Enhancing Disability Monitoring in Multiple Sclerosis Using Digital Tools: Mikael Cohen, MD

WATCH TIME: 5 minutes

“I think it's still a great challenge because there are some other tools that can be used, such as the 9-hole peg test, patient reported outcomes, and so on. But those tools are mainly restricted to tertiary care centers, or in the setting of clinical research. It's difficult to use them in routine use and so what we wanted to do is to provide something that could be used by anyone, and to get a better insight into the disease.”

Although the goal standard for assessing clinical disability in patients living with multiple sclerosis (MS) is with the Expanded Disability Status Scale (EDSS), researchers suggest disease management could benefit from more precise clinical assessment tools. In a recent study, investigators observed that the Quantified Neurological Examination (QNE) strongly correlated with EDSS and allowed for a more precise way to monitor the evolution of disability without requiring any rating task by a provider.¹

In the study, investigators assessed the correlation between EDSS, EDSS functional system scores (FSS), QNE global score, subscores (qFSS), and MRI metric among 200 examinations and 78 patients to comprise the MRI analysis. All told, the global QNE score strongly correlated with the EDSS (ρ = -0.87, r2 = 0.76, P <.0001). Notably, qFSS was statistically different according to the corresponding FSS for each function (P <.01), except for the visual FSS for which the statistical analysis lacked power as the FSS score was rated to 0 in 89% of total examinations (n = 178).

Researchers observed EDSS predominantly correlated to the pyramidal function of the lower limbs (ρ = -0.83, r2 = 0.62, P <.001) compared with upper limbs (ρ = -0.49, r2 = 0.26, p<0.001). In the subgroup of patients with an EDSS higher than 4, EDSS only correlated with lower limbs function (ρ = -0.4, r2 = 0.2, P = .05). In addition, QNE score and qFSS had a stronger correlation to brain MRI measures compared with EDSS, particularly in the grey matter volume (ρ = 0.58, P <.0001) and cortical volume (ρ = 0.5, P <.0001).

Mikael Cohen, MD, senior neurologist at the University Hospital Center of Nice in France, recently presented on these findings in a scientific session at the MSMilan 2023, the 9th Joint ECTRIMS-ACTRIMS meeting, held October 11–13, in Milan, Italy. Cohen sat down with NeurologyLive® for an interview to discuss how a mobile application, QNE, can address the limitations of the EDSS scale in monitoring disability in patients with MS. He also spoke about the challenges the healthcare system faces when implementing digital tools for routine use. Additionally, Cohen discussed AI and digital tools can coexist with the role of clinicians in assessing patients' disability in MS.

Click here for more coverage of MSMilan 2023.

REFERENCES
1. Cohen M, Mondot L, Landes-Chateau C, Lebrun-Frenay C. Towards a more precise rating of neurological disability in multiple sclerosis: A new automatic and linear quantification of the neurological exam. Presented at: 2023 MSMilan; October 11-12; Milan, Italy. Abstract O034.