2023 American Academy of Neurology Abstract Website

Valerie Block¹, Shuiting Cheng¹, Jeremy Juwono¹, Richard Cuneo ², Gina Kirkish ¹, Amber Alexander¹, Mahir Khan ¹, Amit Akula¹, eduardo caverzasi⁴, Nico Papinutto ¹, William Stern¹, University of California, San Francisco MS-EPIC Team³, Mark Pletcher⁵, Gregory Marcus⁶, Jeffrey Olgin⁶, Stephen Hauser⁷, Jeffrey Gelfand², Riley Bove⁷, Bruce Cree², Roland Henry¹
¹Neurology, University of California, San Francisco, ²UCSF, Multiple Sclerosis Center, ³Neurology, UCSF, Multiple Sclerosis Center, ⁴Department of Brain and Behavioral Sciences, University of Pavia, ⁵Department of Epidemiology and Biostatistics, ⁶Department of Epidemiology and Biostatistics,, University of California San Francisco, ⁷UCSF Weill Institute for Neurosciences

Objective:

Evaluate the association of remotely captured ambulatory activity with structural central nervous system pathology via quantitative magnetic imaging, in people with multiple sclerosis (MS).

Background:

Remote activity monitoring has the potential to evaluate real-world motor function and disability outside of the clinic. The relationships of daily physical activity with spinal cord white matter and grey matter areas, MS disability, and leg function are unknown.

Design/Methods:

Fifty adults with progressive or relapsing MS with motor disability who could walk at least 2 minutes, were assessed using clinical, patient-reported, and quantitative brain and spinal cord MRI measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 consecutive days. Univariate and multivariate analyses were performed to assess correlations between remote physical activity and other disability metrics.

Results:

The mean age of the cohort was 53.3 years and the median EDSS was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures (i.e., Timed 25-foot Walk, Timed up and Go tests, and subjective 12-item MS Walking Scale). Greater STEPS correlated with greater C2-C3 spinal cord grey matter areas (rho=0.39, p=0.04), total cord area (rho=0.35, p=0.04), and brain volume (rho=0.32, p=0.04).

Conclusions:

These results provide preliminary evidence that spinal cord grey matter area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.