More MS news articles for Oct 2001

What's the Prognosis for a Young Girl With Nonprogressive RRMS?

http://neurology.medscape.com/Medscape/Neurology/AskExperts/MS/2001/09/NEUR-ae95.html

09/25/2001

Question

I follow a young female, 11 years old, whose symptom onset was diplopia lasting 1 week, responsive to IV corticosteroids. The first MRI, performed 2 weeks after the onset, showed a single subcortical white matter left frontal lesion, of about 3 cm in diameter, without contrast enhancement. Tests for sarcoidosis were negative, while CSF showed 3 oligoclonal bands. MRI after a couple of months revealed 2 new very small lesions in the temporo-occipital peritrigonal subcortical white matter without contrast enhancement, with the old lesion unmodified. After 1 year, the same symptomatology recurred with transient diplopia of few days, responsive to corticosteroids. At this point diagnosis of relapsing-remitting MS (RRMS) was established with no new lesions on a third MRI. To date, after 3 years, this young female did not show new symptoms without adding further treatment. She has completed her growth normally. What's your prognosis?

Ennio Montinaro, MD

Response

from Rohit Bakshi, MD, 09/25/01

Your patient seems to have several features that are consistent with a favorable prognosis of RRMS. A number of prognostic factors have been suggested as summarized below, but most of these are considered of limited value.

Prognostic Factors in Multiple Sclerosis

Better: Worse:

Female Male

Onset: Relapsing-remitting Onset: Progressive disability

Onset: Optic neuritis Onset: Pyramidal involvement

Onset: Sensory involvement Onset: Cerebellar involvement

Onset: Age < 30 Onset: Age > 40

Onset: Low MRI T2 lesion burden Onset: High MRI T2 lesion burden

Infrequent attacks Frequent attacks

Adapted from Ebers and Paty[1]

However, the prognosis in a given patient with MS usually cannot be determined with a high level of certainty. The clinical course is heterogenous and variable within and across subjects. It was previously thought that a subset of MS patients, perhaps 10% to 25%, had a benign course. Recent data have called into question the existence of a truly "benign" subtype. When "benign" subjects are followed over decades, sustained disability often develops.

References

Ebers GC, Paty DW. Natural history studies and applications to clinical trials. In: Paty DW, Ebers GC, eds. Multiple Sclerosis, Philadelphia: FA Davis, 1998:192-228

Suggested Reading

Amato MP, Ponziani G. A prospective study on the prognosis of multiple sclerosis. Neurol Sci. 2000;21(4 suppl 2):S831-S838.

Hawkins SA, McDonnell GV. Benign multiple sclerosis? Clinical course, long term follow up, and assessment of prognostic factors. J Neurol Neurosurg Psychiatr. 1999;67:148-152.

Liguori M, Marrosu MG, Pugliatti M, et al. Age at onset in multiple sclerosis. Neurol Sci. 2000;21(4 suppl 2):S825-S829.

Miller DH, Thompson AJ, Kappos L. MRI and assessment of treatment in multiple sclerosis. Brain. 2001;124(Pt 5):1052-1053.

Myhr KM, Riise T, Vedeler C, et al. Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension. Mult Scler. 2001;7:59-65.

Pinhas-Hamiel O, Sarova-Pinhas I, Achiron A. Multiple sclerosis in childhood and adolescence: clinical features and management. Paediatr Drugs. 2001;3:329-336.

Rudick RA, Cutter G, Baier M, et al. Use of the Multiple Sclerosis Functional Composite to predict disability in relapsing MS. Neurology. 2001;56:1324-1330.

Better:	Worse:
Female	Male
Onset: Relapsing-remitting	Onset: Progressive disability
Onset: Optic neuritis	Onset: Pyramidal involvement
Onset: Sensory involvement	Onset: Cerebellar involvement
Onset: Age < 30	Onset: Age > 40
Onset: Low MRI T2 lesion burden	Onset: High MRI T2 lesion burden
Infrequent attacks	Frequent attacks