Natural History and Early Prognostic Clinical Factors In Multiple Sclerosis

Objective: Multiple sclerosis(MS) can follow different patterns of clinical courses and variable rates of disability accumulation. A major challenge in MS research is to predict the long-term evaluation of patients on the basis of observation taken during an early stage of the disease. We examined the natural history and clinical prognostic factors in a sample of MS patients.Method: Our analysis is based on a longitudinal data from 122 MS patients who were not taking immunomodulatory treatment and had a disease duration of more than 5 years. A multivariate Cox regression analysis for clinical prognostic factors (gender, age at onset, initial symptoms, mono- or poly-regional onset, progressive course, the number of attacks within the first, third and fifth years) related to time to reach EDSS ≥6 were performed.Results: Disease course was defined as relapsing-remitting course in 58% of patients, secondary progressive in 18% and primary progressive in 24% of patients. The disability reached by 15 years was EDSS≥3 in 78 % of patients, EDSS≥6 in 45 %, EDSS≥8 in 4 % and EDSS=10 in 1,63 % of patients. The significant unfavorable prognostic factors were older age at onset and progressive course, initial symptoms related with myelopathy, presentation with motor symptoms and high attack rate within the first years.Conclusions: A slightly better prognosis is observed in our patients. Early prognostic factors are similar to previous series. Defining the natural history and prognostic indicators of the disease will help the clinician before deciding to treat patients with expensive and long-term therapies.