Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis

Minh Le, Charles Malpas, Sifat Sharmin, Dana Horáková, Eva Havrdova, Maria Trojano, Guillermo Izquierdo, Sara Eichau, Serkan Ozakbas, Alessandra Lugaresi, Alexandre Prat, Marc Girard, Pierre Duquette, Catherine Larochelle, Raed Alroughani, Roberto Bergamaschi, Patrizia Sola, Diana Ferraro, Pierre Grammond, Francois Grand’ MaisonMurat Terzi, Cavit Boz, Raymond Hupperts, Helmut Butzkueven, Eugenio Pucci, Franco Granella, Vincent Van Pesch, Aysun Soysal, Bassem I. Yamout, Jeannette Lechner-Scott, Daniele L.A. Spitaleri, Radek Ampapa, Recai Turkoglu, Gerardo Iuliano, Cristina Ramo-Tello, Jose Luis Sanchez-Menoyo, Youssef Sidhom, Riadh Gouider, Vahid Shaygannejad, Julie Prevost, Ayse Altintas, Yara Dadalti Fragoso, Pamela Ann McCombe, Thor Petersen, Mark Slee, Michael H. Barnett, Steve Vucic, Anneke Van Der Walt, Tomas Kalincik, on behalf of the MSBase Study Group

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10 Citations (Scopus)


Background: Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear. Objective: The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms. Methods: This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores. Results: The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = −0.06, p < 0.001). Neither presentation was associated with changes in relapse risk. Conclusion: Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.

Original languageEnglish
Pages (from-to)755-766
Number of pages12
JournalMultiple Sclerosis Journal
Issue number5
Publication statusPublished - Apr 2021


  • Multiple sclerosis
  • disability outcome
  • early symptomatology
  • prognostic marker
  • cerebellar
  • brainstem

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