suitability of a new electronic device for the subcutaneous (sc) administration of interferon (IFN) beta-1a, 44 mcg three times weekly, for relapsing MS. In this Phase IIIb, multicentre, single-arm study, patients with relapsing MS who had been consistently self-injecting sc IFN beta-1a using an autoinjector for at least 6 weeks were taught to use the new device and self-administered treatment for 12 weeks thereafter. Patient-rated suitability of the device was assessed at the end of Week 12 using the Patient User Trial Questionnaire. Patient satisfaction with, and evaluation of, the injection process was assessed using the MS Treatment Concern Questionnaire. Trainers evaluated the device using the Trainer User Trial Questionnaire. At Week 12, 71.6% (73/102) of patients considered the device 'very suitable' or 'suitable' for self-injection; 92.2% (94/102) reported some degree of suitability and only 7.8% (8/102) found the device 'not at all suitable'. At Weeks 4, 8 and 12, most patients reported that injection preparation and clean-up, performing injections and ease of device use in the previous 4 weeks compared favourably with, or was equivalent to, their previous experience of self-injection. Injection-related pain, injection reactions and 'flu-like' symptoms remained stable over the 12 weeks. Each device feature was rated 'very useful' or 'useful' by at least 80% of patients. All trainers and 95.2% (99/104) of patients found device functions 'very easy' or 'easy' to use. Overall convenience was considered the most important benefit of the device. Most patients considered the new electronic injection device suitable for the sc injection of IFN beta-1a. They found the device easy to use with useful features, and reported benefits such as overall convenience. The device may, therefore, increase treatment adherence in patients with MS, particularly those with injection-related issues. NCT00735007.
    BMC Neurology 04/2010; 10(1):28. DOI:10.1186/1471-2377-10-28 · 2.04 Impact Factor
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    H Tremlett · M Yousefi · V Devonshire · P Rieckmann · Y Zhao ·
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    ABSTRACT: The relationship between relapses and long-term disability in multiple sclerosis (MS) remains to be fully elucidated. Current literature is conflicting and focused on early relapses. We investigated the effects of relapses at different stages on disability progression. We conducted a retrospective review of 2,477 patients with definite relapsing-onset MS followed until July 2003 in British Columbia, Canada. Time-dependent Cox proportional hazards models examined the effect of relapses at different time periods (0-5; >5-10; >10 years postonset) on time to cane (Expanded Disability Status Scale [EDSS]) and secondary progressive MS (SPMS). Findings were derived from hazard ratios with 95% confidence intervals (CIs), adjusted for sex, onset age, and symptoms. Mean follow-up was 20.6 years; 11,722 postonset relapses were recorded. An early relapse (within 5 years postonset) was associated with an increased hazard in disease progression over the short term, by 48%; 95% CI 37%-60% for EDSS 6 and 29%; 95% CI 20%-38% for SPMS. However, this substantially lessened to 10%; 95% CI 4%-16% (EDSS 6) and 2%; 95% CI -2%-7% (SPMS) after 10 years postonset. The impact of later relapses (>5-10 years postonset) also lessened over time. Effects were modulated by age, impact being greatest in younger (<25 years at onset) and least in older (>or=35 years) patients where relapses beyond 5-years postonset typically failed to reach significance. Relapses during SPMS had no measurable impact on time to EDSS 6 from SPMS. Relapses within the first 5 years of disease impacted on disease progression over the short term. However, the long-term impact was minimal, either for early or later relapses. Long-term disease progression was least affected by relapses in patients with an extended disease duration (>10 years) or already in the secondary progressive phase.
    Neurology 11/2009; 73(20):1616-23. DOI:10.1212/WNL.0b013e3181c1e44f · 8.29 Impact Factor
  • V. Devonshire · E. Verdun ·

  • V. Devonshire · A. Feinstein · P. Moriarty ·

  • Helen Tremlett · Yinshan Zhao · Virginia Devonshire ·
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    ABSTRACT: Similarities in the onset age of progression in secondary-progressive (SP) and primary-progressive multiple sclerosis (PPMS) have been previously reported. However, with longer follow-up, more relapsing-remitting (RRMS) patients reach SPMS, such that the baseline characteristics, including age at progression may shift. We aimed to examine how this phenomenon impacts on demographic and clinical comparisons made between PP and SPMS. Patients with definite MS, onset by July 1988 and > or = 1 Expanded Disability Status Scale (EDSS) score were selected from the British Columbia-wide MS database (n = 2837). Of these, 353 (12.4 %) had PPMS and 1445/2484 (58.2 %) of the RRMS population reached SPMS at study close (July 2003). Females predominated in the SPMS population regardless of follow-up time (p < or = 0.032). From Kaplan-Meier analysis (all RR, SP and PP patients considered), the estimated median onset age of progression was greater in SPMS (49.0 years; 95 % CI: 48.3-49.7) than PPMS (41.0 years; 95 % CI: 39.7-42.4), p < 0.0005. If the RR patients (who had not developed SPMS) were excluded, median age of onset of SPMS was still greater (43.1 years (95 % CI: 42.3-43.9, p < 0.0005). Although there were some similarities between SPMS and PPMS, the former had a later onset age in our British Columbian MS cohort.
    Journal of Neurology 04/2009; 256(3):374-81. DOI:10.1007/s00415-009-0039-7 · 3.38 Impact Factor
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    Peter Rieckmann · Anthony Traboulsee · Virginia Devonshire · Joel Oger ·
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    ABSTRACT: Basic disease-modifying treatment for relapsing forms of active multiple sclerosis (MS) is now available in many countries with high prevalence rates, for this chronic inflammatory disease of the central nervous system. Several lines of evidence support early immunomodulatory treatment with either recombinant interferon-beta or glatiramer acetate, and positive results from phase III trials encourage start of treatment even in patients with clinically isolated syndromes (CIS). However, currently available drugs for basic therapy are only partially effective and patients may still encounter relapses or disease progression. As treatment-refractory, clinically active MS can quickly lead to irreversible neurological disability there is an urgent need for effective escalating strategies. Patients with suboptimal treatment response to basic therapy have been treated with combination therapies, cytotoxic drugs (such as mitoxantrone and cyclophosphamide) or autologous hematopoietic stem cell transplantation. Recently, the monoclonal antibody, natalizumab, was added to this armamentarium. None of these strategies have been vigorously evaluated in large randomized, controlled phase III trials with patients who failed basic therapy. Therefore, the decision to escalate immunotherapy is still based on limited evidence. This article will review potential candidates for intensified immunosuppression and call for innovative study designs to better evaluate escalating immunotherapy in MS.
    Therapeutic Advances in Neurological Disorders 11/2008; 1(3):181-92. DOI:10.1177/1756285608098359 · 3.14 Impact Factor
  • Helen Tremlett · Yinshan Zhao · Virginia Devonshire ·

    Multiple Sclerosis 10/2008; 14(8):1142-3; author reply 1144-7. DOI:10.1177/1352458508095131 · 4.82 Impact Factor
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    H Tremlett · Y Zhao · J Joseph · V Devonshire ·
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    ABSTRACT: To examine the relative relapse-rate patterns over time in a relapsing multiple sclerosis (MS) cohort and to investigate potential predictors of relapse rates and periods of low-relapse activity. This retrospective cohort study followed 2477 relapsing-remitting (RR) MS patients from onset to 1 July 2003. Annualised relapse rates were examined according to sex, age at onset, the patient's current age and disease duration. The relationship between relapse rates and baseline characteristics (sex, onset age and onset symptoms) were examined using Poisson regression. Time to the first 5 years relapse-free was examined using Kaplan-Meier survival analysis. The mean follow-up time (from onset of MS symptoms) was 20.6 years, during which time 11,722 post-onset relapses were recorded. The relapse rate decreased by 17% every 5 years (between years 5 to 30 post-onset), but this decline increased in magnitude with increasing onset age. Women and those with onset sensory symptoms exhibited a higher relapse rate (p< or =0.001). More than three-quarters of patients (1692/2189) experienced a 5-year relapse-free period during the RR phase. Relapse rates were age- and time-dependent. Our observations have clinical implications: 1) any drug able to modify relapse rates has the greatest potential for a population impact in patients <40 years old and within the first few demi-decades of disease; 2) continuation of drug beyond these times may be of limited value; 3) long-term follow-up studies must consider that relapse rates probably decline at different rates over time according to the patient's onset age; 4) a relapse-quiescent period in MS is not uncommon.
    Journal of neurology, neurosurgery, and psychiatry 07/2008; 79(12):1368-74. DOI:10.1136/jnnp.2008.145805 · 6.81 Impact Factor
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    Paul O'Connor · Virginia Devonshire ·

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 06/2008; 35(2):127-32. · 1.53 Impact Factor
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    Helen Tremlett · Yinshan Zhao · Virginia Devonshire ·
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    ABSTRACT: To examine prognosis and risk factors for progression to and from secondary-progressive multiple sclerosis (SPMS). Patients with definite relapsing-remitting MS (RRMS), onset before July 1988, attending a British-Columbian MS clinic before July 1998, and at least one Expanded Disability Status Scale (EDSS) scores were selected from the population-based database. Time to SPMS (from onset and birth) and the subsequent time to EDSS 8 were examined, as were potential risk factors. In all, 2484/2837 (87.6%) were relapsing-remitting (RR) at onset, with 1445/2484 (58.2%) reaching SPMS, taking a median 18.9 years (95% CI: 18.2-19.7). Those younger at onset took longer to reach SPMS (P < 0.0005), but did so at a younger age (P < 0.0005). Males reached SPMS more rapidly from onset and at a younger age (P < 0.0005), but were around the same age as females at EDSS 8 (P = 0.975). Characteristics at SPMS onset associated with a longer time from SPMS to EDSS 8 and an older age at EDSS 8 were: longer disease duration (P < 0.02), older age (P < 0.01) and lower EDSS (P < 0.0005). Onset symptoms had little influence on time to SPMS or subsequent progression. The RR phase lasted on average almost two decades, being shorter for males and those older at onset of MS. However, neither were necessarily unfavorable predictors as those older at onset were typically older at SPMS and eventually males and females reached EDSS 8 at around the same age. A longer RR phase was a favorable predictor of disease progression in SPMS. Furthermore, reaching SPMS at an older age or lower EDSS did not necessarily confer a worse outcome.
    Multiple Sclerosis 05/2008; 14(3):314-24. DOI:10.1177/1352458507084264 · 4.82 Impact Factor
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    ABSTRACT: Background Previous trials of interferon beta in multiple sclerosis (MS) have shown efficacy, but the degree of clinical benefit remains uncertain, and the optimum dose is not known. We undertook a double-blind, placebo-controlled study in relapsing/remitting MS to investigate the effects of subcutaneous interferon beta-1a. Methods 560 patients with Kurtzke expanded disability status scale (EDSS) scores of 0-5.0, from 22 centres in nine countries, were randomly assigned subcutaneous recombinant interferon beta-1a 22 mu g (n=189), or 44 mu g (n=184), or placebo (n=187) three times a week for 2 years. Neurological examinations were done every 3 months. All patients had MRI twice yearly and 205 had monthly scans in the first 9 months of treatment. Analysis was by intention to treat. Findings Clinical data on 533 (95%) patients were available at 2 years. The relapse rate was significantly lower at 1 and 2 years with both doses of interferon beta-1a than with placebo (mean number per patient 1.82 for 22 mu g group, 1.73 for 44 mu g group vs 2.56 for placebo group: risk reductions 27% [95% CI 14-39] and 33 [21-44]). Time to first relapse was prolonged by 3 and 5 months in the 22 mu g and 44 mu g groups respectively, and the proportion of relapse-free patients was significantly increased (p < 0.05). Interferon beta-1a delayed progression in disability, and decreased accumulated disability during the study. The accumulation of burden of disease and number of active lesions on MRI was lower in both treatment groups than in the placebo group. Interpretation Subcutaneous interferon beta-1a is an effective treatment for relapsing/remitting MS in terms of relapse rate, defined disability, and all MRI outcome measures in a dose-related manner, and it is well tolerated. Longer-term benefits may become clearer with further follow-up and investigation.
  • Ana-Luiza Sayao · Virginia Devonshire · Helen L. Tremlett ·
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    ABSTRACT: To evaluate disease status after 20 years in a cohort defined as "benign multiple sclerosis (MS)" (Expanded Disability Status Scale [EDSS] score < or = 3) at 10 years from onset. Patients with an EDSS score < or = 3 at 10 (+/- 1) years from onset were selected from the British Columbia MS clinic database. The 20-year EDSS score was the primary outcome. Potential risk factors differentiating those who "continued benign" (EDSS score < or = 3.0) from those who were "no longer benign" (EDSS score > 3.0) at 20 years, including age at onset, onset symptoms, and 10-year EDSS score, were analyzed, and lower 10-year EDSS score cutoffs were investigated. Twenty-year EDSS scores were obtained for 169 of 200 patients (84.5%); of these, 88 (52.1%) continued benign, but 36 (21.3%) progressed to require the use of a cane (EDSS score > or = 6). Conversion to secondary progressive MS occurred in 45 of 196 patients (23%) with a relapsing-remitting onset. The only variable associated with disease progression at 20 years was the 10-year EDSS score (p < 0.0005); no 10-year EDSS score seemed ideal in predicting benign status, and an EDSS score < or = 2 resulted in 32% becoming no longer benign. Discussion: At 10 years from onset, neither an Expanded Disability Status Scale (EDSS) score < or = 3 nor an EDSS score < or = 2 adequately represented "benign multiple sclerosis (MS)" because an appreciable proportion of patients progressed in disease severity. Appropriate and reliable criteria to identify which patients with MS remain with mild disability over the long term have yet to be determined.
    Neurology 03/2007; 68(7):496-500. DOI:10.1212/01.wnl.0000253185.03943.66 · 8.29 Impact Factor
  • Helen Tremlett · Virginia Devonshire ·
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    ABSTRACT: To describe the characteristics of late-onset multiple sclerosis (MS) (LOMS, 50+ years) vs adult-onset MS (AOMS, 16 to <50 years) and examine prognosis and associated risk factors. Patients with definite MS, onset prior to July 1988, registered with a BCMS clinic before July 1998, with at least one Expanded Disability Status Scale (EDSS) score, were selected from the longitudinal population-based British Columbian (BC) MS database. Clinical and demographic characteristics were compared between LO and AOMS. Progression was measured as time to reach sustained EDSS 6 and potential risk factors examined were sex, disease course (primary progressive [PP] vs relapsing [R]), and onset symptoms. Of those eligible (n = 2,837), LOMS comprised 132 (4.7%), with PPMS predominating (54.5% vs 10.6% in AOMS, p < 0.0005). Motor onset symptoms were more prevalent in LOMS and sensory and optic neuropathy more prevalent in AOMS (p < 0.0005). AOMS averaged 27.7 years (95% CI: 26.3 to 29.1) to EDSS 6 from onset vs 16.9 years (95% CI: 9.0 to 24.8) in LOMS, p < 0.0005. However, AOMS was associated with a younger age at EDSS 6 (58.4 years [95% CI: 57.1 to 59.6] vs 71.2 years [95% CI: 65.2 to 77.3] in LOMS, p < 0.0005). There were no differences in progression between AO or LO for those with PPMS (p = 0.373) or R-MS (p = 0.438), although considerable variation was observed. Late-onset multiple sclerosis (LOMS) is not necessarily associated with a worse outcome: first, progression in the primary progressive or relapsing patients differed little between late-onset vs adult-onset; secondly, those with LOMS were older when reaching Expanded Disability Status Scale 6. The disease course has a far greater implication for disease prognosis than the presence of LOMS.
    Neurology 10/2006; 67(6):954-9. DOI:10.1212/01.wnl.0000237475.01655.9d · 8.29 Impact Factor

Publication Stats

945 Citations
147.61 Total Impact Points


  • 2005-2014
    • University of British Columbia - Vancouver
      • • Faculty of Medicine
      • • Department of Medicine
      • • Division of Neurology
      • • Division of Medical Oncology
      Vancouver, British Columbia, Canada
  • 2012
    • Government of British Columbia, Canada
      Vancouver, British Columbia, Canada
  • 2008
    • St. Michael's Hospital
      Toronto, Ontario, Canada