Poor recovery after the first two attacks of multiple sclerosis is associated with poor outcome five years later

Abstract 

Objective

Examine the relative importance of several risk factors for progression, in a large sample of MS patients.

Methods

Using a retrospective design in a single university-based MS treatment center, we studied 207 patients with relapsing remitting MS diagnosed, treated at our center, evaluated within one year of their second attack, and at least 2years after their first attack. Risk factors were: 1) age greater than 40 at first attack; 2) more than 2 attacks in the 2years from onset; 3) EDSS >1.5 after second attack (poor recovery); 4) male gender; and 5) motor symptoms at onset. Groups were defined as having a few (0 to 2) or many (3 to 5) risk factors.

Results

Two hundred seven patients were followed for an average of 94months (SD=44). 30% were over 40years of age at onset, 38% had more than 2 attacks in 2years, 28% had an EDSS >1.5 after the second attack (i.e., had poor recovery), 24% were male, and 58% had motor symptoms at onset. Regression analysis and Kaplan–Meier survival curves that suggested poor recovery after the first two attacks were the best individual predictors of progression at 5years after initial diagnosis. In addition, having many individual risk factors was associated with having a higher risk of progression (p<.001 by Mann Whitney U, sustained final EDSS at an average disease duration of 9.7years).

Conclusions

This study suggests a paramount importance of recovery from early attacks, as well as an additive effect of individual risk factors for progression of MS in the first several years after diagnosis.

Keywords: Multiple sclerosis, Risk factors, Prognosis, Relapse, Progression