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Does 'benign' multiple sclerosis exist? A 30-year follow-up study of people presenting with clinically isolated syndrome
ECTRIMS Online Library. Chung K. Oct 27, 2017; 202557
Karen Chung
Karen Chung
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Abstract: 199

Type: Oral

Abstract Category: Clinical aspects of MS - 4 Natural course

Background: Multiple sclerosis (MS) is a very heterogeneous condition. While most people with MS develop neurological impairments over time, it is clear that some do not. Such an outcome has been termed benign MS, and its existence and definition are often debated.
Objective: To determine if people with MS can have a 'benign' outcome 30 years after first symptom onset.
Methods: Members of the first London clinically isolated syndrome (CIS) cohort were traced, and either assessed clinically in person, or by telephone interview. MS was defined according to the 2010 McDonald criteria, based on both clinical and radiological evidence of dissemination in time and space. Expanded disability status scale (EDSS) score and employment status were recorded for all participants, with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) assessed in those who attended in person.
Results: The original cohort consisted of 132 people. At 30-year follow-up, 29 had deceased (of whom 19 had MS). Of the remaining 103 individuals, clinical outcome data was obtained from 91: 30 remained CIS, 35 had relapsing-remitting multiple sclerosis (RRMS), and 26 had secondary progressive multiple sclerosis (SPMS). Eleven had received an MS disease modifying treatment at some time. Of the 35 with RRMS, 31 (88%) had an EDSS score ≤3.0. All 31 individuals remained in employment, or had retired at the national state pension age. Z-scores from BICAMS were available in 20 of the 31 individuals, with only one subject scoring < -1.5.
Conclusion: In this 30-year follow-up of a CIS onset cohort, 31 out of 80 known to have MS had no or mild physical disability, and of these subjects, only one of 20 who were tested were classified as having cognitive impairment. This suggests that it is not uncommon for people with relapse-onset MS to have only mild or no physical or cognitive dysfunction approximately three decades after clinical onset.
Disclosure: Karen Chung has received funding for travel to scientific meetings from Teva and has received honoraria for speaking at scientific and patient-education meetings for Biogen-Idec and Roche.
Frederik Barkhof serves as a consultant for Bayer Schering Pharma, Sanofi-Aventis, Genzyme, Biogen-Idec, Teva, Novartis, Roche, Synthon BV and Jansen Research.
Daniel Altmann has nothing to disclose.
David Miller has received honoraria through payments to UCL Institute of Neurology, for Advisory Committee and/or Consultancy advice in MS studies from Novartis and Mitsubishi Pharma Europe and compensation through payments to UCL Institute of Neurology for performing central MRI analysis of a MS trial from Novartis.
Declan Chard has received honoraria (paid to his employer) from Ismar Healthcare NV, Swiss MS Society, Excemed (previously Serono Symposia International Foundation), Merck, Bayer and Teva for faculty-led education work; Teva for advisory board work; meeting expenses from Merck, Teva, Novartis, the MS Trust and National MS Society; and has previously held stock in GlaxoSmithKline.
This study was funded by a grant from the MS Society of Great Britain and Northern Ireland

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