Abstract
Objective: To evaluate disability and prognosis in an untreated population-based incidence cohort of multiple sclerosis (MS) patients. Methods: The Expanded Disability Status Scale (EDSS) score was recorded in 220 MS patients. Disease progression was assessed by life table analysis with different endpoints and multivariate Cox regression analysis was performed for evaluation of prognostic factors. Results: The probability of being alive after 15 years was 94.8+1.8% (s.e.), of managing without a wheelchair (EDSS57.0) 75.8+3.2%, of walking without walking assistance (EDSS56.0) 60.3+3.6%, and of not being awarded a disability pension 46.0+3.7%. The probability of still having a relapsing-remitting (RR) course after 15 years was 62.0+4.1%. A RR course and long interval between the initial (onset) and second episode (43 years) predicted favorable outcome. There was also a trend towards favorable outcome in patients with optic neuritis, sensory symptoms and low age at onset, but these factors were associated with the RR course. Motor symptoms and high age at onset indicated unfavorable outcome, but these factors were associated with the primary progressive course. Conclusions: A RR course and long inter-episode intervals in the early phase of the disease were associated with a better outcome. Other onset characteristics indicating a favorable outcome were associated with the RR course while characteristics indicating an unfavorable outcome were associated with the PP course.
Weinshenker BG , Ebers GC. (1987) The natural history of multiple sclerosis . Can J Neurol Sci 14: 255-261 . Google Scholar | Crossref | Medline | ISI | |
Kurtzke JF. (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) . Neurology 33: 1444-1452 . Google Scholar | Crossref | Medline | ISI | |
Weinshenker BG et al. (1989) The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability . Brain 112: 133-146 . Google Scholar | Crossref | Medline | ISI | |
Runmarker B , Andersen O. (1993) Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up . Brain 116: 117-134 . Google Scholar | Crossref | Medline | ISI | |
Kantarci O et al. (1998) Survival and predictors of disability in Turkish MS patients . Neurology 51: 765-772 . Google Scholar | Crossref | Medline | ISI | |
Weinshenker BG. (1995) the natural history of multiple sclerosis . Neurol Clin 13: 119-146 . Google Scholar | Crossref | Medline | ISI | |
Ebers GC. (1998) Natural history of multiple sclerosis. In: Compston A , Ebers G , Lassmann H , McDonald I , Matthews B , Wekerle H , eds. McAlpine's multiple sclerosis. London: Churchill Livingstone : pp 191-221. Google Scholar | |
Presthus J. (1960) Report on the multiple sclerosis investigation in West-Norway . Acta Neurol Scand 35 (Suppl 147): 88-92 . Google Scholar | Crossref | |
Larsen JP et al. (1984) Western Norway, a high-risk area for multiple sclerosis: a prevalence/incidence study in the county of Hordaland . Neurology 34: 1202-1207 . Google Scholar | Crossref | Medline | ISI | |
Grønning M et al. (1991) Incidence of multiple sclerosis in Hordaland, Western Norway: a fluctuating pattern . Neuroepidemiology 10: 53-61 . Google Scholar | Crossref | Medline | ISI | |
Grønning M et al. (1993) Infections in childhood and adolescence in multiple sclerosis. A case-control study . Neuroepidemiology 12: 61-69 . Google Scholar | Crossref | Medline | ISI | |
Poser CM et al. (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols . Ann Neurol 13: 227-231 . Google Scholar | Crossref | Medline | ISI | |
Miller DH , Hornabrook RW , Purdie G. (1992) The natural history of multiple sclerosis: a regional study with some longitudinal data . J Neurol Neurosurg Psychiatry 55: 341-346 . Google Scholar | Crossref | Medline | ISI | |
Midgard R , Riise T , Nyland H. (1996) Impairment, disability, and handicap in multiple sclerosis. A cross-sectional study in an incident cohort in Møre and Romsdal County, Norway . JNeurol 243: 337-344 . Google Scholar | |
Grønning M , Hannisdal E , Mellgren SI. (1990) Multivariate analyses of factors associated with unemployment in people with multiple sclerosis . JNeurol Neurosurg Psychiatry 53: 388-390 . Google Scholar | Crossref | Medline | ISI | |
Cottrell DA et al. (1999) The natural history of multiple sclerosis: a geographically based study. 5. The clinical features and natural history of primitive progressive multiple sclerosis . Brain 122: 625-639 . Google Scholar | Crossref | Medline | ISI | |
Riise T et al. (1988) Prognostic factors for life expectancy in multiple sclerosis analyzed by Cox-models . JClin Epidemiol 41: 1031-1036 . Google Scholar | Crossref | ISI | |
Brønnum-Hansen H , Koch-Henriksen N , Hyllested K. (1994) Survival of patients with multiple sclerosis in Denmark: a nation-wide, long-term epidemiological survey . Neurology 44: 1901-1907 . Google Scholar | Crossref | Medline | ISI | |
McAlpine D , Compston N. (1952) Some aspects of the natural history of disseminated sclerosis . QJM 21: 135-167 . Google Scholar | Medline | |
Patzold U , Pocklington PR. (1982) Course of multiple sclerosis. First results of a prospective study carried out of 102 MS patients from 1976-1980 . Acta Neurol Scand 65: 248-266 . Google Scholar | Medline | ISI | |
Weinshenker BG et al. (1989) The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course . Brain 112: 1419-1428 . Google Scholar | Crossref | Medline | ISI | |
Confavreux C , Aimard G , Devic M. (1980) Course and prognosis of multiple sclerosis assessed by the computerised data processing of 349 patients . Brain 103: 281-300 . Google Scholar | Crossref | Medline | ISI | |
Thompson AJ et al. (1986) A clinical and laboratory study of benign multiple sclerosis . QJM 58: 69-80 . Google Scholar | Medline | |
Phadke JG. (1990) Clinical aspects of multiple sclerosis in north-east Scotland with particular reference to its course and prognosis . Brain 113: 1597-1628 . Google Scholar | Crossref | Medline | ISI | |
Christian Confavreux et al. (2000) Relapses and Progression of Disability in Multiple Sclerosis . New Engl J Med 343: 1430-1438 . Google Scholar | Crossref | Medline | ISI | |
Fog T , Linnemann F. (1970) The course of multiple sclerosis in 73 cases with computer-designed curves . Acta Neurol Scand 46 (Suppl 47): 3-175 . Google Scholar | |
Panelius M. (1969) Studies on epidemiological, clinical and etiological aspects of multiple sclerosis . Acta Neurol Scand 45 (Suppl 39): 1-82 . Google Scholar | Medline | ISI | |
Midgard R et al. (1995) Prognostic factors for survival in multiple sclerosis: a longitudinal, population based study in Møre and Romsdal, Norway . J Neurol Neurosurg Psychiatry 58: 417-421 . Google Scholar | Crossref | Medline | ISI | |
Weinshenker BG et al. (1991) The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome . Brain 114: 1045-1056 . Google Scholar | Crossref | Medline | ISI | |
Liu C , Blumhardt LD. (1999) Randomised, double-blind, placebo controlled study of interferon beta-1a in relapsing-remitting multiple sclerosis analysed by area under disability/time curves . J Neurol Neurosurg Psychiatry 67: 451-456 . Google Scholar | Crossref | Medline | ISI | |
Lassmann H. (1998) Neuropathology in multiple sclerosis: new concepts . Multiple Sclerosis 4: 93-98 . Google Scholar | SAGE Journals | ISI | |
Jacobs LD et al. (2000) Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis . N Engl J Med 343: 898-904 . Google Scholar | Crossref | Medline | ISI |