Prediction Of Outcome In Multiple Sclerosis
Based on multivariate models
Runmarker B; Andersson C; Oden A; Andersen O
J Neurol 1994 Oct;241(10):597-604
Sahlgren's Hospital, Dept of Neurology, Goteborg, Sweden
IS# 0340-5354; UI# 95138749
An incidence cohort of 308 Multiple Sclerosis patients was followed up repeatedly during at least 25 years of disease.
In the patients with acute Onset, multivariate survival analyzes were performed and predictive models created. The endpoints DSS 6 and start of Progressive Disease were used. A number of variables were tested.
The most important of these for prediction and therefore included in these models were: age at Onset, sex, degree of remission after relapse, Mono- or PolyRegional symptoms, type of affected Nerve fibers, number of affected Neurological Systems. The relapse rate did not correlate with prognosis.
In the predictive models, coefficients and risk ratios are provided that can be used for calculating the risk of progression and DSS 6 or to predict the median time for these endpoints in individual patients.
It was also found that the risk of progression is not constant, but has a maximum a certain time after disease Onset.
For a patient with early Onset, the risk is low in the beginning, but reaches a maximum level, which is several times higher, after about 15 years.
The patient with a late Onset has a much higher risk of endpoint immediately after Onset, but reaches the maximum in a few years, and after that the risk decreases.
Prognostic Criteria In Multiple Sclerosis
An exploratory study of an epidemiological group
Lauer K; Firnhaber W
J Neurol 1992 Feb;239(2):93-7
Neurologische Klinik, Darmstadt-Eberstadt, Federal Republic of Germany
IS# 0340-5354; UI# 92202963
Demographic and clinical features and data on medical history and prior environmental exposure collected during an Epidemiological long-term study of Multiple Sclerosis (MS) were tested for their possible prognostic value.
Fifty-two Benign MS patients were compared with 29 patients having a Malignant course.
A Primary or Secondary/Progressive course and Cerebellar/lower BrainStem Symptoms at Onset indicated an unfavorable course.
Whereas no predictive value of sex or of any other type of Onset symptomatology was found.
Age at Onset per se had no influence on prognosis but was associated with more rapid progression only by its relationship with a Chronic/Progressive type of course.
Prior illness, surgery, trauma and childhood exposure to defined environmental factors could not be identified as relevant for prognosis.
Prognosis In Multiple Sclerosis
Schweiz Med Wochenschr 1997 Mar 22; 127(12): 500-505
PMID# 9148400; UI# 97260833
Prognosis of the natural course of Multiple Sclerosis is most often measured on Kurtzke's Expanded Disability Status Scale (EDSS), a non-linear scale over 20 steps, heavily weighted on mobility.
Optic Neuritis and Sensory disturbances as initial symptoms, lower age at Onset of the disease, female sex and a longer interval between relapses are indicators of a more favorable prognosis.
As a rule, disability as measured on this scale 5 years after Onset corresponds to 3/4 of the disability status after 15 years.
The number of relapses diminishes naturally over the course of the disease. Presence and extent of lesions on the initial MRI of the Brain in Clinically Isolated Syndromes are valuable predictors of dissemination of the disease process over the following 5-10 years.
New therapies (e.g. Interferon-ß 1b and 1a, Copolymer-1) reduce relapse frequency by 1/3 and diminish the extent of pathological lesions in Brain MRI, but fail to show (as yet) significant influence on disability.
A 5-year follow-up study
Morrissey SP, Miller DH, Kendall BE, Kingsley DP, Kelly MA, Francis DA, MacManus DG, McDonald WI
Brain 1993 Feb;116 ( Pt 1):135-46
Institute of Neurology, National Hospital for Neurology and NeuroSurgery, Univ, Dept of Clinical Neurology, London, UK
PMID# 8453454; UI# 93201222
A 5-year follow-up study was performed on 89 patients who had undergone Brain Magnetic Resonance Imaging (MRI) at presentation with an acute Clinically Isolated Syndrome of the Optic Nerves, BrainStem or Spinal Cord of a type suggestive of Multiple Sclerosis.
At presentation, MRI was abnormal, revealing one or more asymptomatic Cerebral White Matter lesions in 57 (64%), and was normal in 32 (36%).
At follow-up, progression to Clinically Definite Multiple Sclerosis had occurred in 37 out of 57 (65%) with an abnormal MRI and one out of 32 (3%) with normal MRI.
Human Leucocyte Antigen (HLA) typing was performed in 70 patients and CerebroSpinal Fluid (CSF) was examined at presentation in 36.
The presence of HLA-DR2 Antigen or CerebroSpinal Fluid OligoClonal IgG Bands were both associated with a significantly increased risk of progression to Multiple Sclerosis, but MRI was much more powerful in predicting outcome.
The presence of four or more MRI lesions at presentation was associated with:
- Higher rate of progression to Multiple Sclerosis
- More frequent development of moderate or severe disabilities
- Greater number of new MRI lesions at follow-up
The results indicate that Brain MRI at presentation with a Clinically Isolated Syndrome suggestive of Multiple Sclerosis is a powerful predictor of the clinical course over the next 5 years.
This observation, combined with an ability to detect other sometimes treatable disorders which can also cause such syndromes, suggests that MRI is the investigation of choice in evaluating this group of patients.