title: The relationship between relapse, impairment and disability in multiple sclerosis.
abstract: OBJECTIVE
  To describe the spatial relationship between relapse and disability in multiple sclerosis (MS).
  
  
  METHODS
  141 relapse onset MS patients were studied. For each patient an examination was performed and a relapse history obtained. Multivariate logistic regression examined whether there was an association between localizing clinical signs and a history of relevant relapse in order to explore the spatial relationship between relapse and subsequent disability.
  
  
  RESULTS
  The presence of impaired vision or sensation was independently associated with a history of one or more anatomically related relapses. The presence of weakness or cerebellar ataxia in a limb was not associated with a single relevant relapse but was associated with multiple relevant relapses. A history of multiple episodes of weakness or ataxia in the same limb was uncommon.
  
  
  CONCLUSIONS
  Our data suggest that motor pathways are relatively resistant to chronic impairment from acute relapse, whereas afferent pathways are more susceptible. This, in combination with prominent usage of the Expanded Disability Status Scale, which is dependent on mobility and motor function at higher scores, may explain the paradox between natural history studies that suggest relapses are irrelevant to long-term disability and shorter studies at lower disability levels suggesting relapses are responsible for disability accumulation.
authors.affiliation: Institute of Clinical Neurosciences, University of Bristol, UK. luke.bennetto@bris.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Bennetto
authors.forename: J
authors.initials: J
authors.lastname: Burrow
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.forename: J
authors.initials: J
authors.lastname: Cobby
authors.forename: N P
authors.initials: NP
authors.lastname: Robertson
authors.forename: N
authors.initials: N
authors.lastname: Scolding
mesh_terms: D000328:Adult; D001259:Ataxia / Q000209:etiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D018908:Muscle Weakness / Q000209:etiology*; D012008:Recurrence; D012678:Sensation Disorders / Q000209:etiology*