What is benign MS?

This is a reposting in response to yesterday's discussions about benign MS:

Amato et al. Benign multiple sclerosis: cognitive, psychological and social aspects in a clinical cohort. J Neurol. 2006 Aug;253(8):1054-9.

OBJECTIVES: A study of cognitive, psychological and social aspects in benign MS.

METHODS: 163 benign MS'ers (defined as disease duration > or = 15 years and Expanded Disability Status Scale (EDSS) score < or = 3.0 ) underwent neuropsychological testing on the Rao's Brief Repeatable Battery (BRB)* and the Stroop test*, evaluation of depression on the Montgomery and Asberg Depression Rating Scale (MADRS)*, of fatigue on the Fatigue Severity Scale (FSS)* and of handicap on the Environmental Status Scale (ESS)*.

Patients' cognitive performance was compared with that of 111 demographically matched healthy controls.

Cognitive impairment was defined as the failure in at least 3 tests, using the fifth percentile of controls' performance as the cut-off point.

* these are all standardised measurement scales.

RESULTS: Cognitive assessment led to the identification of 74 subjects (45%) with cognitive impairment. Significant fatigue was found in 80 subjects (49%) and depression in 88 patients (54%). In comparison with cognitively preserved subjects, cognitively impaired patients exhibited higher handicap scores on the ESS (p = 0.005). In the regression analysis, only EDSS scores were significantly associated with cognitive impairment (OR 1.8, 95%CI 1.2-2.6).

CONCLUSION: Current definitions of benign MS may overestimate this entity, since they are mainly weighted for the patients' motor abilities and fail to capture relevant disease-related cognitive, psychological and social problems.

"Despite fulfilling a contemporary definition of benign MS this study shows MS'ers with so called benign MS have significant problems with cognitive impairment (45%), fatigue (49%) and depression (54%)."
 
"In other words the EDSS is not very good at defining benign disease! We can't rely on disease duration and the EDSS to define benign disease. The corollary is that is very difficult if not impossible to make this call early on in the course of MS. All you can say is that you have a certain number of good prognostic factors and poor prognostic factors; how these interact with each other to determine prognosis is the million $ question for MSers."
 
Other posts of interest on benign MS:
06 Aug 2012
Research: Benign MS is not so benign. Leray E, Coustans M, Le Page E, Yaouanq J, Oger J, Edan G. Clinically definite benign multiple sclerosis', an unwarranted conceptual hodgepodge: evidence from a 30-year ...
11 May 2012
My stance has always been that you can't make a call on benign disease up front; benign MS is a retrospective diagnosis. I have seen too many disabled MSers who were told early in the course of their disease that as they ...
26 Apr 2012
OBJECTIVE: Using conversion to secondary progressive (SP) multiple sclerosis (MS) as cutoff event for selecting patients with benign course, we tested which baseline features affects the probability of becoming "no longer ...