{"id":261,"date":"2026-10-22T19:57:23","date_gmt":"2026-10-22T17:57:23","guid":{"rendered":"https:\/\/neuraccure.com\/?p=261"},"modified":"2026-10-22T19:57:23","modified_gmt":"2026-10-22T17:57:23","slug":"score-neuraccure-et-trajectoire-de-ledss-dans-la-sep-remittente-ce-que-nous-presentons-a-lectrims-2026","status":"publish","type":"post","link":"https:\/\/neuraccure.com\/en\/score-neuraccure-et-trajectoire-de-ledss-dans-la-sep-remittente-ce-que-nous-presentons-a-lectrims-2026\/","title":{"rendered":"Score Neuraccure et trajectoire de l&#8217;EDSS dans la SEP r\u00e9mittente : ce que nous pr\u00e9sentons \u00e0 l&#8217;ECTRIMS 2026"},"content":{"rendered":"<em>En bref: Dans une \u00e9tude prospective bicentrique (CHU de Nice, CHU de Saint-\u00c9tienne) portant sur 135 patients atteints de scl\u00e9rose en plaques r\u00e9mittente sous traitement de haute efficacit\u00e9, nous montrons qu&#8217;un cumul de d\u00e9ficits subtils d\u00e9tect\u00e9s \u00e0 l&#8217;aide de Neuraccure s&#8217;associe \u00e0 une trajectoire d&#8217;EDSS d\u00e9favorable : une aggravation moyenne de 0,45 point, contre une am\u00e9lioration moyenne de 0,13 point dans le reste de la cohorte (p=0,036). Ces r\u00e9sultats sont pr\u00e9sent\u00e9s sous la forme d&#8217;un poster \u00e0 l&#8217;ECTRIMS 2026 \u00e0 Toronto.<\/em>\n\n<br\/>\n<br\/>\n\n<strong>Pourquoi s&#8217;int\u00e9resser \u00e0 l&#8217;accumulation de d\u00e9ficits subtils ?<\/strong>\n\n<br\/>\n<br\/>\n\nLa progression ind\u00e9pendante de l&#8217;activit\u00e9 des pouss\u00e9es (PIRA) est aujourd&#8217;hui reconnue comme le principal m\u00e9canisme d&#8217;accumulation du handicap conduisant \u00e0 la conversion vers une forme secondairement progressive de la scl\u00e9rose en plaques. Elle n&#8217;est cependant pas \u00e9valu\u00e9e en routine, faute de consensus sur sa d\u00e9finition, et repose dans la plupart des \u00e9tudes sur le score EDSS, dont les limites sont bien document\u00e9es : peu sensible aux changements subtils, elle capture mal de nombreux sympt\u00f4mes invisibles \u00e0 l&#8217;examen, et sa variabilit\u00e9 inter-\u00e9valuateur limite sa fiabilit\u00e9 pour un suivi au long cours. Dans un travail prospectif longitudinal, nous avons voulu \u00e9valuer si un cumul d&#8217;anomalies cliniques subtiles et ind\u00e9tectable \u00e0 l&#8217;oeil nu pouvait constituer un marqueur pronostique de l&#8217;\u00e9volution vers une forme progressive de maladie.\n\n<br\/>\n<br\/>\n\n<strong>Design de l&#8217;\u00e9tude<\/strong>\n\n<br\/>\n<br\/>\n\nIl s&#8217;agit d&#8217;une \u00e9tude prospective, bicentrique, conduite entre mai 2024 et juin 2025 dans deux centres hospitaliers universitaires fran\u00e7ais (Nice, Saint-\u00c9tienne). Cent trente-cinq patients atteints de scl\u00e9rose en plaques r\u00e9mittente, trait\u00e9s par anticorps monoclonal anti-CD20 (44,4 %) ou anti-VLA4 (55,6 %), sans pouss\u00e9e ni activit\u00e9 IRM au cours des six mois pr\u00e9c\u00e9dant l&#8217;inclusion, ont \u00e9t\u00e9 inclus (\u00e2ge moyen 39,7 ans, ratio femmes\/hommes 2,4:1, EDSS m\u00e9dian \u00e0 l&#8217;inclusion 1,5). Les patients ont \u00e9t\u00e9 \u00e9valu\u00e9s \u00e0 l&#8217;inclusion (M0) et \u00e0 six mois (M6) avec Neuraccure, au travers d&#8217;une \u00e9valuation de quatre fonctions neurologiques: coordination manuelle fine, vision des contrastes, temps de r\u00e9action moteur et mouvements oculaires. Chaque fonction a \u00e9t\u00e9 class\u00e9e comme normale ou anormale en se basant sur des donn\u00e9es publi\u00e9es dans nos pr\u00e9c\u00e9dents travaux de recherche. Le nombre de fonctions alt\u00e9r\u00e9es a \u00e9t\u00e9 exprim\u00e9 sous la forme d&#8217;un score (Score Neuraccure, NS) allant de 0 \u00e0 4. L&#8217;EDSS a \u00e9t\u00e9 recueilli \u00e0 trois temps (initiation du traitement, M0, M6), et l&#8217;impression globale de changement per\u00e7ue par le patient (PGI-C) \u00e0 M6. En cas d&#8217;aggravation confirm\u00e9e du score Neuraccure entre M0 et M6, une visite de confirmation \u00e9tait pr\u00e9vue \u00e0 neuf mois (M9).\n<br\/>\n<br\/>\n<strong>Que montre la trajectoire de l&#8217;EDSS selon le score Neuraccure \u00e0 l&#8217;inclusion ?<\/strong>\n\n<br\/>\n<br\/>\n\n\u00c0 l&#8217;inclusion, 25,4 % des patients (n=33) pr\u00e9sentaient une alt\u00e9ration des quatre fonctions test\u00e9es (NS=4). Le score Neuraccure \u00e0 l&#8217;inclusion \u00e9tait associ\u00e9 \u00e0 l&#8217;EDSS m\u00e9dian de fa\u00e7on croissante avec la dur\u00e9e de suivi : l&#8217;association n&#8217;\u00e9tait pas significative au moment de l&#8217;initiation du traitement (p=0,183), mais le devenait \u00e0 l&#8217;inclusion (p=0,001) puis se renfor\u00e7ait encore \u00e0 six mois (p&lt;0,001). Plus sp\u00e9cifiquement, les patients avec un NS \u00e0 4 connaissaient une progression moyenne de l&#8217;EDSS de 0,45 point entre l&#8217;initiation du traitement et l&#8217;inclusion, contre -0,13 point dans le reste de la cohorte (p=0,036), une association qui restait significative apr\u00e8s ajustement sur l&#8217;\u00e2ge (p=0,002). Parmi ces patients du groupe NS4 \u00e0 l&#8217;inclusion, les six qui conservaient ce niveau alt\u00e9ration de mani\u00e8re soutenue \u00e0 six mois (4,4 % de la cohorte) avaient un EDSS significativement plus \u00e9lev\u00e9 que que les autres (4,4 contre 2,3 ; p=0,016), avec une trajectoire de handicap qui r\u00e9pondait \u00e0 la d\u00e9finition d&#8217;une forme secondairement progressive qui n&#8217;avait pas encore \u00e9t\u00e9 reconnue par le clinicien.\n\n<br\/>\n<br\/>\n\n<img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-266 aligncenter\" src=\"https:\/\/neuraccure.com\/wp-content\/uploads\/2026\/10\/Figure-2-poster-officiel-ECTRIMS-300x251.png\" alt=\"\" width=\"300\" height=\"251\" srcset=\"https:\/\/neuraccure.com\/wp-content\/uploads\/2026\/10\/Figure-2-poster-officiel-ECTRIMS-300x251.png 300w, https:\/\/neuraccure.com\/wp-content\/uploads\/2026\/10\/Figure-2-poster-officiel-ECTRIMS-768x643.png 768w, https:\/\/neuraccure.com\/wp-content\/uploads\/2026\/10\/Figure-2-poster-officiel-ECTRIMS-14x12.png 14w, https:\/\/neuraccure.com\/wp-content\/uploads\/2026\/10\/Figure-2-poster-officiel-ECTRIMS.png 1003w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>\n\n<br\/>\n<br\/>\n\n<strong>Quand l&#8217;EDSS ne suffit pas \u00e0 trancher<\/strong>\n\n<br\/>\n<br\/>\n\nParmi les autres patients, la pr\u00e9sence d&#8217;une aggravation confirm\u00e9e du score Neuraccure entre M0 et M6 \u00e9tait associ\u00e9e \u00e0 une tendance \u00e0 l&#8217;aggravation de l&#8217;EDSS qui n&#8217;atteignait pas la significativit\u00e9 statistique. Pourtant, l&#8217;ensemble de ces patients rapportaient une impression subjective d&#8217;aggravation \u00e0 l&#8217;\u00e9chelle PGI-C, contre seulement 6 % des autres patients (p&lt;0,0001).\n\n<br\/>\n<br\/>\n\n<strong>Limites et perspectives<\/strong>\n\n<br\/>\n<br\/>\n\nCette \u00e9tude est exploratoire, sans calcul a priori de taille d&#8217;\u00e9chantillon, et l&#8217;ampleur de la progression d&#8217;EDSS observ\u00e9e chez les patients \u00e0 NS=4 reste modeste au regard des seuils habituellement retenus pour une progression cliniquement significative ; un suivi plus long pourrait r\u00e9v\u00e9ler une progression plus marqu\u00e9e dans ce sous-groupe. Le sous-groupe de six patients r\u00e9pondant aux crit\u00e8res de forme progressive est \u00e9galement restreint et demande \u00e0 \u00eatre confirm\u00e9 sur des effectifs plus larges. Comme pour l&#8217;ensemble des indicateurs mesur\u00e9s par Neuraccure, il s&#8217;agit l\u00e0 d&#8217;une aide \u00e0 la d\u00e9cision destin\u00e9e au neurologue, et non d&#8217;un outil de diagnostic autonome : c&#8217;est l&#8217;interpr\u00e9tation clinique int\u00e9gr\u00e9e au contexte global qui reste d\u00e9terminante.\n<br\/>\n<br\/>\nNeuraccure est un outil d&#8217;aide \u00e0 la d\u00e9cision destin\u00e9 aux professionnels de sant\u00e9 ; il ne pose pas de diagnostic de mani\u00e8re autonome.\n<br\/>\n<br\/>\nR\u00e9f\u00e9rence : Hohweiller A, Cohen M, Camdessanche JP, Lebrun-Frenay C. Digital Multidomain Neurological Assessment Identifies Early Disability Accumulation in Relapsing Multiple Sclerosis. ECTRIMS 2026, EP2541","protected":false},"excerpt":{"rendered":"En bref: Dans une \u00e9tude prospective bicentrique (CHU de Nice, CHU de Saint-\u00c9tienne) portant sur 135 patients atteints de scl\u00e9rose en plaques r\u00e9mittente sous traitement de haute efficacit\u00e9, nous montrons qu&#8217;un cumul de d\u00e9ficits subtils d\u00e9tect\u00e9s \u00e0 l&#8217;aide de Neuraccure s&#8217;associe \u00e0 une trajectoire d&#8217;EDSS d\u00e9favorable : une aggravation moyenne de 0,45 point, contre une&#8230;","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-261","post","type-post","status-publish","format-standard","hentry","category-non-classe"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - 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