Natalizumab use for neuropsychological deficits in relapsing multiple sclerosis K. Edwards,1,2 W. Goodman,1 1MS Center of Northeastern New York (Latham, NY, USA), 2Harvard Medical School (Boston, MA, USA)

1
Natalizumab use for neuropsychological deficits
in relapsing multiple sclerosisK. Edwards,1,2
W. Goodman,1 1MS Center of Northeastern New York
(Latham, NY, USA), 2Harvard Medical School
(Boston, MA, USA)
Abstract
Methods
Conclusions
Neuropsychological Impairment Improves Over Time
With Natalizumab Treatment

This is a single center, open label,
retrospective analysis evaluating change in NP
parameters in MS patients before and after 6 or
more months of treatment with natalizumab.
Subjects were compared to their own baseline
activity. Retrospective data from 40
consecutively treated patients were analyzed. The
method evaluated each sub-test of a standardized
neuropsychological evaluation specific for MS as
to a normal or one or more standard deviations
from the norm. Each of 9 sub-tests was assigned
a value of zero if normal or 0.11 if one standard
deviation or more from the norm. If the total
score was 0.22 or higher at baseline, the patient
was considered impaired for NP purposes
Natalizumab has been shown to reduce the physical
disability in MS patients in the Affirm1 and
Sentinel2 trials. However, the main cause of
disability in MS patients is due to
neuropsychological (NP) dysfunction.3 Physical
disability in MS does not necessarily correlate
with NP disability. A recent study from Milan4
showed that nearly 1/3 of patients with benign
MS as based on the EDSS were disabled due to the
NP dysfunction.
Natalizumab may stabilize or improve NP function
in a significant proportion of MS patients. The
improvement of NP status does not appear to be
dependent upon improvement in depression and
physical disability.This was a small
retrospective study. Larger, prospective,
controlled studies with NP function as the
primary outcome measure need to be pursued.

NP Impairment
References
Objective
The primary objective of this retrospective
analysis was to evaluate the effect of
natalizumab treatment on NP function in patients
with relapsing-remitting multiple sclerosis
(RRMS) who had a measurable cognitive deficit
prior to natalizumab treatment initiation.

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p 0.001, standard error bars shown
Results
Number of patients improving with Natalizumab
treatment
Proportion of patients improving at Follow-up
visit

• The mean age was 48.5 years with SD of 7.6.
  Neuropsychological impairment Index at baseline
  showed a mean of 0.49 with SD of 0.21.
• The impairment index at follow-up showed a mean
  of 0.41 with SD of 0.26.
• Paired sample t-tests demonstrated significant
  improvement after Natalizumab treatment of p
  0.001. As did the MacNemars non-parametric test
  (p 0.007)
• The proportion of patients with an improvement,
  no change, or worsening was 21 (52.5), (22.5),
  and8 (20), respectively (p0.007).

Supported by an
unrestricted educational grant from Biogen Idec