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Factors predicting incomplete recovery from relapses in multiple sclerosis: a prospective study

¹ Clinica Neurologica, Ospedale Maggiore della Carità, Novara, Italy and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Novara, Italy
² Clinica Neurologica, Università del Piemonte Orientale 'A. Avogadro', Novara, Italy
³ S.C. di Neurologia, Ospedale 'S. Andrea', Vercelli, Italy
⁴ Istituto di Radiologia Diagnostica e Interventistica, Ospedale Maggiore della Carità, Novara, Italy
⁵ Clinica Neurologica, Ospedale Maggiore della Carità, Novara, Italy
⁶ Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Novara, Italy and Clinica Neurologica, Università del Piemonte Orientale 'A. Avogadro', Novara, Italy

^* To whom correspondence should be addressed.

	Abstract

Objective To prospectively evaluate predictors of incomplete recovery after the first attacks in a cohortof patients with clinically isolated syndrome or relapsing–remitting multiple sclerosis.Methods Seventy-two consecutive patients recruited from January 2001 to December 2003, evaluatedevery six months or at any relapse up to 31 July 2005. Relapse intervals were calculated fromthe date of onset, nadir, onset of improvement and maximum improvement. Predictive factorsanalysed were relapse-related (age at relapse onset, season and severity of the relapse, type of symptoms,speed of onset, plateau and total duration, number of affected Functional systems, precedinginfections) and individual-related (gender, age at first attack, season of birth and first attack, characteristicsof first brain MRI and cerebrospinal fluid oligoclonal bands, Link Index, IgG).Results We counted 209 attacks: 44 (21%) left mild sequelae, and 27 (13%) severe. The highest probabilityof sequelae was associated with sphincteric symptoms (9/20; 45%), followed by sensitive(38/113; 34%), motor (20/84; 24%), visual (13/61; 21%), cerebellar (4/24; 17%), brainstem (5/44;11%) and others (0/6) (P _ 0.005). Four variables were still relevant to predict sequelae after multivariateanalysis: mild, moderate or severe relapses versus very mild (Odds ratio _ 17.2, 95% confidencelimits _ 2.2–136.4), intermediate or long relapses versus short (3.2, 1.5–6.9), age _ 30 atrelapse onset (2.9, 1.5–5.7) and bi-polysymptomatic versus monosymptomatic (2.2, 1.1–4.3).Conclusions Factors predicting incomplete recovery are more closely linked to the characteristics ofthe single relapse (extension and duration of tissue damage) than to the patient's genetic and environmentalbackground.

Key Words: multiple sclerosis; prognosis; recovery; relapse

First published on January 21, 2008, doi:10.1177/1352458507084650

Multiple Sclerosis 2008;14:485.

A more recent version of this article appeared on May 1, 2008


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