Neuro Evaluations & LDN

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Hello Everyone,

I came across this abstract and thought of its implications for LDN

and those of you on LDN that have neuros acknowledging your

improvements. EDSS neuro exam scores do not accurately reflect

disability Msers are actually experiencing as scored by GNDS. In

other words when our neuros run us through our paces, these exams do

not give them a precise assessment of how we're doing because they

don`t measure everything we're perceiving disabilitywise. Thinking

optimistically, if your neuros are acknowledging improvements based

on your EDSS scoring; rather than just a passing `glad you're doing

well' kind of thing based on what you relay; would that not clearly

document measureable improvement? The conclusion is very telling in

my view, and all the more reason neuros should be paying more

attention to what patients report than they seem too regardless of

any scores.

My Best to All,

Lesa

JNNP Online

http://jnnp.bmjjournals.com/cgi/content/full/74/4/439/DC1/1

One year changes in disability in multiple sclerosis: neurological

examination compared with patient self report

E L J Hoogervorst, M J Eikelenboom, B M J Uitdehaag, C H Polman

Objective: To characterise prospectively the relation between one

year changes in neurologist rating of neurological exam abnormalities

as measured by the Expanded Disability Status Scale (EDSS) and

changes in patient perceived disability as measured by the Guy's

Neurological Disability Scale (GNDS) in patients with multiple

sclerosis.

Methods: Two hundred and fifty patients with MS were recruited at an

outpatient clinic. Disability at baseline and one year follow-up was

assessed using the EDSS and GNDS. Correlations between change in

EDSS, GNDS-sum score, Functional Systems and GNDS subcategories were

studied as well as the significance of changes in EDSS associated

with changes in perceived disability.

Results: The correlation between one year changes in EDSS versus GNDS

was substantially lower (0.19) than cross-sectional correlations

between EDSS and GNDS either at baseline (0.62) or at follow-up

(0.77). Notably, changes in functional system scores that are based

on neurological examination are poorly or not at all correlated with

changes in disability as perceived by the patient. Analysing the

impact of a significant worsening in EDSS-score, a commonly applied

outcome criterion in clinical trials, we found that this was

associated with significant worsening, insignificant change, and

significant improvement in the patients' perceived disability in 45%,

39% and 15% of patients, respectively.

Conclusion: Patients' perception of change in disability differs not

only quantitatively but also qualitatively from that of an examining

physician. This seems to be due both to the fact that there are true

differences in change as perceived by the patient and that measured

by the physician and to the fact that changes in many dimensions of

disability that are relevant to the patient have no measurable impact

on the EDSS.