Tuesday, 9 July 2013

Articles of interest: benign MS

How do we define benign MS? How to identify benign disease. #MSBlog #MSResearch

Hawkins SA, McDonnell GV. Benign multiple sclerosis? Clinical course, long term follow up, and assessment of prognostic factors. J Neurol Neurosurg Psychiatry. 1999;67(2):148-52.

OBJECTIVE: To establish the characteristics of MSers following a benign course of MS and evaluate the importance of potential prognostic factors. Also, an assessment of the value of the Kurtzke EDSS as a prognostic indicator has been undertaken in MSers previously determined to have benign multiple sclerosis, after 10 years of follow up.


METHODS: A prevalence study in the Coleraine, Ballymena, Ballymoney, and Moyle districts of Northern Ireland used the Kurtzke expanded disability scale score (EDSS) in 259 MSers with MS. Of these, 181 had had MS for>/=10 years, 36 having benign disease (EDSS</=3.0) >/=10 years after onset. Clinical and demographic details of the various MSer groups, including the minimal record of disability, were compared. The 1987 study in Northern Ireland identified 33 MSers with benign multiple sclerosis. Twenty eight were available for follow up in 1996 along with 42 contemporary non-benign MSers.

RESULTS: MSers with benign multiple sclerosis were predominantly women (ratio 4.1:1 v 2.1:1) and younger at onset (25.8 v 31.2 years). Commonest symptoms at onset were sensory and optic neuritis (33.3% each). MSers with late onset (older than 40 years) were less likely to have a benign course, more likely to have a progressive course from onset, significantly more likely to have motor disturbance at presentation, and had a lesser female predominance. Optic neuritis was significantly more common in those with a younger age at onset. In the follow up study, MSers with benign MS continued to have a more favourable course than non-benign counterparts but progression of disability and to the secondary progressive phase remained significant.


CONCLUSIONS: The association of female sex, early onset, and presentation with optic neuritis and sensory symptoms with a favourable course is confirmed. However, although the EDSS does provide a useful indicator of prognosis, the label "benign multiple sclerosis" is often temporary as apparently benign disease often becomes disabling.

Pittock et al. Clinical implications of benign multiple sclerosis: a 20-year population-based follow-up study. Ann Neurol. 2004 Aug;56(2):303-6.

In 2001, these investigators followed up all MSers from the 1991 Olmsted County Multiple Sclerosis (MS) prevalence cohort. They found that the longer the duration of MS and the lower the disability, the more likely a MSer is to remain stable and not progress. This is particularly powerful for MSers with benign MS with an Expanded Disability Status Scale score of 2 or lower for 10 years or longer who have a greater than 90% chance of remaining stable. This is important because these MSers represent 17% of the entire prevalence cohort. These data should assist in the shared therapeutic decision-making process of whether to start immunomodulatory medications.



"These studies show that there are a proportion of MSers who stay stable; i.e. who turn out to have benign MS. However, what they don't show is how difficult it is to make this call up front, that is early in the course of the disease. What is also not discussed is how disability is assessed in these MSers. We know that the EDSS is poor at catching hidden signs, for example depression, fatigue and cognitive impairment. Other studies show that ~50% MSers with benign MS as defined using the EDSS have significant cognitive impairment in at least 2 cognitive domains." 

18 Jun 2013
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 .
23 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 .
06 Aug 2012
BACKGROUND:Benign multiple sclerosis (BMS) is a controversial concept which is still debated. However identification of this kind of patients is crucial to prevent them from unnecessary exposure to aggressive and/or long ...
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 ...

29 Nov 2011
Brain atrophy in benign MS. Another post in response to the question about benign MS. Gauthier et al. Rate of brain atrophy in benign vs early multiple sclerosis. Arch Neurol. 2009 Feb;66(2):234-7. BACKGROUND: Benign ...
23 Oct 2012
Calabrese M, Favaretto A, Poretto V, Romualdi C, Rinaldi F, Mattisi I, Morra A, Perini P, Gallo P. Low degree of cortical pathology is associated with benign course of multiple sclerosis. Mult Scler. 2012 Oct 15. [Epub ahead of ...
11 Jun 2013
Multiple Sclerosis Research ... Should we be denying people early active treatment because we may be treating a few MSers who will turn out to have benign disease 20 years later. More on this another time." CoI: multiple ...
15 Feb 2013
Brain atrophy in benign MS. Another post in response to the question about benign MS. Gauthier et al. Rate of brain atrophy in benign vs early multiple sclerosis. Arch Neurol. 2009 Feb;66(2):234-7. BACKGROUND: Benign .

1 comment:

  1. I think my experience fits in with the Prof's comments :

    Double vision, pins & needles and twitchy muscles investigated at age 20 - no diagnosis and symptoms went away. Repeated episodes over 20 years of lethargy and/or dizziness - diagnosed as post-viral fatigue. Diagnosed with highly-active RRMS at 44 after multiple back-to-back relapses.

    Did I have untreated "benign" MS for two decades and (if they had been available then) would HEDMTs have prevented the sudden disease ramp up ?

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.