Disability and Mortality in a Cohort of Multiple Sclerosis Patients: A Reappraisal

Abstract

The aim of the study was to evaluate how the natural history of multiple sclerosis (MS) had changed over a 15-year period. We compared disability and mortality in a cohort of 83 MS patients hospitalised in the Neurological Institute of Pavia, northern Italy, from January 1, 1990, to December 31, 1991, with a similar cohort of 52 patients analysed in the past. After the follow-up, an unfavourable course (death or relevant disability) was observed in 41% of the patients in the new cohort, compared to 63.5% of the patients in the old one. The percentage of deceased patients was reduced from 25 to 6%. The analysis of the pooled data of the two cohorts indicates a recent tendency of firstly hospitalised patients having a shorter disease duration and a lower disability level, which could explain the relevant decrease both in mortality and disability. Finally, our findings confirmed that age at onset, early disability and a short interval between onset and secondary progression increase the risk of an unfavourable course.

Early prognosis of multiple sclerosis

“…Of this cohort, 41% had an unfavorable course, defined as either death due to MS (n ¼ 5) or an EDSS of 5 EARLY PROGNOSIS OF MULTIPLE SCLEROSIS 373 or more (n ¼ 29); 54% had an EDSS of 2.0-4.5; and only 5% had an EDSS < 2.0 (Bergamaschi et al, 2005). Factors associated with a better prognosis seem generally consistent between studies.…”

“…Patients over 30 at CIS onset were found to have 1.7 times higher risk of secondary progression 25 years from diagnosis than younger patients (Eriksson et al, 2003;Bergamaschi et al, 2005). CIS patients presenting with motor symptoms have a risk of secondary progression 2.0 times higher and a risk of being wheelchair-bound after 25 years 2.8 times higher than patients with purely sensory symptoms (Eriksson et al, 2003).…”

“…Thus, although several studies have found females to have a more favorable course than men, some have found no such influence of gender (Phadke, 1990;Ramsaransing et al, 2001). Similarly, although ON or sensory disturbance at presentation is frequently reported to have a more benign disease course (Rizzo and Lessell, 1988;Phadke, 1990;Hawkins and McDonnell, 1999;Confavreux et al, 2003;Eriksson et al, 2003;Optic Neuritis Study Group, 2004;Bergamaschi et al, 2005), a meta-analysis found no such association (Ramsaransing et al, 2001). Other factors that have been associated with benign course in a few studies include unifocal onset (Eriksson et al, 2003), less than 6 months' duration of initial symptoms, lack of family history of MS (Phadke, 1990), and only one exacerbation in the first 5 years (Ramsaransing et al, 2001).…”

“…Development of a progressive course is the most important factor associated with long-term outcome (Bergamaschi et al, 2005;Ebers, 2005;Scalifari et al, 2010); the development of SPMS seems to increase with time. For example, in studies of RRMS patients followed for only 10 years, 32-40% of patients will have developed SPMS (Confavreux et al, 2003;Bergamaschi et al, 2005).…”

“…For example, in studies of RRMS patients followed for only 10 years, 32-40% of patients will have developed SPMS (Confavreux et al, 2003;Bergamaschi et al, 2005). By contrast, in cohorts followed up for 25 years, up to 90% will have developed SPMS (Weinshenker et al, 1989).…”