Background The influence of the patterns of onset of multiplesclerosis and relapses of the disease on the time course ofirreversible disability is controversial.
Methods In 1844 patients who had had multiple sclerosis fora mean (±SD) of 11±10 years, we determined thetime of the clinical onset of the disease, the initial course(relapsing–remitting or progressive) and the subsequentcourse (relapsing–remitting, secondary progressive, orprimary progressive), the times of relapses, the time to theonset of irreversible disability, and the time course of progressive,irreversible disability. We used three scores on the KurtzkeDisability Status Scale (range, 0 to 10, with higher scoresindicating more severe disability) as measures of the severityand progression of disability: a score of 4 (limited walkingability but able to walk more than 500 m without aid or rest),a score of 6 (ability to walk with unilateral support no morethan 100 m without rest), and a score of 7 (ability to walkno more than 10 m without rest while leaning against a wallor holding onto furniture for support). We used Kaplan–Meieranalyses to determine the influence of relapses on the timeto the onset of irreversible disability.
Results The median times from the onset of multiple sclerosisto the assignment of a score of 4, a score of 6, and a scoreof 7 on the disability scale were longer among the 1562 patientswith a relapsing–remitting onset of disease (11.4, 23.1,and 33.1 years, respectively) than among the 282 patients whohad progressive disease from the onset (0.0, 7.1, and 13.4 years,respectively; P<0.001 for all comparisons). In contrast,the times from the assignment of a score of 4 to a score of6 were similar in the two groups (5.7 and 5.4 years, P=0.74).The time course of progressive, irreversible disease among patientswith the primary progressive type of multiple sclerosis wasnot affected by the presence or absence of superimposed relapses.
Conclusions Among patients with multiple sclerosis, relapsesdo not significantly influence the progression of irreversibledisability. (N Engl J Med 2000; 343:1430-8.)
Source Information
From the European Database for Multiple Sclerosis Coordinating Center and Service de Neurologie A, Hôpital Neurologique (C.C., S.V., T.M.); and Unité de Biostatistique et Informatique Médicale, Hospices Civils de Lyon (P.A.) — both in Lyons, France.
Address reprint requests to Dr. Confavreux at the EDMUS Coordinating Center and Service de Neurologie A, Hôpital Neurologique, 59 Blvd. Pinel, 69394 Lyons CEDEX 03, France.
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