Research Article| Volume 324, ISSUE 1-2, P29-33, January 15, 2013

Prognostic indicators for long-term disability in multiple sclerosis patients

Published:October 16, 2012DOI:



      Daily practice is still faced with uncertainty in predicting the long-term disability of multiple sclerosis (MS). Most information comes from northern hemisphere cohorts, but in South America this information is scarce, and race, genetic and environmental factors could play an important role in the heterogeneity observed in disease outcomes.


      We evaluated 197 patients attending our MS Center gathering clinical and demographic information. Outcome measures analyzed were time from first clinical symptom to EDSS of 6, 7 and 8. For survival analysis we employed Cox regression models and the Kaplan–Meier method.


      Time to EDSS 6 was 25.83 years (95% CI 15.36–36.31), and 36.25 years (95% CI 20.72–51.78) for EDSS 7. Male sex was associated with a 4.63 and 4.69 fold increased risk to EDSS 6 and 7, respectively (p<0.001 and p=0.006). Motor and brainstem symptoms at onset were also associated with an 8.1 and 13.1 fold increased risk to EDSS 6, respectively (p=0.04 and p=0.01). The number of relapses in five and ten years of disease onset was associated with a slightly increased risk to EDSS 8 (1.28 and 1.19, respectively; p=0.032 and p=0.015).


      Male patients presenting with frequent relapses, especially those with motor and brainstem involvement, deserve close observation and should be cautiously monitored to early signs of treatment failure.


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        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann Neurol. 2011; 69: 292-302
        • Confavreux C.
        • Vukusic S.
        • Moreau T.
        • Adeleine P.
        Relapses and progression of disability in multiple sclerosis.
        N Engl J Med. 2000; 343: 1430-1438
        • Langer-Gould A.
        • Popat R.A.
        • Huang S.M.
        • Cobb K.
        • Fontoura P.
        • Gould M.K.
        • et al.
        Clinical and demographic predictors of long-term disability in patients with relapsing–remitting multiple sclerosis: a systematic review.
        Arch Neurol. 2006; 63: 1686-1691
        • Weinstock-Guttman B.
        • Jacobs L.D.
        • Brownscheidle C.M.
        • Baier M.
        • Rea D.F.
        • Apatoff B.R.
        • et al.
        Multiple sclerosis characteristics in African American patients in the New York State Multiple Sclerosis Consortium.
        Mult Scler. 2003; 9: 293-298
        • Cree B.A.
        • Reich D.E.
        • Khan O.
        • De Jager P.L.
        • Nakashima I.
        • Takahashi T.
        • et al.
        Modification of multiple sclerosis phenotypes by African ancestry at HLA.
        Arch Neurol. 2009; 66: 226-233
        • Damasceno A.
        • von Glehn F.
        • Martinez A.R.
        • Longhini A.L.
        • Deus-Silva L.
        • Brandão C.O.
        • et al.
        Early onset of natalizumab-related progressive multifocal leukoencephalopathy.
        Mult Scler. 2011; 17: 1397-1398
        • Polman C.H.
        • Reingold S.C.
        • Edan G.
        • Filippi M.
        • Hartung H.P.
        • Kappos L.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”.
        Ann Neurol. 2005; 58: 840-846
        • Weinshenker B.G.
        • Bass B.
        • Rice G.P.
        • Noseworthy J.
        • Carriere W.
        • Baskerville J.
        • et al.
        The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability.
        Brain. 1989; 112: 133-146
        • Runmarker B.
        • Andersen O.
        Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up.
        Brain. 1993; 116: 117-134
        • Callegaro D.
        • Goldbaum M.
        • Morais L.
        • Tilbery C.P.
        • Moreira M.A.
        • Gabbai A.A.
        • et al.
        The prevalence of multiple sclerosis in the city of São Paulo, Brazil, 1997.
        Acta Neurol Scand. 2001; 104: 208-213
        • Pena S.D.
        • Di Pietro G.
        • Fuchshuber-Moraes M.
        • Genro J.P.
        • Hutz M.H.
        • Kehdy Fde S.
        • et al.
        The genomic ancestry of individuals from different geographical regions of Brazil is more uniform than expected.
        PLoS One. 2011; 6: e17063
        • Confavreux C.
        • Compston A.
        The natural history of multiple sclerosis.
        in: Compston A. Confavreux C. Lassmann H. McDonald I. Miller D. Noseworthy J. Smith K. Wekerle H. McAlpine's multiple sclerosis. Churchill Livingstone, Philadelphia2006: 183-272
        • Confavreux C.
        • Vukusic S.
        • Adeleine P.
        Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process.
        Brain. 2003; 126: 770-782
        • Vukusic S.
        • Confavreux C.
        Natural history of multiple sclerosis: risk factors and prognostic indicators.
        Curr Opin Neurol. 2007; 20: 269-274
        • Confavreux C.
        • Vukusic S.
        Age at disability milestones in multiple sclerosis.
        Brain. 2006; 129: 595-605
        • Amato M.P.
        • Ponziani G.
        • Bartolozzi M.L.
        • Siracusa G.
        A prospective study on the natural history of multiple sclerosis: clues to the conduct and interpretation of clinical trials.
        J Neurol Sci. 1999; 168: 96-106
        • Brandão C.O.
        • Ruocco H.H.
        • Farias A.S.
        • Oliveira C.
        • Cendes F.
        • Damasceno B.P.
        • et al.
        Intrathecal immunoglobulin G synthesis and brain injury by quantitative MRI in multiple sclerosis.
        Neuroimmunomodulation. 2006; 13: 89-95
        • Moreira M.A.
        • Felipe E.
        • Mendes M.F.
        • Tilbery C.P.
        Multiple sclerosis: descriptive study of its clinical forms in 302 cases.
        Arq Neuropsiquiatr. 2000; 58: 460-466