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Early prediction of a benign course of multiple sclerosis on clinical grounds: a systematic review

Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, The Netherlands

Natasha Maurits

Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, The Netherlands

Cornelis Zwanikken

Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, The Netherlands

Jacques De Keyser

Department of Neurology, Academisch Ziekenhuis Groningen, Groningen, The Netherlands

Background: There is growing consensus that neurologists should consider disease-modifying therapies early in multiple sclerosis (MS). However, there is a subgroup with a natural benign course, in which treatment could be postponed. We sought to determine the frequency of benign MS and early clinical factors that may predict a benign course. Methods: We performed a systematic review of the existing literature on benign MS, which was defined as minimal or no disability equivalent to a score on the Expanded Disability Status Scale (EDSS) 43.0 at least 10 years after disease onset. Results: Only a small number of studies of adequate quality was available. In total there were nine published studies representing 2204 patients. The estimated frequency of benign MS was 26.7%. Onset with optic neuritis, onset before the age of 40 years, absence of pyramidal signs at presentation, duration of first remission more than 1 year, and only one exacerbation in the first 5 years after onset of MS, were associated with a benign course. Conclusions: From the existing literature a set of unrelated clinical characteristics emerged that was associated with a benign course of MS. However, there is a need for prospective studies to define more precisely clinical and paraclinical predictors of benign MS.

Key Words: multiple sclerosis • benign • outcome • systematic review • EDSS • prognosis

Multiple Sclerosis, Vol. 7, No. 5, 345-347 (2001)
DOI: 10.1177/135245850100700512


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