Yeni teşhis konulan multipl sklerozlu bireylerde servikal omurilik lezyonunun üst ekstremite fonksiyonu üzerindeki etkisinin değerlendirilmesi
Abstract
Amaç: Çok erken evre multipl skleroz (MS) hastalarında servikal kord lezyonlarının üst ekstremite fonksiyonları üzerindeki etkisini değerlendirmek ve bu popülasyonda üst ekstremite fonksiyonlarını etkileyen faktörleri tanımlamak.
Gereç ve Yöntem: Çalışmaya 245 ilk semptomlardan 24 ay geçmiş ve 378 tanıdan sonraki altı ay içinde hastalık modifiye edici tedaviye (DMT) başlamış MS’li bireyler dahil edilmiştir. Üst ekstremite fonksiyonlarını değerlendirmek için Dokuz Çivi Peg Testi (N-HPT) uygulanmıştır. Servikal kord lezyonunun varlığına göre katılımcılar iki gruba ayrıldı.
Bulgular: Gruplar arasında yaş, cinsiyet, hastalık süresi ve atak sayısı açısından anlamlı bir fark bulunmamıştır. Ancak, toplam Genişletilmiş Engellilik Durumu Ölçeği (EDSS) skoru, piramidal ve duyusal fonksiyonel sistem skorları, servikal kord lezyonları olan MS’li bireylerde olmayanlara göre daha yüksek bulunmuştur. Tanıdan sonraki altı ay içinde DMT başlatılan katılımcılarda, dominant ve ortalama N-HPT performans süreleri, servikal kord lezyonu olan MS’li bireylerde olmayanlara göre anlamlı derecede daha uzun bulunmuştur. Ancak, ilk semptomlardan 24 ay sonra tanı konulan katılımcılar arasında gruplar arasında anlamlı bir fark gözlenmemiştir. Yaş, hastalık süresi ve tanıdan tedaviye kadar geçen süre, N-HPT performansını etkileyen önemli faktörler olarak belirlenmiştir. Daha genç, daha kısa hastalık süresine sahip ve tanı sonrası daha erken tedavi alan MS’li bireyler, diğerlerine göre daha iyi performans göstermiştir.
Sonuç: Çalışmamız, MS’in erken evrelerinde bile servikal kord lezyonlarının üst ekstremite fonksiyonları üzerindeki etkisini vurgulamakta ve erken tanı ile DMT’lerin hızlı bir şekilde başlatılmasının önemini ortaya koymaktadır.
References
- Johansson S, Ytterberg C, Claesson IM, Lindberg J, Hillert J, Andersson M, et al. High concurrent presence of disability in multiple sclerosis. J Neurol. 2007 Jun 2;254(6):767–73.
- Bertoni R, Lamers I, Chen CC, Feys P, Cattaneo D. Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis. Multiple Sclerosis Journal. 2015 Oct 6;21(12):1566–74.
- Park S, Park JY. Grip strength in post-stroke hemiplegia. J Phys Ther Sci. 2016;28(2):677–9.
- Bohannon RW. <p>Grip Strength: An Indispensable Biomarker For Older Adults</p>. Clin Interv Aging. 2019 Oct;Volume 14:1681–91.
- Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis Journal. 2017 Apr 16;23(5):711–20.
- Ovacik U, Tarakci E, Ozdemir Z. Upper limb dysfunction in people with early-stage Multiple Sclerosis: Perceived performance can be misleading. Mult Scler Relat Disord. 2023 Nov 1;79.
- Weier K, Mazraeh J, Naegelin Y, Thoeni A, Hirsch JG, Fabbro T, et al. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Multiple Sclerosis Journal. 2012 Nov 26;18(11):1560–9.
- Lukas C, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Bendfeldt K, et al. Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients. Radiology. 2013 Nov;269(2):542–52.
- Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444–52.
- Kilic S. Effect size. Journal of Mood Disorders. 2014;4(1):44.
- Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, et al. Natural History of Multiple Sclerosis Symptoms. Int J MS Care. 2013 Oct 1;15(3):146–56.
- van Munster CEP, Burggraaff J, Steinheimer S, Kamm CP, D’Souza M, Diederich M, et al. Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis. Int J MS Care. 2023 Sep 1;25(5):226–32.
- Guclu-Gunduz A, Citaker S, Nazliel B, Irkec C. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis. NeuroRehabilitation. 2012 Jun 1;30(4):369–74.
- ECTRIMS 2024 – Oral Presentations. Multiple Sclerosis Journal. 2024 Sep 5;30(3_suppl):4–124.
- Zurawski J, Glanz BI, Healy BC, Tauhid S, Khalid F, Chitnis T, et al. The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis. J Neurol Sci. 2019 Aug;403:38–43.
- Daams M, Weiler F, Steenwijk MD, Hahn HK, Geurts JJ, Vrenken H, et al. Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: Relation to brain findings and clinical disability. Multiple Sclerosis Journal. 2014 Dec 8;20(14):1860–5.
Evaluation of the effect of cervical cord lesion on upper extremity function in newly diagnosed persons with multiple sclerosis running head: upper extremity function in multiple sclerosis
Abstract
Aim: To evaluate the effect of cervical cord lesions on upper extremity functions in persons with very early-stage multiple sclerosis (MS) and describe the factors that affect the upper extremity functions in that population.
Materials and Methods: Two hundred forty-five persons with MS (pwMS) were diagnosed 24 months after the first symptoms and three hundred seventy-eight pwMS initiated disease-modified treatment (DMT) within six months after diagnosis were included to study. Nine-Hole Peg Test (N-HPT) were performed to evaluate upper extremity functions. Participants divided two groups according to presence of cervical cord lesion.
Results: There were no significant differences between groups in terms of age, gender, disease duration, and the number of relapses. However, the total Expanded Disability Status Score (EDSS) score, pyramidal and sensory functional system scores were higher in pwMS with cervical cord lesions than without cervical cord lesions. Average and dominant hand N-HPT performance times were found significantly longer in pwMS with cervical cord lesion than without cervical cord lesion in participants-initiated DMT within six months after diagnosis. However, there were no significant differences between groups in participants diagnosed 24 months after first symptoms Age, disease duration, and time from diagnosis to treatment were identified as significant factors influencing N-HPT performance. PwMS who were younger, had a shorter disease duration, and received treatment sooner after diagnosis showed better performance than others.
Conclusion: Our study highlights the influence of cervical cord lesions on upper extremity function, even in the early stages of MS, and underscores the importance of early diagnosis and prompt initiation of DMTs.
References
- Johansson S, Ytterberg C, Claesson IM, Lindberg J, Hillert J, Andersson M, et al. High concurrent presence of disability in multiple sclerosis. J Neurol. 2007 Jun 2;254(6):767–73.
- Bertoni R, Lamers I, Chen CC, Feys P, Cattaneo D. Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis. Multiple Sclerosis Journal. 2015 Oct 6;21(12):1566–74.
- Park S, Park JY. Grip strength in post-stroke hemiplegia. J Phys Ther Sci. 2016;28(2):677–9.
- Bohannon RW. <p>Grip Strength: An Indispensable Biomarker For Older Adults</p>. Clin Interv Aging. 2019 Oct;Volume 14:1681–91.
- Feys P, Lamers I, Francis G, Benedict R, Phillips G, LaRocca N, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Multiple Sclerosis Journal. 2017 Apr 16;23(5):711–20.
- Ovacik U, Tarakci E, Ozdemir Z. Upper limb dysfunction in people with early-stage Multiple Sclerosis: Perceived performance can be misleading. Mult Scler Relat Disord. 2023 Nov 1;79.
- Weier K, Mazraeh J, Naegelin Y, Thoeni A, Hirsch JG, Fabbro T, et al. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Multiple Sclerosis Journal. 2012 Nov 26;18(11):1560–9.
- Lukas C, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Bendfeldt K, et al. Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients. Radiology. 2013 Nov;269(2):542–52.
- Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444–52.
- Kilic S. Effect size. Journal of Mood Disorders. 2014;4(1):44.
- Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, et al. Natural History of Multiple Sclerosis Symptoms. Int J MS Care. 2013 Oct 1;15(3):146–56.
- van Munster CEP, Burggraaff J, Steinheimer S, Kamm CP, D’Souza M, Diederich M, et al. Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis. Int J MS Care. 2023 Sep 1;25(5):226–32.
- Guclu-Gunduz A, Citaker S, Nazliel B, Irkec C. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis. NeuroRehabilitation. 2012 Jun 1;30(4):369–74.
- ECTRIMS 2024 – Oral Presentations. Multiple Sclerosis Journal. 2024 Sep 5;30(3_suppl):4–124.
- Zurawski J, Glanz BI, Healy BC, Tauhid S, Khalid F, Chitnis T, et al. The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis. J Neurol Sci. 2019 Aug;403:38–43.
- Daams M, Weiler F, Steenwijk MD, Hahn HK, Geurts JJ, Vrenken H, et al. Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: Relation to brain findings and clinical disability. Multiple Sclerosis Journal. 2014 Dec 8;20(14):1860–5.
Details
| Primary Language | English |
|---|---|
| Subjects | Neurology and Neuromuscular Diseases |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 8, 2025 |
| Submission Date | December 24, 2024 |
| Acceptance Date | May 6, 2025 |
| Published in Issue | Year 2025 Volume: 64 Issue: 3 |
