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J Neurol Neurosurg Psychiatry. Aug 1999; 67(2): 148–152.
PMCID: PMC1736487

Benign multiple sclerosis? Clinical course, long term follow up, and assessment of prognostic factors


OBJECTIVE—To establish the characteristics of patients following a benign course of multiple sclerosis 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 patients 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 patients with multiple sclerosis. Of these, 181 had had multiple sclerosis for[gt-or-equal, slanted]10 years, 36 having benign disease (EDSS[less-than-or-eq, slant]3.0) [gt-or-equal, slanted]10 years after onset. Clinical and demographic details of the various patient groups, including the minimal record of disability, were compared. The 1987 study in Northern Ireland identified 33 patients with benign multiple sclerosis. Twenty eight were available for follow up in 1996 along with 42contemporary non-benign patients.
RESULTS—Patients 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). Patients 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, patients with benign multiple sclerosis 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.

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Selected References

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  • Sadovnick AD, Armstrong H, Rice GP, Bulman D, Hashimoto L, Paty DW, Hashimoto SA, Warren S, Hader W, Murray TJ, et al. A population-based study of multiple sclerosis in twins: update. Ann Neurol. 1993 Mar;33(3):281–285. [PubMed]
  • Gilbert JJ, Sadler M. Unsuspected multiple sclerosis. Arch Neurol. 1983 Sep;40(9):533–536. [PubMed]
  • Herndon RM, Rudick RA. Multiple sclerosis. The spectrum of severity. Arch Neurol. 1983 Sep;40(9):531–532. [PubMed]
  • Poser S, Wikström J, Bauer HJ. Clinical data and the identification of special forms of multiple sclerosis in 1271 cases studied with a standardized documentation system. J Neurol Sci. 1979 Feb;40(2-3):159–168. [PubMed]
  • Hutchinson M. Disability due to multiple sclerosis: a community-based study on an Irish county. Ir Med J. 1986 Feb;79(2):48–50. [PubMed]
  • MCALPINE D. The benign form of multiple sclerosis. A study based on 241 cases seen within three years of onset and followed up until the tenth year or more of the disease. Brain. 1961 Jun;84:186–203. [PubMed]
  • Riser M, Géraud J, Rascol A, Benazet AM, Segria MG. L'évolution de la sclérose en plaques. Etude de 203 observations suivies au-delà de 10 ans. Rev Neurol (Paris) 1971 Jun;124(6):479–486. [PubMed]
  • Kurtzke JF, Beebe GW, Nagler B, Kurland LT, Auth TL. Studies on the natural history of multiple sclerosis--8. Early prognostic features of the later course of the illness. J Chronic Dis. 1977 Dec;30(12):819–830. [PubMed]
  • Thompson AJ, Hutchinson M, Brazil J, Feighery C, Martin EA. A clinical and laboratory study of benign multiple sclerosis. Q J Med. 1986 Jan;58(225):69–80. [PubMed]
  • Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996 Apr;46(4):907–911. [PubMed]
  • Leibowitz U, Alter M. Clinical factors associated with increased disability in multiple sclerosis. Acta Neurol Scand. 1970;46(1):53–70. [PubMed]
  • Confavreux C, Aimard G, Devic M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain. 1980 Jun;103(2):281–300. [PubMed]
  • Poser S, Bauer HJ, Poser W. Prognosis of multiple sclerosis. Results from an epidemiological area in Germany. Acta Neurol Scand. 1982 Apr;65(4):347–354. [PubMed]
  • Verjans E, Theys P, Delmotte P, Carton H. Clinical parameters and intrathecal IgG synthesis as prognostic features in multiple sclerosis. Part I. J Neurol. 1983;229(3):155–165. [PubMed]
  • Patzold U, Pocklington PR. Course of multiple sclerosis. First results of a prospective study carried out of 102 MS patients from 1976-1980. Acta Neurol Scand. 1982 Apr;65(4):248–266. [PubMed]
  • Fog T, Linnemann F. The course of multiple sclerosis in 73 cases with computer-designed curves. Acta Neurol Scand Suppl. 1970;47:3–175. [PubMed]
  • Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain. 1991 Apr;114(Pt 2):1045–1056. [PubMed]
  • Runmarker B, Andersen O. Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up. Brain. 1993 Feb;116(Pt 1):117–134. [PubMed]
  • McALPINE D, COMPSTON N. Some aspects of the natural history of disseminated sclerosis. Q J Med. 1952 Apr;21(82):135–167. [PubMed]
  • Detels R, Clark VA, Valdiviezo NL, Visscher BR, Malmgren RM, Dudley JP. Factors associated with a rapid course of multiple sclerosis. Arch Neurol. 1982 Jun;39(6):337–341. [PubMed]
  • Visscher BR, Liu KS, Clark VA, Detels R, Malmgren RM, Dudley JP. Onset symptoms as predictors of mortality and disability in multiple sclerosis. Acta Neurol Scand. 1984 Nov;70(5):321–328. [PubMed]
  • McDonnell GV, Hawkins SA. An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology. 1998 Feb;50(2):423–428. [PubMed]
  • Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar;13(3):227–231. [PubMed]
  • O'Riordan JI, Thompson AJ, Kingsley DP, MacManus DG, Kendall BE, Rudge P, McDonald WI, Miller DH. The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up. Brain. 1998 Mar;121(Pt 3):495–503. [PubMed]
  • Sanders EA, Bollen EL, van der Velde EA. Presenting signs and symptoms in multiple sclerosis. Acta Neurol Scand. 1986 Mar;73(3):269–272. [PubMed]
  • MCALPINE D. THE BENIGN FORM OF MULTIPLE SCLEROSIS: RESULTS OF A LONG-TERM STUDY. Br Med J. 1964 Oct 24;2(5416):1029–1032. [PMC free article] [PubMed]

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