PDF file, 86K, Effect modification of the association between the ratio of parent estrogens to estrogen metabolites and multivariable adjusted* percent density by BMI and years since menopause. Adjusted percent density measures are untransformed residuals from linear models that account for variation in percent density in association with age, BMI, combination hormone therapy, and parity / age at first birth (nulliparous, first birth at age <21 y, 22-29 y, and 30+ y). The line represents a fitted linear model of the association between multivariable adjusted percent density and log-transformed measures of the ratio of parent estrogens to estrogen metabolites.

BACKGROUND:Multiple sclerosis (MS) is a chronic, progressively disabling condition of the central nervous system. We sought to evaluate and compare mood states in patients with MS with increased disability residing in nursing homes and those receiving home-based care.METHODS:We conducted a cross-sectional analysis of the New York State Multiple Sclerosis Consortium to identify patients with MS using a Kurtzke Expanded Disability Status Scale (EDSS) score of 7.0 or greater. The nursing home group was compared with home-based care patients regarding self-reported levels of loneliness, pessimism, tension, panic, irritation, morbid thoughts, feelings of guilt, and fatigue using independent-samples t tests and χ2 tests. Multivariate logistic regression analyses were used to investigate risk-adjusted differences in mood states.RESULTS:Ninety-four of 924 patients with EDSS scores of at least 7.0 lived in a nursing home (10.2%). Nursing home patients were less likely to use disease-modifying therapy and had higher mean EDSS scores compared with home-based patients. However, nursing home patients were less likely than home-based patients to report fatigue (odds ratio [OR] for no fatigue, 3.8; 95% CI, 2.1-7.2), feeling tense (OR for no tension, 1.7; 95% CI, 1.1-2.7), and having feelings of pessimism (OR for no pessimism, 1.8; 95% CI, 1.2-2.8).CONCLUSIONS:The nursing home patients with MS were less likely to report fatigue, pessimism, and tension than those receiving home-based care. Further studies should examine ways of facilitating a greater degree of autonomy and decision-making control in MS patients receiving home-based care.

Purpose: Timing providing highest yield of initial electroencephalogram (EEG) after new onset unprovoked seizures, is an important and practical issue both in diagnosis and patient care. Current guidelines suggest routine EEG is the standard of care in work-up. However, yield of the initial EEG and exact timeframe in which to perform remain unclear and standardization in both adult and pediatric populations is still lacking. Our objective was to determine a concrete timeframe to perform initial EEG in patients with new onset unprovoked seizures and provide greater yield of EEG benefits in patient management.Method: This is a retrospective chart review study of both pediatric and adult patients identified from EEG Database over 1999-2014 located at Kaleida Health at Buffalo using keyword "new onset seizure".Results: The percentage of EEGs revealing epileptiform discharges is much higher if EEGs are performed within 12 hours after the seizure onset compared to studies done beyond this timeframe (53.1% versus 23.9%). There was no significant difference in the presence of epileptiform discharges if the study is done 12 hours after the seizure onset. Odds ratio was 3.599 (the presence of epileptiform discharges) with a Confidence Interval of 1.691-7.660 (p = 0.001) within first 12 hours of initial event.Conclusion: This study demonstrated statistical significance in yield of epileptiform discharges by performing EEG within the first 12 hours of seizure onset, in both adult and pediatric populations, which should be considered for clinical practice and patient care. (C) 2016 Elsevier B.V. All rights reserved.

This retrospective analysis explored prognostic factors associated with a benign multiple sclerosis (BMS) disease course at baseline and over the 4-year follow-up.

The life expectancy and average age of persons with multiple sclerosis (MS) have increased significantly during the last two decades. The introduction of disease-modifying therapies and a better delineation and understanding of the superimposed comorbidities often diagnosed in MS patients are probably the most important factors accountable for the increase in aging MS population worldwide. Healthcare teams must therefore address the problems arising due to advancing age superimposed on this chronic neurologic disease. In this review, we focus on the physiology of aging, its effects on MS disease course, and the pathological and immunological changes associated with aging and disease progression. Additionally, we discuss the common comorbidities that occur in aging persons with MS that may arise either as a result of the aging process or from relentless chronic MS disease progression as well as the challenges on differentiating the two processes for a more appropriate therapeutic approach.

OBJECTIVE: To assess the value of Timed Up and Go (TUGO) as predictor for falls and determine their correlate with other standard disability measures and patient reported outcomes (PRO; Lifeware) BACKGROUND: Nearly 60[percnt] of individuals with MS will experience a fall in a given year and a significant portion of these falls will cause an injury. Identifying patients at risk and preventing falls especially in elderly MS population is of crucial importance. DESIGN/METHODS: Subjects (n=36) (mean age=57.7±12.7) including MS/CIS (N=28) and healthy controls (HC)/other neurological diseases (OND's) are part of an ongoing prospective longitudinal Environmental and Genetic study that will enroll 350 MS patients and 250 HC/OND. Falls during last year were recorded. Pearson correlations between age and mobility measures including the TUGO, Timed 25 Foot Walk (T25FW), Expanded Disability Status Scale (EDSS) as well as PRO's were investigated only in MS/ CIS cohort. RESULTS: Nineteen subjects reported falls during the past year, Subjects who reported a fall took a longer time to complete the T25FW (8.4±4.1 vs 4.5±0.4, p=.005) and TUGO (1.5±0.6 vs 0.8±0.2, p=.002) compared to subjects who did not report a fall. Among MS/ CIS patients reporting a fall was significantly associated with EDSS (5.0±2.1 vs 2.5±1.4, p=.001). Age ≥ 60 (n=23 ) was positively correlated to TUGO (r=.47, p=.009) but not to T25FW. TUGO was associated with T25FW (r=.78, p<.001; r=.50 p=.029) and with EDSS (r=.56, p=.011 vs. r=.55, p=.013). Patient reported difficulty in getting up from chair was correlated to TUGO (p=.005) and for a trend with T25FW (p=0.03) but not with EDSS. CONCLUSION: TUGO appears as a sensitive measure correlated with falls as well as with patient self- reported difficulty in getting up from chair. Additional data from a larger samples will be provided at the time of AAN presentation.

Background: Although dysimmunity is considered an important link between multiple sclerosis (MS), family history and cancer risk, their relationship to the use of disease modifying therapies (DMT) is not fully understood.Objective: To assess the observed versus expected number of cancers in MS patients, and family history of cancer, among DMT users and DMT naive patients.Methods: Cancer, DMT use, and family history of cancer were assessed using the New York State Multiple Sclerosis Consortium (NYSMSC) registry. Self-reported cancers in MS patients were tested for associations with DMT use, family history of cancer and other factors. Expected number of cancer cases was estimated using age- and gender-specific prevalence and incidence rates from the general population.Results: The prevalence of cancer in males and females in the NYSMSC cohort was lower than expected (p < 0.001). Patients with cancer were older at MS diagnosis and more likely to be female (p < 0.001). MS patients with a personal history of cancer were more likely to report DMT use (p < 0.001) and family history of cancer (p < 0.001). Multivariable analysis did not support a higher risk of cancer after DMT initiation.Conclusions: We report a lower than expected number of cancer cases in MS patients compared to the general population. MS patients with a personal history of cancer were more likely to report DMT use suggesting that DMTs may abrogate the lower incidence of cancer in MS. (C) 2016 Elsevier B.V. All rights reserved.

OBJECTIVE: To compare demographics and patient-reported outcomes (PRO) in multiple sclerosis (MS) patients over age 55 classified as stable vs. progressive group. BACKGROUND: MS is a chronic debilitating central nervous system illness affecting mostly young adults. Disease perception and disability progression rate in elderly MS patients warrants further research. DESIGN/METHODS: Our retrospective longitudinal cohort includes patients >55years with disease duration 蠅15years, enrolled in New York Multiple Sclerosis Consortium with 蠅3years serial follow-ups. Disability progression was assessed by comparing Expanded Disability Status Scale (EDSS) scores at registration and most recent follow-up (MRF) respectively. Two groups were subsequently created: a progressive group that showed an increase in EDSS (of +1 if EDSS ≤5.5 or +0.5 if EDSS 蠅6) and a stable group with an unchanged EDSS. Basic demographic characteristics and PRO were compared between the two groups. RESULTS: The mean age of patients was 67.7±5.5 years with mean disease duration of 29.9±10.3years. Over the duration of available F/U (5.9±3.2 years), EDSS scores worsened from 5.4±2.1 (baseline) to 6.1±1.9 (MRF) p<.001. Of the 340 subjects fulfilling inclusion criteria, 150 (44.1[percnt]) had a stable disease course while 190 (55.9[percnt]) had progressive disability. Stable subjects were older (62.5 vs 60.5 ), had a longer disease duration (25.9 vs 21.8), higher EDSS score at enrollment (5.9 vs 5.0) but lower EDSS score at MRF (5.6 vs 6.5) (all comparisons p<.001). However all patients deteriorated over time with regards to PRO outcomes such as getting up from sofa” (p<.001), “climbing stairs” (p<.001), “difficulty driving” (p<.001) and “bowel incontinence” (p=.031), with no differences between those who were defined as stable vs. progressive. CONCLUSIONS: For MS aging population PROs appear to deteriorate over time despite stable and even improved EDSS. More sensitive outcome measures may be required to monitor disease status in aging MS population. Disclosure: Dr. Saini has nothing to disclose. Dr. Kavak has nothing to disclose. Dr. Nadeem has nothing to disclose. Dr. Younus has nothing to disclose. Dr. Kolb has nothing to disclose. Dr. Teter has received research support from Biogen Idec, Teva Neuroscience, EMD Serono, Avanir Pharmaceuticals, Novartis, and Genzyme Corporation. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer Inc., Novartis, Genzyme Corporation, Sanofi-Aventis Pharmaceuticals, Inc., Mylan, and Acorda Therapeutics. Dr. Weinstock-Guttma

BACKGROUND:The relation between the use of disease modifying therapies (DMT׳s) and the occurrence of comorbid autoimmune diseases (AID׳s) in multiple sclerosis (MS) patients is still unclear.OBJECTIVE:To investigate the difference in duration from MS symptom onset to first reported AID in subjects using DMT׳s vs. DMT naïve. Type and prevalence of comorbid AID׳s was also investigated.METHODS:Data was extracted from the New York State MS Consortium (NYSMSC) registry and comprised of MS patients with a minimum of 5 years follow-up. After exclusion, 1792 patients were enrolled in the study, 1478 had no AID, and 314 patients had comorbid AID׳s that developed after the initial enrollment. Patients who had an AID were divided into two groups: those with an AID after DMT initiation (n=281) and patients with an AID who were DMT naïve (n=33). Logistic regression analysis was used to test differences in duration between MS symptom onset and the development of AID between the two groups while adjusting for confoundersRESULTS:DMT use did not change the frequency of self-reported AID (17.2 vs. 20.4%). However, the duration between first MS symptom onset and the initial reported occurrence of a comorbid AID was significantly shorter in the DMT user group (192 months±115) compared to the DMT naïve group (262 months±107, p=.002).CONCLUSION:There were no group differences between DMT users vs. DMT naïve subjects with regards to AID frequency. The DMT user group reported the development of an AID earlier than the DMT naïve group. Further studies that can identify patients with higher risk for developing AID׳s is warranted.

Objective: To investigate the prevalence of cancer in multiple sclerosis (MS) patients and to compare cancer prevalence in patients on disease modifying therapy (DMT) versus those who were DMT naive. Background: Few studies have studied whether MS alters the risk of cancer, with varying results. Previous studies suggest that the use of DMT does not increase the risk of cancer, however these studies did not investigate the use of long term DMT use and subsequent cancer risk. Method: Subjects were part of the New York State Multiple Sclerosis Consortium (NYSMSC) registry. Cancer prevalence and DMT use was determined at study enrollment. Independent samples t-tests and chi-square tests were utilized to determine if there were any differences between those who had cancer compared to those who did not. A binomial test was used to determine if the prevalence of cancer in our sample was significantly different from the North American cancer prevalence of 3.2[percnt] as reported by the National Cancer Institute (NCI). Results: Of the 9,240 subjects in our study, 133 (1.4[percnt]) reported having cancer. Those who had cancer were older (51.8±11.2) than those who did not (43.7±11.2, p<.001) and had a later age at MS symptom onset compared to those who did not have cancer (38.6±12.1 vs 32.6±9.9, p<.001). Furthermore, MS patients with cancer were more likely to be female (84.2[percnt] vs 74.2[percnt], p=.009). There were no difference in DMT use between those who had cancer and those who did not. Conclusions: Results show that cancer prevalence in our sample of patients with MS was lower than reported by the NCI (p<.001). There were no significant differences in prevalence between those using a DMT and those who did not. We are in the process of collecting more information about type of cancer, specifics on medication use, and family history.

Objective: Investigate the association between patients’ perceived improvement in quality of life and the relapse rate reduction among a group of multiple sclerosis (MS) patients on subcutaneous (SC) interferon beta 1-a (IFNβ-1a) three times a week (tiw) therapy. Background: The relationship between clinical symptoms and patient perceived quality of life outside of the controlled environment clinical trial is not yet elucidated. Methods: Patients on IFNβ-1a therapy were extracted from the New York State MS Consortium (NYSMSC) registry. Complete two-year follow-up data after IFNβ-1a initiation was examined to determine differences between the annualized relapse rate (ARR) in the year preceding SC IFNβ-1a initiation to 蠅 1 year following therapy initiation using a Poisson log linear repeated measures regression model. Patients were categorized into two groups, those whose ARR improved or was stable vs. those whose ARR worsened. Self-reported quality of life variables were measured over the follow-up period and examined between the two clinical metric groups. Results: 54 patients using IFNβ-1a with complete relapse history were available for initial assessment. Regression analyses show an approximate 42[percnt] reduction in relapses by IFNβ-1a treatment, with an ARR rate before SC IFNβ-1a initiation of 0.90±0.65, compared to an ARR of 0.52±0.72 on therapy. Compared to the clinically worsened group, the improved/stable group was associated with quality of life indicators of improvement/stability. The improved/stable group reported no worsening or improvement in loneliness and pessimism (80.5[percnt]), irritation (70.7[percnt]), guilt (82.5[percnt]), morbid thoughts (87.8[percnt]), pain (100[percnt]), fatigue (75.0[percnt]) and life satisfaction (85.0[percnt]). Discussion: These preliminary results from a small sample of patients showed that patient related outcomes can corroborate the improved clinical status as related to the decrease in relapse rate on patients on SC IFNβ-1a tiw therapy. Additional data from the larger NYSMSC cohort will be provided at the time of presentation. Disclosure: Dr. Teter has received research support from Biogen Idec, Teva Neuroscience, EMD Serono, Avanir Pharmaceuticals, Novartis, and Genzyme Corporation. Dr. Kavak has nothing to disclose. Dr. Dangond has received personal compensation for activities with EMD Serono, Inc. an employee. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer Inc., Novartis, Genzyme Corporation, Sanofi-Aventis Pharmaceuticals, Inc., Mylan, and Acorda Therapeutics. Dr. Weinstock-Guttma

We have developed the Multiple Sclerosis Patient Data Ontology (MSPD) to represent data from the patient data registry of the New York State Multiple Sclerosis Consortium (NYSMSC). MSPD is an application ontology that provides a set of classes for the annotation of both clinical measures and patient reported outcome data obtained from the enrollment forms used by the NYSMSC. To do so, we have adopted the paradigm established for representing assays in the Ontology for Biomedical Investigations. Our goal is to compare patient reported outcomes, such as self-reported disability and quality of life perceptions, to objective outcome measures in clinical practice, with reference to diagnoses and treatment modalities. We have begun an ontology-driven retrospective analysis of the patient records in the NYSMSC registry using an ontology term enrichment method in order to spot significant patterns in patient-reported and clinical outcomes in subsets of patients in the NYSMSC patient registry as compared to the NYSMSC patient population as a whole.

BACKGROUNDThe reasons women with MS do not become pregnant are not fully elucidated. Observational data from real-world MS clinical practice of parous (having born a child) and nulliparous (not having born a child) women may demonstrate pregnancy decision-making is based on other factors not related to having MS as well as concerns of being a parent with MS.OBJECTIVEInvestigate factors which influence pregnancy decision-making for women with MS.METHODSAnalysis was based on 207 responses to a reproductive events study questionnaire distributed to 450 eligible female patients with clinically-defined MS (CDMS) of the New York State MS Consortium registry database.RESULTSThe mean age 31.1 (SD 9.1) at time of MS symptom onset and mean baseline disability Kurtzke Expanded Disability Severity Score (EDSS 2.6 (SD 1.9)) did not differ between parous and nulliparous women. 18.4% of the sample was nulliparous. The reasons for not bearing children included only 15.9% due to concerns of raising a child as a parent with MS. Reasons not due to having MS included 28.9% attributed to not wanting children, 23.7% to attempting pregnancy without success, 18.4% to not having a spouse, 2.6% having adopted, 5.3% contemplating pregnancy, and 5.2% other conditions.CONCLUSIONOur results suggest that pregnancy decision-making for nulliparous women with CDMS includes reasons not related to having MS and that the 15.9% due to concerns of raising children as a parent with MS warrants further elucidation. Disclosure: Dr. Teter has received research support from Biogen Idec, EMD Serono, Novartis, and Genzyme Corp. Dr. Kavak has nothing to disclose. Dr. Zakalik has nothing to disclose. Dr. Kolb has received personal compensation for activities with Teva Neuroscience, Biogen Idec and EMD Serono as a speaker and scientific advisory board member. Dr. Coyle has received personal compensation for activities with Acorda, Accordant, Bayer, Biogen Idec, Merck Serono/Pfizer, Genzyme/Sanofi Aventis, Mylan, Novartis, Genentech/Roche, and Teva Neuroscience. Dr. Coyle has received research support from Actelion, Novartis, and Opexa. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer, Novartis, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., Mylan, and Acorda Therapeutics. Dr. Weinstock-Guttman has received research support from Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer Inc, Novartis, Acorda, ITN, Questcor, Shire, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., National Multiple Sclerosis Society, the National Institutes of Health and Aspreva-Roche.

OBJECTIVE : To investigate the effects of comorbid allergies on physical and psychological outcomes among multiple sclerosis (MS) patients. BACKGROUND : MS and allergies are considered to be mediated by hyperactive Th1 and Th2 cells respectively. Autoimmune comorbidities associated with Th1/Th2 ratio imbalance may influence the phonotypical presentation and long term disease outcomes. Previous research on the relationship of allergies and MS has provided conflicting results. METHODS : In this case-control study, 4653 subjects (with and without allergies) were extracted from the New York State Multiple Sclerosis Consortium database; the groups were matched 1:1 on sex, disease duration and disease modifying therapy use at enrollment and were followed up for 5 years. Patients’ perceived physical limitations are measured on a scale of 1-6 ranging from “no limitation” to “severe limitation”. Patients also reported presence or absence of psychological factors like loneliness, tension, annoyance and guilt. Independent sample t-tests and chi-square tests were used to compare the demographics, physical and psychological characteristics between both groups. RESULTS : Demographic characteristics did not differ between the two groups except for lower EDSS scores (3.4 vs 3.6 p=0.001), higher education level (p<0.001) and more cases of relapsing-remitting subtype of MS (69.9% vs 64.6% p<0.001) seen in patients with allergies. Patients with allergies reported better motor functions in the lower limbs (p<0.001), upper limbs (p=0.017) and better vision (p=0.003). However, patients with allergies also reported worse psychological symptoms like increased tension (p<0.001), annoyance (p=0.004) and guilt (p=0.015). CONCLUSION : Coexistence of allergies may provide a better physical outcome in MS patients Our findings support the protective effects of Th2 mediated disorders on Th1 immune responses seen in MS. Worse psychological symptoms can be attributed to cholinergic /beta adrenergic deregulation identified in patients with allergies. Additional prospective studies are required to elucidate these relationships. Disclosure: Dr. Gupta has nothing to disclose. Dr. Kavak has nothing to disclose. Dr. Teter has received research support from Biogen Idec, EMD Serono, Novartis, and Genzyme Corp. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer, Novartis, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., Mylan, and Acorda Therapeutics. Dr. Weinstock-Guttman has received research support from Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer Inc, Novartis, Acorda, ITN, Questcor, Shire, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., National Multiple Sclerosis Society, the National Institutes of Health and Aspreva-Roche.

April 30, 2014April 8, 2014Free AccessTriphasic Waves and Epileptiform Correlates on Electroencephalogram (P5.060)Alyssa Fiddler, Osman Farooq, Barbara Teter, Katelyn Kavak, and Arie WeinstockAuthors Info & AffiliationsApril 8, 2014 issue82 (10_supplement)https://doi.org/10.1212/WNL.82.10_supplement.P5.060 Letters to the Editor

Background: Triphasic waves have been shown to co-exist with other abnormal EEG patterns, but the correlation between typical triphasic waves and epileptiform discharges in the same EEG has yet to be investigated. Objective/Hypothesis: To assess how often triphasic waves and epileptiform activity occur together on electroencephalogram (EEG) in an adult epilepsy population. Methods: This is a retrospective chart review of the Women and Children’s Hospital of Buffalo EEG database. Charts from 1999-2013 were reviewed. Inclusion criteria included age 18 years and older with an EEG in the WCHOB database. The diagnosis of triphasic waves and epileptiform activity was done by the neurologist assigned to read EEGs. Statistical analysis was performed using SPSS Version 21 and correlation statistics including Pearson’s Chi Squared test were used. Results: A total of 5978 records were included. Patients were divided into 4 groups. Normal EEGs, EEGs with triphasic waves and epileptiform activity, EEGs with triphasic waves, EEGs with epileptiform activity. 320 (or 5.2%) had triphasic waves. Epileptiform activity was noted in 1340 (22.4%). 2958 (43.5%) of the records were male patients and 3380 (56.5%) were female. When all subjects were studied together Pearson’s Chi Squared test had a two sided p value of < 0.001 showing an association between triphasic waves and epileptiform activity on the same EEG. This relationship held true when males and females were studied separately. When subgroup analysis was done of patients on antiepileptic medication, the Pearson’s Chi Squared test lost significance at a p value of 0.122. Conclusion: This study showed an association between epileptiform activity and triphasic waves on the same EEG. The association between triphasic waves and epileptiform activity within a single electroencephalogram is important to neurologists for a multitude of reasons. Often the encephalopathy of these patients is attributed to the underlying etiology of the triphasic waves. The epileptiform activity, with resultant seizures, may be contributing to the encephalopathy seen in many of these patients. Disclosure: Dr. Fiddler has nothing to disclose. Dr. Farooq has nothing to disclose. Dr. Teter has received research support from Biogen Idec, EMD Serono, Novartis, and Genzyme Corp. Dr. Kavak has nothing to disclose. Dr. Weinstock has received personal compensation for activities with GlaxoSmithKline Inc., and Cyberonic as a member of the speaker9s bureau. Dr. Weinstock has received research support from UCB Pharma, and Eisai Inc.

Objective: To research the association between smoking and mood state in Multiple sclerosis (MS) patients. Background: Smoking is a well-known risk factor for MS and may influence disease progression. Previous research has shown a relationship between psychological morbidity (depression, anxiety, and stress) and addictive substance use, including nicotine. To our knowledge, no studies have evaluated the relationship between smoking and psychosocial factors in MS patients. Methods: Subjects were extracted from the New York State Multiple Sclerosis Consortium database. Patients’ perceived level of loneliness, pessimism, tension, panic, irritation, morbid thoughts and feelings of guilt were measured on a 1 to 5 scale, ranging from “none” to “extremely”. A cumulative measure of mood state was created by taking the sum of the seven Rasch scored items, followed by log transformation to normalize the data. Chi-squared tests and general linear modeling were used to compare the mood states between smokers and non-smokers, while adjusting for age at symptom onset, sex, education level and EDSS scores. Results: Of the 2,249 subjects, 761 (33.8%) were current smokers. Demographic characteristics did not differ between smokers and non-smokers, except for EDSS score (higher) and education level (lower), which were subsequently included as confounders in statistical models. Smokers reported higher levels of loneliness, pessimism, panic, irritation and morbid thoughts (all p-values <.001), while no significant differences were observed in levels of tension and feelings of guilt. Furthermore, smokers had a significantly worse cumulative mood state than non-smokers as tested using ANCOVA. Conclusion: Smokers with MS had lower levels of self-reported mood state compared to non-smokers. The direction of the association cannot be determined, as people with psychosocial problems might be more likely to smoke. Gaining more insight into the outcomes of smoking among MS patients may lead to further interventions and influence the wellbeing of people with MS. Disclosure: Dr. Kavak has nothing to disclose. Dr. Teter has received research support from Biogen Idec, EMD Serono, Novartis, and Genzyme Corp. Dr. Weinstock-Guttman has received personal compensation for activities with Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer, Novartis, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., Mylan, and Acorda Therapeutics. Dr. Weinstock-Guttman has received research support from Biogen Idec, Teva Neuroscience, EMD Serono, Pfizer Inc, Novartis, Acorda, ITN, Questcor, Shire, Genzyme, Sanofi-Aventis Pharmaceuticals, Inc., National Multiple Sclerosis Society, the National Institutes of Health and Aspreva-Roche.

Background: Factors driving disease-modifying therapy (DMT) switch behavior are not well understood. Objective: The objective of this paper is to identify patient characteristics and clinical events predictive of therapy switching in patients with suboptimal response to DMT. Methods: This retrospective study analyzed patients with relapsing–remitting multiple sclerosis (MS) and a suboptimal response to initial therapy with either interferon β or glatiramer acetate. Suboptimal responders were defined as patients with ≥1 MS event (clinical relapse, worsening disability, or MRI worsening) while on DMT. Switchers were defined as those who changed DMT within six to 12 months after the MS event. Results: Of 606 suboptimal responders, 214 (35.3%) switched therapy. Switchers were younger at symptom onset ( p = 0.012), MS diagnosis ( p = 0.004), DMT initiation ( p < 0.001), and first MS event ( p = 0.011) compared with nonswitchers. Compared with one relapse alone, MRI worsening alone most strongly predicted switch behavior (odds ratio 6.3; 95% CI, 3.1–12.9; p < 0.001), followed by ≥2 relapses (2.8; 95% CI, 1.1–7.3; p = 0.040), EDSS plus MRI worsening (2.5; 95% CI, 1.1–5.9; p = 0.031) and EDSS worsening alone (2.2; 95% CI, 1.2–4.1; p = 0.009). Conclusions: Younger patients with disease activity, especially MRI changes, are more likely to have their therapy switched sooner than patients who are older at the time of MS diagnosis and DMT initiation.

April 30, 2014April 8, 2014Free AccessNursing Home MS Residents Experience Less Stress and Pessimism Compared to Home-Based Non-Ambulatory MS Patients. (P4.153)Zilfah Younus, Irfan Ahsan, Sahil Gupta, Katelyn Kavak, Barbara Teter, and Bianca Weinstock-GuttmanAuthors Info & AffiliationsApril 8, 2014 issue82 (10_supplement)https://doi.org/10.1212/WNL.82.10_supplement.P4.153 Letters to the Editor

OBJECTIVE: We aim to find a significant association between Vitamin D insufficiency and Statin induced myopathy.