The Multiple Sclerosis Functional Composite and Symbol Digit Modalities Test as outcome measures in pediatric multiple sclerosis

J Nicholas Brenton, Hitoshi Koshiya, Emma Woolbright, Myla D Goldman, J Nicholas Brenton, Hitoshi Koshiya, Emma Woolbright, Myla D Goldman

Abstract

Background: There is an increasing number of pediatric multiple sclerosis (MS) clinical trials occurring; however, data validating outcome metrics that accurately capture functional disability within pediatric cohorts are limited.

Objective: The aim of this study was to investigate the ability of the MS Functional Composite (MSFC) and Symbol Digit Modalities Test (SDMT) to distinguish functional disability in pediatric MS patients.

Methods: A total of 20 pediatric MS patients and 40 age and sex-matched controls completed the SDMT and MSFC components: a timed 25-foot walk (T25FW); 9-hole peg test (9HPT); and paced auditory serial addition test (PASAT). Z scores for MS patients were created for each test based on control means. MS patients underwent Expanded Disability Status Scale (EDSS) examination.

Results: Pediatric MS patients exhibited low levels of disability on EDSS, median [range]: 1.5 [1.0-3.0]. Compared with controls, MS patients performed significantly lower on SDMT (p = 0.0002) and all MSFC components: T25FW (p = 0.001), 9HPT (p = 0.01), and PASAT (p = 0.004). SDMT and MSFC performance were not correlated with EDSS.

Conclusions: Despite low levels of neurologic disability as measured by EDSS, pediatric patients with MS exhibit impaired performance in leg function, upper limb fine motor function, and auditory/visuospatial processing speeds, supporting the value of the MSFC and SDMT in this population. Longitudinal studies are needed to further validate their utility.

Keywords: MSFC; Multiple sclerosis; SDMT; outcome measure; pediatric.

Figures

Figure 1.
Figure 1.
Performance on MSFC (A–C) and SDMT (D) for pediatric patients with multiple sclerosis versus controls. Boxplots demonstrate median with interquartile range. Whiskers represent the range. MS: multiple sclerosis; MSFC: Multiple Sclerosis Functional Composite; PASAT: Paced Auditory Serial Addition Test; SDMT: Symbol Digit Modalities Test.
Figure 2.
Figure 2.
Z scores for pediatric patients with multiple sclerosis with 95th percentile confidence intervals. Presented z scores for patients with multiple sclerosis are representative of the standard deviation from the control group mean per outcome measure. 9HPT: 9-hole peg test; PASAT: Paced Auditory Serial Addition Test; SDMT: Symbol Digit Modalities Test; T25FW: timed 25-foot walk.

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Source: PubMed

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