This chapter focuses on natural history studies, early clinical predictors of disability outcome and their application to an individual patient, and the controversy surrounding the entity of benign multiple sclerosis (MS). New approaches to data set analysis with emphasis on age at disability milestones are discussed. Natural history studies have focused on the time from onset or diagnosis of the disease to the assignment of one of the expanded disability status scale (EDSS) scores; these data provide information regarding the rate of disability progression. A formal classification of MS disease subtypes widely accepted is: relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP), and progressive relapsing (PR). Patients with an RR course take a longer time from onset to reach disability milestones than do patients with an initially progressive course. A multitude of demographic and clinical variables including female gender, a younger age at onset, sensory symptoms, and optic neuritis are associated. Prognostic variables associated with a poor outcome have included male gender; onset with motor, sphincter, or cerebellar features; poor recovery from initial or early attacks; higher attack rate in the first 5 years; and a progressive course. Disease-modifying agents (DMAs) have been shown in large, randomized controlled trials to reduce the relapse rate, and to reduce the accrual of lesions identified on magnetic resonance imaging.
|Original language||English (US)|
|Number of pages||18|
|Journal||Blue Books of Neurology|
|State||Published - Jan 1 2010|
ASJC Scopus subject areas
- Clinical Neurology