EDSS, 9-HPT and SDMT
death, Sustained disability, fever
DISEASE PROGRESSION
The EDSS is based on a standard neurological examination, incorporating seven functional systems (visual, pyramidal, cerebellar, brainstem, sensory, bowel and bladder and cerebral) rated and stored as functional system scores (FSSs). Each FSS is an ordinal clinical rating scale ranging from 0 to 5 or 6. These ratings are then used in combination with ambulation capacity to determine the EDSS score that ranges from 0 (normal) to 10 (death due to MS). Sustained disability progression is defined as an increase of >0.5 EDSS points in the last 12 months. This change must not be attributable to another etiology (that is, fever, concurrent illness, MS relapse or concomitant medication), and it must be confirmed at a regularly scheduled visit after at least 12 weeks after the initial disease progression. The neurological examination with EDSS assessment was performed at baseline, at day −1 and at 1, 3, 6, 9, 12, 15, 18, 21 and 24 months. The 9-HPT evaluates upper extremities and coordination. To conduct this timed test, the patients are seated with a peg board in front of them. The board has nine holes on one side and a shallow round dish on the other side, and the patients are asked to place the pegs into each hole on the peg board, one at a time, and remove them again one at a time, while the test speed is measured. The patients were tested twice for each arm, the dominant arm first. An average time was calculated separately for the dominant and non-dominant hands. The SDMT quantifies the speed of information processing, by asking the patient to associate symbols and numbers as quickly as possible. The patient’s score is estimated as the number of correct associations produced in 90 seconds. 9-HPT and SDMT were evaluated at baseline and at 6, 12, 18 and 24 months.