Tuesday, 13 March 2012

Research: Clinical Course and Progression

Skoog B, et al. A representative cohort of patients with non-progressive multiple sclerosis at the age of normal life expectancy.Brain. 2012;135:900-11.

Multiple sclerosis may have a non-progressive symptomatology for decades; however, it is not clear whether the disease activity may abate completely.

We identified a cohort of patients, resident in Sweden at the time of disease onset, between the years 1950-64 (n = 307). This 15-year incidence cohort was essentially followed prospectively for 37-59 years after onset. The shortest follow-up time for patients without primary or secondary progression was 45 years. For patients with an initial relapsing-remitting course and multiple sclerosis diagnosis according to the Poser criteria (n = 202), the probability of non-progressive disease after 40 years was 22% (standard error 3.0%), and after 50 years it was 14% (standard error 3.2%). For attack-onset including patients with possible multiple sclerosis, the corresponding probabilities after 40 and 50 years were 35% (standard error 3.3%) and 28% (standard error 3.5%), respectively.

At the last follow-up in 2009-10, when patients reached the average age of the Swedish population life expectancy (74 years in Males and 80 years in females), only 13 patients from the multiple sclerosis diagnosis cohort, according to the Poser criteria, remained alive and non-progressive. Their annualized attack frequency diminished with time from 0.29 to 0.015. These patients had been functioning well socially. Nine patients had an Expanded Disability Status Scale score of 0-2.5, and four patients had a score of 3 or 3.5, with deficits dating back to attacks decades ago. Eight patients participated in a complete neuropsychological examination, which showed a slight difference (P less than 0.01) concerning verbal memory and executive function compared to an age and socially matched reference group, whereas results for five other cognitive domains were within the normal range.

Magnetic resonance images fulfilled the Barkhof-Tintoré criteria for multiple sclerosis in 10 of 11 patients, with conspicuously few subcortical lesions relative to extensive periventricular lesions and lesions extending from the inferior midline aspect of the corpus callosum. Prediction of the non-progressive stage was possible with moderate hazard ratios and low sensitivity.

Early features that predicted a non-progressive course were complete remission of the onset attack, low or moderate initial relapse frequency and-when the patients with possible multiple sclerosis were included-dominating afferent symptoms. The clinical disease activity had abated in these 13 patients, with the caveat that transition to secondary progression continued to occur after four decades, albeit with decreasing risk.

Benign MS is relatively-low activity disease following onset. This is reported to occur in about 25% MSers with up to 25-30years of follow up. This current study looks to see how Benign is Begin MS and shows that it does occur but with unfortunately low frequency. These people generally had good recovery from their attacks a focal (affecting one area of the CNS) disease onset.
Predictors of median time to onset of secondary progression was being female (18 years verses 15 years in males), having a low number of relapses in first five years (less than 3 = 9 years, more than 4 = 4 years), good recovery from last relapse (complete recovery = 13 years, incomplete recovery 4 years), symptoms affecting behavioural effects verses movement effects ( Behaviour = 12 years verses 4 years for motor control problems.

Following onset the majority of people with MS will eventually develop progressive disease. After 40 years the probability of a non-progressive relapsing-remitting course was 22% after 45 years 18% and 50 years 14%.


  1. yep, the bloody thing is guaranteed to kill you:

    The morbid summary in italic that Mr. Mouse did not write:
    You have a chance of 4.2% of living as long as your MS-free neighbour (of the same sex).


  2. Donald said...
    Great article! I will share this!

    Here is the latest Clinical research and news on trials. NICE guidelines, tools & resources for you to keep up-to-date in Medical & Primary Care.



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