Original article
Limb Apraxia in Multiple Sclerosis: Prevalence and Impact on Manual Dexterity and Activities of Daily Living

https://doi.org/10.1016/j.apmr.2012.01.008Get rights and content

Abstract

Kamm CP, Heldner MR, Vanbellingen T, Mattle HP, Müri R, Bohlhalter S. Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living.

Objective

To evaluate the prevalence and impact of limb apraxia on manual dexterity and activities of daily living (ADLs) in patients with multiple sclerosis (MS).

Design

Survey.

Setting

University hospital.

Participants

Consecutive patients (N=76) with clinically isolated syndrome, relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) or primary progressive multiple sclerosis (PPMS), Expanded Disability Status Scale (EDSS) score from 0 to 6.5, and aged from 18 to 70 years were included.

Interventions

Not applicable.

Main Outcome Measures

Apraxia was assessed by the apraxia screen of TULIA (AST). The relationship of apraxia with ADLs and manual dexterity was evaluated using a dexterity questionnaire and the coin rotation task, respectively.

Results

Overall, limb apraxia was found in 26.3% of patients (mean AST score ± SD, 7.3±1.3; cutoff <9). Apraxia was significantly correlated with higher EDSS scores, longer disease duration, and higher age with the EDSS being predictive. Furthermore, patients with SPMS and PPMS were more apraxic than patients with RRMS. Finally, limb apraxia was significantly associated with impaired ADLs and manual dexterity.

Conclusions

Limb apraxia is a frequent and clinically significant symptom contributing to disability in MS. It should therefore be evaluated and possibly treated, particularly in patients with MS reporting manual difficulties in everyday life.

Section snippets

Study Design and Patients

Seventy-six consecutive patients from our MS clinic with clinically isolated syndrome (CIS), relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS), or primary progressive multiple sclerosis (PPMS) according to McDonald's criteria, Expanded Disability Status Scale (EDSS) score from 0 to 6.5 (inclusive), aged from 18 to 70 years, with or without immunomodulatory treatment, were included. We aimed to have an equal EDSS distribution from 0 to 6.5. Main

Results

The characteristics of the study population regarding age, sex, disease duration, MS type, EDSS, relapse rate, and immunomodulatory therapy are presented in table 1. The EDSS of the study population was well distributed except for EDSS scores from 0 to 0.5 with 4 patients only. There were no relevant comorbidities. Apraxic (12 of 20) and nonapraxic (10 of 56) patients had ongoing physical therapy. Nonsteroidal anti-inflammatory drugs and antidepressants were the most common additional medical

Discussion

Disability in MS usually results from a combination of several neurologic deficits, and knowledge of the miscellaneous deficits is essential for optimal pharmaceutic and nonpharmaceutic treatment of patients with MS. The EDSS is commonly performed to evaluate disability in MS. However, it primarily focuses on ambulation and does not sufficiently assess motor skills of the upper limbs.18 Limb apraxia is rarely considered in MS and has been, to the best of our knowledge, not evaluated with

Conclusions

Limb apraxia is a frequent and clinically significant symptom contributing to impaired manual dexterity and ADLs in patients with MS. Therefore, we advocate apraxia be routinely evaluated for MS patients, particularly if they self-report dexterous problems. Furthermore, recognizing apraxia opens up new avenues in neurorehabilitation by targeted interventions in occupational therapy.

Supplier

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    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

References (32)

  • R.C. Leiguarda et al.

    Apraxia in Parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism

    Brain

    (1997)
  • N.E. Abou Zeid et al.

    Gait apraxia in multiple sclerosis

    Can J Neurol Sci

    (2009)
  • B. Weinshenker et al.

    The natural history of multiple sclerosis: a geographically based studyI. Clinical course and disability

    Brain

    (1989)
  • N.P. Staff et al.

    Multiple sclerosis with predominant, severe cognitive impairment

    Arch Neurol

    (2009)
  • H. Lassmann et al.

    The immunopathology of multiple sclerosisAn overview

    Brain Pathol

    (2007)
  • M. Charcot

    Histologie de la sclerose en plaques

    Gaz Hosp

    (1868)
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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints are not available from the author.

    In-press corrected proof published online on Mar 30, 2012, at www.archives-pmr.org.

    Helder and Vanbellingen contributed equally to this article.

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