MSProDiscuss – Entwicklung eines digitalen Tools zur standardisierten Patientenanamnese, um Progredienz bei Multipler Sklerose zu identifizieren

Zusammenfassung

Die Mehrheit der Patienten mit schubförmiger remittierender Multipler Sklerose (RRMS) konvertiert im langfristigen Verlauf ihrer Erkrankung zu einer sekundär-progredienten Verlaufsform (SPMS), die durch eine schubunabhängige Behinderungszunahme charakterisiert und mit einer deutlich schlechteren Prognose assoziiert ist. Aufgrund der Heterogenität der SPMS-Transition ist dieser Übergang nur schwer feststellbar, daher wird in der Regel eine SPMS-Diagnose nur retrospektiv und oft mit mehrjähriger Verzögerung gestellt. In dieser Übersichtsarbeit stellen wir Ansätze für eine frühere SPMS-Diagnose wie das SPMS-Nomogramm, den MS Prediction Score oder den Best Definition Ansatz vor, die beitragen könnten, die Phase der diagnostischen Unsicherheit zu verkürzen. Im Fokus dieser Übersichtsarbeit steht die Entwicklung von MSProDiscuss, einem neuen webbasierten Tool, durch das der Arzt systematisch und während der Routineanamnese alle progressionsrelevanten Parameter der Krankheitsaktivität, Symptomatik und täglichen Beeinträchtigungen aus Patientenperspektive erheben kann. In einer aktuellen Validierungsstudie zeigte MSProDiscuss eine hohe Sensitivität, Spezifität und Interrater-Reliabilität bei der Identifizierung von SPMS-Patienten und Patienten im SPMS-Übergang. Da MSProDiscuss aufgrund des geringen Zeitbedarfs zu keiner Mehrbelastung des behandelnden Neurologen führt und sein Ergebnis mittels eines einfachen Ampelsystems leicht interpretiert werden kann, wurde es in ersten Usability-Tests als äußerst hilfreiches diagnostisches Werkzeug für die neurologische Praxis bewertet. Die frühzeitige Identifizierung von signifikanter klinischer Progression durch diagnostische Tools wie MSProDiscuss könnte beitragen, ein Zeitfenster für mögliche therapeutische Interventionen zu öffnen.

Abstract

During the course of Multiple Sclerosis (MS), most patients with relapsing remitting MS (RRMS) convert to secondary progressive MS (SPMS), an MS-phenotype associated with a steady deterioration of functional ability independent from relapses and worsened prognosis. Due to the heterogeneity of this conversion, SPMS-diagnosis is often challenging and made retrospectively with a delay of several years. In this review, we first discuss advantages and limitations of screening tools for early SPMS-detection such as the SPMS nomogram, the MS prediction score, and the best SPMS definition approach. These screening tools might help to shorten the phase of diagnostic uncertainty. We then focus on the development of MSProDiscuss, a novel web-based tool that helps the treating neurologist to systematically assesses parameters highly relevant for SPMS-conversion during routine anamnesis. These parameters involve disease activity, symptoms, and impacts of the patient’s overall symptoms. In a recent validation study, MSProDiscuss demonstrated high sensitivity, specificity, and interrater reliability. MSProDiscuss does not impose an additional time burden on the treating neurologist and its results are easy to interpret by a simple traffic light system. In first usability tests, it was therefore assessed as a helpful tool for the clinical routine. The early detection of clinically significant progression by diagnostic tools such as MSProDiscuss could open a time-window for therapeutic interventions.

Schlüsselwörter

sekundär progrediente Multiple Sklerose - MSProDiscuss - digitales Werkzeug - Transition - Progression

Key words

MSProDiscuss - digital tool - transition - progression - secondary progressive multiple sclerosis

Publication History

Received: 28 September 2020

Accepted: 16 February 2021

Article published online:
15 March 2021

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