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Short-term prognosis in early relapsing-remitting multiple sclerosis

From the Medical College of Pennsylvania and Hahnemann University (Dr. Scott), Philadelphia; and Department of Neurology, Allegheny General Hospital (Drs. Schramke and Novero, and C. Chieffe), Pittsburgh, PA.

Address correspondence and reprint requests to Dr. Thomas F. Scott, Suite 206, East Wing Office Building, 420 East North Avenue, Pittsburgh, PA 15212.

OBJECTIVE: To characterize a group of patients with early MS using prognostic factors and to determine whether these prognostic factors impact on short-term prognosis.

METHODS: Data were collected prospectively on 98 patients newly diagnosed with MS in our MS clinic between 1990 and 1998 (average follow-up, 37 months from the time of onset of clinically definite MS [CDMS]). Six prognostic factors were recorded: age at onset, symptoms at onset, MRI status at onset and at diagnosis of CDMS, interval between the first and second attack, attack frequency in the first 2 years, and completeness of recovery from initial attacks. Completeness of recovery was determined using Expanded Disability Status Scale scores (EDSS). Progression was determined by final EDSS and changes in EDSS between initial presentation and final follow-up.

RESULTS: Patients predicted to have low risk of progression of MS based on the prognostic factors represented 17% of our patient population (0 to 1 risk factor for progression). The patients with high risk of progression (4 to 6 risk factors) represented 24% of patients. Patients with a high number of risk factors did significantly worse than those with a small or medium number of risk factors in terms of final EDSS and progression to higher EDSS. At the time of diagnosis of CDMS, MRI findings suggestive of MS were seen in 84% of patients (suspicious in 13%, negative in 3%).

CONCLUSION: Short-term prognosis was influenced by the presence or absence of a high number of these six risk factors.

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