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Predicting benign multiple sclerosis

 

Clinical bottom line

Benign MS, defined by minimal or no disability equivalent to an EDSS score of 3 or less at least 10 years after disease onset was present in about a quarter of patients with MS. It was associated with onset with optic neuritis, onset before age 40, absence of pyramidal signs at presentation, duration of first remission more than one year and only one exacerbation in the first five years after onset.


Reference:

G Ramasaransing et al. Early prediction of a benign course of multiple sclerosis on clinical grounds: a systematic review. Multiple Sclerosis 2001 7: 345-347.

Search

Databases were searched for English, French and german studies (to 1999) in which features of MS related to course and prognosis were studied. Benign MS was defined as minimal or no disability equivalent to an EDSS score of 3 or less at least 10 years after disease onset.

Prognostic variables of age, sex, presenting manifestations and duration of first remission were investigated in relation to benign course when they were investigated in at least two studies. Benign MS patients were compared with the remainder of MS patients.

Results

There were nine studies with 2204 patients. Of these, 589 (27%) had a benign form. Odds ratios for each of the presenting criteria are shown in Table 1, where odds ratios significantly above 1 favour benign MS.

Table 1: Relation between criteria and benign MS (OR above 1 favours benign course)

Criterion

OR (95% CI)

Favours benign course  
Duration of first remission more than 1 year 2.7 (1.9 to 3.8)
Onset before 40 years 2.0 (1.1 to 3.9)
Onset with optic neuritis 1.7 (1.3 to 2.4)
Only one exacerbation in first 5 years 1.6 (1.2 to 2.2)
Not predictive  
Female sex 1.3 (0.9 to 1.7)
Onset with sensory manifestation 1.0 (0.7 to 1.5)
Onset with brainstem/cerebellar signs 1.0 (0.7 to 1.4)
Against benign course  
Pyramidal tract signs at onset 0.5 (0.3 to 0.7)

Duration of first remission more than one year, onset before age 40 years, onset with optic neuritis, and only one exacerbation in the first five years were all associated with a benign course. Pyramidal tract signs at onset were associated with a non-benign course.

Comment

This is an interesting and important study that is helpful in relating initial presentation with eventual outcome for the first 10 years at least. Early identification of this important subgroup could have considerable consequences in ensuring resources are used to the best, and in reassuring a significant minority of patients with a diagnosis of MS. It could also have very significant implications in the design of trials of MS therapies.